Paola Iannello

The Representation of Risk in Routine Medical Experience: What Actions for Contemporary Health Policy?

Background The comprehension of appropriate information about illnesses and treatments, can have beneficial effects on patients’ satisfaction and on important health outcomes. However, it is questionable whether people are able to understand risk properly. Aim To describe patients’ representation of risk in common medical experiences by linking such a representation to the concept of trust. A further goal was to test whether the representation of risk in the medical domain is associated to the level of expertise. The third goal was to verify whether socio-demographic differences influence the representation of risk. Methods Eighty voluntary participants from 6 health-centers in northern Italy were enrolled to conduct a semi-structured interview which included demographic questions, term-associations about risk representation, closed and open questions about attitudes and perception of risk in the medical context, as well as about medical expertise and trust. Results The results showed that people do not have in mind a scientific definition of risk in medicine. Risk is seen as a synonym for surgery and disease and it is often confused with fear. However, general knowledge of medical matters helps people to have a better health management through risk identification and risk information, adoption of careful behaviors and tendency to have a critical view about safety and medical news. Finally, trust proved to be an important variable in risk representation and risk and trust were correlated positively. Conclusions People must receive appropriate information about the risks and benefits of treatment, in a form that they can understand and apply to their own circumstances. Moreover, contemporary health policy should empower patients to adopt an active self-care attitude. Methodologies to enhance people’s decision-making outcomes based on better risk communication should be improved in order to enable low literacy population as well elderly people to better understand their treatment and associated risk.

Metacognitive Knowledge of Decision-Making: An Explorative Study

This chapter is a first attempt to investigate people’s metacognitive knowledge about decision making, an area which has been neglected within the domain of metacognition. By following an ecological approach which focuses on decisions that people make in their actual professional life, a self-report instrument, the Solomon Questionnaire was developed with the aim both to induce people to describe the types of decisions they usually make at work and to test to what extent they are aware of the emotions experienced and of the processes and strategies applied during decision making. The Solomon Questionnaire and the Preference for Intuition and Deliberation Scale, which aims at assessing individual inclinations towards intuitive and deliberate decision-making, were administered to 85 adults who practised different types of professions and had distinct levels of expertise. Results showed that both awareness and metacognitive knowledge about decision making are linked to professions and expertise; also that individual decision-making style modulates this facet of metacognition, thus suggesting the importance of keeping in mind, when trying to enhance decision-making skills through metacognition, that the level of metacognition is functionally connected to the actual decision tasks people have to face.

Decision-Making Styles in the Workplace: Relationships Between Self-Report Questionnaires and a Contextualized Measure of the Analytical-Systematic Versus Global-Intuitive Approach

Two procedures were adopted to assess decision-making styles in the workplace: (a) the administration of traditional standardized self-report questionnaires and (b) open-ended questions about the way respondents would take decisions in a critical business case. Seventy-four adults were given two questionnaires: the Preference for Intuition and Deliberation, which assesses “deliberative” or “intuitive” decision style, and the Style of Learning and Thinking, which assesses thinking styles as “left” (namely, analytical-systematic) or “right” (that is, global-intuitive). Participants were also presented with a business case that involved taking a decision. Responses to the business case were used to classify approaches to decision making as “analytical-systematic” or “global-intuitive.” Results showed that the questionnaires correlated consistently with scores from the business case, thus supporting the notion that the assessment of decision style through self-report questionnaires is reliable and valid.

What are judgment skills in health literacy? A psycho-cognitive perspective of judgment and decision-making research

Objective The aim of this review is to summarize current research relating to psychological processes involved in judgment and decision-making (JDM) and identify which processes can be incorporated and used in the construct of health literacy (HL) in order to enrich its conceptualization and to provide more information about people’s preferences. Methods The literature review was aimed at identifying comprehensive research in the field; therefore appropriate databases were searched for English language articles dated from 1998 to 2015. Results Several psychological processes have been found to be constituents of JDM and potentially incorporated in the definition of HL: cognition, self-regulation, emotion, reasoning-thinking, and social perception. Conclusion HL research can benefit from this JDM literature overview, first, by elaborating on the idea that judgment is multidimensional and constituted by several specific processes, and second, by using the results to implement the definition of “judgment skills”. Moreover, this review can favor the development of new instruments that can measure HL. Practical implications Future researchers in HL should work together with researchers in psychological sciences not only to investigate the processes behind JDM in-depth but also to create effective opportunities to improve HL in all patients, to promote good decisions, and orient patients’ preferences in all health contexts.

What Do Physicians Believe About the Way Decisions Are Made? A Pilot Study on Metacognitive Knowledge in the Medical Context

Metacognition relative to medical decision making has been poorly investigated to date. However, beliefs about methods of decision making (metacognition) play a fundamental role in determining the efficiency of the decision itself. In the present study, we investigated a set of beliefs that physicians develop in relation to the modes of making decisions in a professional environment. The Solomon Questionnaire, designed to assess metacognitive knowledge about behaviors and mental processes involved in decision making, was administered to a sample of 18 emergency physicians, 18 surgeons, and 18 internists. Significant differences in metacognitive knowledge emerged among these three medical areas. Physicians’ self-reports about the decision process mirrored the peculiarities of the context in which they operate. Their metacognitive knowledge demonstrated a reflective attitude that is an effective tool during the decision making process.

