The Health Care Providers' Perspectives on End-of-Life Patients' Sense of Dignity. A Comparison Among Four Different Professionals' Categories.

The studies on terminally ill patients' dignity as perceived by health care providers (HCPs) in palliative care are growing. The comparison of different HCPs' perspectives in particular is necessary to explore how HCPs perceive patients' dignity in order to promote reflection on this core issue. This study aimed to investigate the perspectives on end-of-life patients' sense of dignity among four different categories of professionals: nurse assistants, nurses, psychologists, and physicians. A sample of 306 HCPs completed the Patient Dignity Inventory-Italian Version (PDI-IT) adapted for them and an ad hoc semi-structured written interview. Their responses were then analyzed using frequencies of the answers to the PDI-IT, a multivariate analysis of variance, Pearson's correlation index, t tests, and content analysis. All HCPs scored the relevance to the dignity-related physical aspects highly, followed by the psychological distress. Nurse assistants and nurses provided higher scores on the psychological and existential and spiritual PDI subscales than the other HCP groups. The social sphere was evaluated as the least salient for the patients' sense of dignity. Physicians who attended a course on dignity considered the psychological and existential dignity dimensions more. Differences in role and expertise could lead to different HCPs' perspectives on dignity, while the multidisciplinary work could favor their aligning. Therefore, it is essential to encourage HCPs' communicative exchange and reflective awareness through training, i.e., courses, seminars, and focus groups. These developments could promote increasingly adequate patient-centered care.

Correction to: The impact of social-emotional context in chronic cancer pain: patient-caregiver reverberations.

The last 4 authornames in the original manscript was inadvertently inverted and is now corrected in this article.

Dignity-related existential distress in end-of-life cancer patients: Prevalence, underlying factors, and associated coping strategies.

OBJECTIVE: Cancer patients often have to face increasing levels of existential distress (ED) during disease progression, especially when nearing death. This cross-sectional study aimed to assess the prevalence of the dignity-related existential distress (DR-ED) in a sample of end-of-life cancer patients, and to explore the "existential distress" Patient Dignity Inventory (PDI-IT) subscale internal structure and its associations with different coping strategies. METHODS: Two hundred seven cancer inpatients with a Karnofsky Performance Status ≤50 and a life expectancy of 4 months or less have been examined with the following self-report measures: PDI-IT, Demoralization Scale (DS-IT) and Brief Coping Orientation to Problem Experienced (Brief-COPE). The existential distress PDI-IT subscale factor structure was explored through principal component analysis, and the DR-ED associations with the other considered variables were examined through X2 tests, MANOVA, and multivariate regression analysis. RESULTS: Dignity-related existential distress was a problem/major problem for 18.8% of the patients, especially for the younger (F(1, 205) = 3.40; P = 0.020) and more demoralized (F(1, 205) = 20.36; P < 0.001) individuals. Factor analysis supported 2 dimensions labeled "self-discontinuity" and "loss of personal autonomy," accounting for 58% of the variance. Positive reframing (ß = -0.146, P < 0.05) and self-blame (ß = 0.247, P < 0.001) coping styles emerged as DR-ED significant predictors. CONCLUSIONS: This study showed how DR-ED is a relevant problem for patients nearing death and furthermore highlighted 2 underlying factors. Finally, the research has shown that positive reframing and self-blame coping styles might be clinically relevant elements for interventions on ED.

Dignity in cancer patients with a life expectancy of a few weeks. Implementation of the factor structure of the Patient Dignity Inventory and dignity assessment for a patient-centered clinical intervention: A cross-sectional study.

OBJECTIVE: Hospice is a favored setting for dignity care. Studies on dignity dimension in end-of-life patients are growing. The Patient Dignity Inventory (PDI) is a tool that can lead to interesting information on dignity-related aspects of suffering. The study aimed to investigate dignity among end-of-life cancer patients, by examining the Italian version of the PDI factor structure and assessing the relationship between dignity and other patients' psychosocial and spiritual variables to improve a patient-centered clinical practice. METHOD: This is a cross-sectional study. Data were collected using a battery of self-administered validated rating scales. The sample included 127 hospice patients with a life expectancy of a few weeks and a Karnofsky Performance Status ≤40. Factor structure and concurrent validity of PDI and correlations between dignity and anxious and depressive symptomatology, quality of life, demoralization, personal coping styles, spiritual well-being, and spiritual daily experience were analyzed.ResultFactor analysis highlighted a five-factor solution, accounting for 60% of the overall variance. The factors were labeled Psychological Distress, Social Support, Physical Symptoms and Dependency, Existential Distress, and Loss of Purpose/Meaning. Dignity assessment evidenced that self-blame coping style, emotional and physical well-being, and depression were the loss of dignity significant predictors (R2 = 0.605; p < 0.01).Significance of resultsThe results point out the intercultural validity of the PDI and empower an accurate detection of dignity-related distress sources in the daily clinical practice. Personality traits seem to have an active role in the loss of dignity, whereas spirituality is confirmed to be positively involved in dignity enhancement.

A Review of the Emotional Aspects of Neuropathic Pain: From Comorbidity to Co-Pathogenesis.

Neuropathic pain is characterized by both sensory and affective disturbances, supporting the notion that pain and mood disorders share common pathogenetic mechanisms. Moreover, biological and neuroimaging data show that common brain areas are involved in the modulation of painful and emotional experiences. Improved understanding of the molecular mechanisms underlying the role of neuroinflammation in regulation of affective behavior in neuropathic pain states is important for the development of novel therapeutic strategies. Psychological issues must be considered a factor influencing treatment and outcome in patients with neuropathic pain. FUNDING: Pfizer, Italy.

The role of gender, psycho-social factors and anthropological-cultural dimensions on pain in neurorehabilitation. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.

Pain is frequent in patients undergoing neurorehabilitation, but there is a number of still unanswered questions on this topic. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was constituted with the purpose to identify the best practices that can be used in this context. In this article we summarize the existing evidence and recommendations provided by the ICCPN about the role of gender, psycho-social factors and anthropological-cultural dimensions on pain in neurorehabilitation. Sex, gender, psycho-social variables, anthropological and cultural features may influence pain expression, and its pharmacological and non-pharmacological outcome, but the role of these factors has not been consistently explored in neurorehabilitation. There is a number of psychological factors that can be correlated with or represent a predictor for pain, or may influence the treatment and outcome of neurorehabilitation programs. All these factors should be considered when designing these programs, and future studies should incorporate them as potential covariates that may influence outcome.

Pharmacological management of depression in patients with cancer: practical considerations.

This article provides an overview of the prevalence, pathogenesis and diagnosis of, and treatment strategies for, depression in cancer patients. Untreated depression can increase the burden of oncology symptoms and worsen the cancer prognosis through the relationship between mood and immunity. The issues to consider when treating a patient with cancer who has depression include when to introduce pharmacotherapy, the criteria for choosing an antidepressant, and the necessary caution regarding side effects and drug interactions. The choice of an antidepressant is a complex decision that has to balance previous pharmacological experiences, different clusters of target symptoms, pharmacological interactions, and objective and subjective risks of side effects, with the aim of tailoring a strategy for each patient.