Ketti Mazzocco

Pecunia olet: the role of incidental disgust in the ultimatum game.

We address the role of the incidental emotion of disgust in the Ultimatum Game. Participants had to choose whether or not to accept a €2 offer from a €10 pot made by another participant; 120 were in a room where a disgusting smell was released and 120 were in a room with no particular smell. Acceptance rates were higher in the room with the disgusting smell. The effect was mainly carried by the male participants who also reported more disgust with the disgusting smell and judged the offer as less unfair than females. We propose a spontaneous discounting explanation. Acceptance rates were higher in the room with the disgusting smell because participants misattributed the disgust induced by the offer to the ambient disgusting smell.

Smart Recommendation Services in Support of Patient Empowerment and Personalized Medicine

Medicine is undergoing a revolution that is transforming the nature of healthcare from reactive to preventive. The changes are catalyzed by a new systems approach to disease which focuses on integrated diagnosis, treatment and prevention of disease in individuals. This will replace our current mode of medicine over the coming years with a personalized predictive treatment. While the goal is clear, the path is fraught with challenges. The p-medicine EU project aspires to create an infrastructure that will facilitate this translation from current medical practice to personalized medicine. This Chapter focus on current research activities related to the design and implementation of an intelligent patient empowerment platform and its services. The focus of our work concerns the nature of the interaction between health institutions and individuals, particularly the communicative relation between physicians and patients, the ways of exchanging information, the nature of the information itself and the information assimilation capabilities of the patients. Our practical focus is the domain of cancer patients, whether in normal treatment or participating in clinical trials. The ultimate objective is to implement a smart environment (recommender system) able to act as a decision support infrastructure to support the communication, interaction and information delivery process form the doctor to the patient. A prerequisite of personalized delivery of information and intelligent guidance of the patient into his/her treatment plans is our ability to develop an appropriate and accurate profile of the user. In the p-medicine project we focus on modeling and profiling the psycho-cognitive capabilities of the patient based on questionnaires and other information features and behaviors extracted from a personal health record of the patient. In this chapter we will provide a systematic review of user profiling techniques and approaches and present our results in developing a psycho-cognitive profile of the user/patient. Subsequently we will describe the details and challenges of implementing the recommendation system and services using a combination of methods to counter-balance the intrinsic weaknesses in various algorithmic approaches. We will review solutions that have combined demographic user classes and content-based filters using implicit behavior and explicit preferences, collaborative filtering and demographic or collaborative filtering and knowledge-based filters. Finally, our approach will be fully described, which uses an adaptive user interface for the presentation of the e-consent, an ontology and a semantic web rule language to formally describe patient choices, and a reasoning engine to handle access and personalized delivery of pertinent disease related information.

Development of interactive empowerment services in support of personalised medicine.

In an epoch where shared decision making is gaining importance, a patient’s commitment to and knowledge about his/her health condition is becoming more and more relevant. Health literacy is one of the most important factors in enhancing the involvement of patients in their care. Nevertheless, other factors can impair patient processing and understanding of health information: psychological aspects and cognitive style may affect the way patients approach, select, and retain information. This paper describes the development and validation of a short and easy to fill-out questionnaire that measures and collects psycho-cognitive information about patients, named ALGA-C. ALGA-C is a multilingual, multidevice instrument, and its validation was carried out in healthy people and breast cancer patients. In addition to the aforementioned questionnaire, a patient profiling mechanism has also been developed. The ALGA-C Profiler enables physicians to rapidly inspect each patient’s individual cognitive profile and see at a glance the areas of concern. With this tool, doctors can modulate the language, vocabulary, and content of subsequent discussions with the patient, thus enabling easier understanding by the patient. This, in turn, helps the patient formulate questions and participate on an equal footing in the decision-making processes. Finally, a preview is given on the techniques under consideration for exploiting the constructed patient profile by a personal health record (PHR). Predefined rules will use a patient’s profile to personalise the contents of the information presented and to customise ways in which users complete their tasks in a PHR system. This optimises information delivery to patients and makes it easier for the patient to decide what is of interest to him/her at the moment.

IEmS: A collaborative environment for patient empowerment

Personalized medicine refers to the tailoring of treatment to the individual characteristics of a patient. Part of the personalized medicine is the patient profiling and the communicative relation between physician and patient. The ways of exchanging information, the nature of the information itself and the information assimilation capabilities of the patient can assist the physicians to have a better understanding. Taking advantage of these information sources, a smart environment could be implemented. This environment will be able to act as a decision support infrastructure to support the communication, interaction and information delivery process from the doctor to the patient. A prerequisite of personalized delivery of information and intelligent guidance of the patient into his/her treatment plans is our ability to develop an appropriate and accurate profile of the patient. In this paper we present a collaborative platform which will empower patient with knowledge about his/her health condition and at the same time it will assist the physician to have a better understanding about the patients unique psychological profile. We also introduce the p-medicine project and its vision in the field of personalized medicine and show projects approach on patient empowerment.