A Metacognitive Approach to Financial Literacy

An emerging body of literature in the study of financial literacy highlights that information plays a little role in many financial decisions. Being informed about financial topics does not seem the key aspect to make efficient choices. Recent studies indicated that what is really crucial in order to prompt adequate attitudes towards financial issues is the way human mind processes information. Deliberation, intuition, and heuristics are three different modes of thinking which can be activated when individuals reason about financial issues. None of them is absolutely better than the others since they are qualitatively different types of information processing. Rather, the effectiveness of a financial decision depends on the individual ability to select the specific mode of thinking which best suits the situation at hand. Metacognition might be considered as a way to help people promoting their ability to identify the relevant strategies to be applied in a specific situation and to self-regulate their own behaviour in order to flexibly manage the three thinking systems and make effective financial decisions.

The Role of Autobiographical Story-Telling During Rehabilitation Among Hip-Fracture Geriatric Patients

Hip fracture is one of the most common health care problems among elderly people. Literature shows that high self-efficacy expectations and positive affect are some of the key issues in functional recovery after hip fracture. The present investigation tested whether self-narration of such life-breaking event influences self-efficacy and depression during the process of rehabilitation. We designed a Self-Narration Journey (SNJ) to be administered during the in-hospital rehabilitation. In Study 1, we investigated the influence of SNJ on depression and perceived self-efficacy. Study 2 aimed to explore the effect of SNJ, depression, and self-efficacy on functional recovery of independence to perform daily activities during the rehabilitation process. The data showed that the Self-Narration Journey proved effective in increasing the perceived self-efficacy and in lowering the level of depression. The present work highlights a significant effect of the SNJ on the functional recovery process.

Rehabilitation After Urgent or Elective Orthopedic Surgery: The Role of Resilience in Elderly Patients

Purpose The aim of this investigation was to assess resilience within an elderly population during postacute rehabilitation for orthopedic surgery and to identify the role of resilience on rehabilitation outcomes by comparing hip fracture and elective patients (total knee and hip arthroplasty). Design We conducted a prospective study in an orthopedic rehabilitation department. Methods On admission and on discharge, 80 patients aged over 60 years underwent a multidimensional evaluation with the Resilience Scale, the Functional Independence Measure (FIM), the Multidimensional Prognostic Index, and the World Health Organization Quality of Life-BREF. Findings Hip-fractured patients had a lower level of resilience. High-resilient fracture patients achieved higher FIM scores. For elective patients, no differences on FIM score occurred for different resilience levels. Conclusions and Clinical Relevance Resilience plays a significant role in reaching optimal functional recovery in hip-fractured elderly people. Results suggest the introduction of early routine assessment of resilience in future outcome studies in rehabilitation.

Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians

ABSTRACT Medical practice is inherently ambiguous and uncertain. The physicians’ ability to tolerate ambiguity and uncertainty has been proved to have a great impact on clinical practice. The primary aim of the present study was to test the hypothesis that higher degree of physicians’ ambiguity and uncertainty intolerance and higher need for cognitive closure will predict higher work stress. Two hundred and twelve physicians (mean age = 42.94 years; SD = 10.72) from different medical specialties with different levels of expertise were administered a set of questionnaires measuring perceived levels of work-related stress, individual ability to tolerate ambiguity, stress deriving from uncertainty, and personal need for cognitive closure. A linear regression analysis was performed to examine which variables predict the perceived level of stress. The regression model was statistically significant [R2 = .32; F(10,206) = 8.78, p ≤ .001], thus showing that, after controlling for gender and medical specialty, ambiguity and uncertainty tolerance, decisiveness (a dimension included in need for closure), and the years of practice were significant predictors of perceived work-related stress. Findings from the present study have some implications for medical education. Given the great impact that the individual ability to tolerate ambiguity and uncertainty has on the physicians’ level of perceived work-related stress, it would be worth paying particular attention to such a skill in medical education settings. It would be crucial to introduce or to empower educational tools and strategies that could increase medical students’ ability to tolerate ambiguity and uncertainty. Abbreviations: JSQ: Job stress questionnaire; NFCS: Need for cognitive closure scale; PRU: Physicians’ reactions to uncertainty; TFA: Tolerance for ambiguity

The Stability of Individual Well-Being in Short Windows of Time: Women’s Perceptions across the Ovulatory Cycle

Empirical research on well-being has rapidly increased in recent years. One of the most dominant issue concerns the degree of cross-situational consistency and stability of well-being across time, and this is of particular relevance to women life. The aim of this study was to verify the stability of women well-being in short windows of time, specifically across menstrual cycle phases. A within-subject design with 25 normally cycling women (range: 19–26 years) was carried out. The multidimensional assessment of well-being included the administration of psychological well-being, self-esteem, and emotional self-efficacy beliefs questionnaires during both high and low-fertility phases. The results showed the stability of the level of individual well-being across menstrual cycle phases. Albeit preliminary, results indicated that women representations of their well-being do not change according to menstrual cycle. Rather, an effective organization and integration of the entire self-system appears sustained by the stability of well-being measured through a multi-componential assessment over short periods of time.