Rethinking the focusing effect in decision-making

According to Legrenzi et al. [Cognition 49 (1993) 37], in making a choice people consider only the alternatives explicitly represented in their mental model of the decision situation. Their idea has found empirical support in the focusing effect: Individuals focus on the alternatives explicitly stated in the problem context, and do not take into account other possibilities. In their original study, Legrenzi and colleagues considered only one factor to account for the explicit representation of an alternative--i.e., its explicit verbal formulation in the decision problem. Recent theories of relevance and information gain can help articulate their original idea, suggesting that individuals explicitly represent relevant alternatives, whether or not they are explicitly formulated in the decision problem. In three experiments we first replicated Legrenzi et al.s original experiment, and then showed that the explicit verbal mention of an alternative is neither sufficient nor necessary to focus on it. The results suggest that individuals are able to consider relevant alternatives, even when they are not made explicit in the verbal formulation of a decision problem.

The effect of outcome information on health professionals' spontaneous learning

Medical Education 2010: 44: 962–968

Research studies on patients' illness experience using the Narrative Medicine approach: a systematic review

Objective Since its birth about 30u2005years ago, Narrative Medicine approach has increased in popularity in the medical context as well as in other disciplines. This paper aims to review Narrative Medicine research studies on patients and their caregivers illness experience. Setting and participants MEDLINE, Psycinfo, EBSCO Psychological and Behavioural Science, The Cochrane Library and CINAHL databases were searched to identify all the research studies which focused on the Narrative Medicine approach reported in the title, in the abstract and in the keywords the words ‘Narrative Medicine’ or ‘Narrative-based Medicine’. Primary and secondary outcome measures: number of participants, type of disease, race and age of participants, type of study, dependent variables, intervention methods, assessment. Results Of the 325 titles screened, we identified 10 research articles fitting the inclusion criteria. Our systematic review showed that research on Narrative Medicine has no common specific methodology: narrative in Medicine is used as an intervention protocol as well as an assessment tool. Patients characteristics, types of disease and data analysis procedures differ among the screened studies. Conclusions Narrative Medicine research in medical practice needs to find clear and specific protocols to deepen the impact of narrative on medical practice and on patients lives.

Incidence and Determinants of Port Occlusions in Cancer Outpatients: A Prospective Cohort Study.

Background: Normal saline is considered a safe alternative for heparin as a locking solution in totally implantable venous access devices. The incidence rate of partial occlusion with the use of normal saline (easy injection, impossible aspiration) is estimated at 4%. Objective: The aim of this study was to investigate determinants of partial occlusions with the use of normal saline solution and the maintenance of positive pressure in the catheter. Methods: We enrolled 218 patients with different solid tumors who underwent pharmacologic treatment through the port with different frequencies: from once every week to at least once every month. The port was flushed with normal saline solution keeping a positive pressure in the catheter. Results: We performed 4111 observations and documented normal port functioning in 99% of observations (n = 4057) and partial occlusions in 1% of observations (n = 54). Partial occlusions were significantly associated with frequency of port flushing (P < .05), chemotherapy (P < .001), and blood sample collection (P < .001). Conclusions: The use of positive pressure in addition to normal saline reduces the incidence rate of partial occlusions. The type of treatment, blood sample collection, and treatment schedule are important determinants of partial occlusions. Implications for Practice: Nurses play a key role in maintaining a functioning port using positive pressure during the flushing techniques. Certain risk factors must be monitored to prevent partial occlusions, and certain patients are more likely to present with port-related problems.

Eliminating “ductal carcinoma in situ” and “lobular carcinoma in situ” (DCIS and LCIS) terminology in clinical breast practice: The cognitive psychology point of view

There is evidence from the literature that the terms ductal carcinoma in situ and lobular carcinoma in situ (DCIS and LCIS) should be eliminated in clinical breast cancer practice and replaced with the new ductal intraepithelial neoplasia (DIN) and lobular intraepithelial neoplasia (LIN) terminology. The main purpose of the present article is to expand on this argument from a cognitive psychology perspective and offer suggestions for further research, emphasizing how the elimination of the term carcinoma in in situ breast cancer diagnoses has the potential to reduce both patient and health care professional confusion and misperceptions that are often associated with the DCIS and LCIS diagnoses, as well as limit the adverse psychological effects of women receiving a DCIS or LCIS diagnosis. We comment on the recent peer-reviewed literature on the clinical implications and psychological consequences for breast cancer patients receiving a DCIS or LCIS diagnosis and we use a cognitive perspective to offer new insight into the benefits of embracing the new DIN and LIN terminology. Using cognitive psychology and cognitive science in general, as a foundation, further research is advocated in order to yield data in support of changing the terminology and therefore, offer a chance to significantly improve the lives and psychological sequelae of women facing such a diagnosis. Typology: Controversies/Short Commentary.

Rationale and protocol of CML study: cognitive and emotional impact of discontinuation of therapy in patients with chronic myeloid leukemia

Introduction Discontinuation of therapy can be proposed to patients with chronic myelogenous leukemia (CML) who reach a sustained deep molecular response (DMR) for a minimum and stable period. Today, a considerable number of patients reach a sustained DMR, especially when they are treated with the latest drugs. Although new-generation treatments may provide significant improvement in terms of patient health and health-related quality of life, many patients are uncertain about discontinuation and may refuse a treatment switch. Methods This study is an observational research project aimed at investigating, from a psychological point of view, possible cognitive and emotional components that can influence treatment discontinuation and treatment decisions in a cohort sample of 120 CML patients. Results The expected results indicate that cognitive and emotional factors may influence decision-making in this setting and may prevent appropriate risk-and-benefit evaluation of new treatment approaches. Conclusions This is the first study that will analyze in depth all possible psychological variables that can interfere with the medical decision process of treatment discontinuation in CML, providing new insights for clinical practice.