[Support to spiritual needs in hospital care. Integration perspective in modern hospitals]. / Il supporto ai bisogni spirituali nella cura ospedaliera. Prospettive di integrazione nell'ospedale moderno.

Within the course of medical care in the most advanced health care settings, an increasing attention is being paid to the so-called care humanization. According to this perspective, we try to integrate the usual care pathways with aspects related to the spiritual and religious dimension of all people and their families, as well as the employees themselves. It is clearly important to establish this kind of practices on the basis of scientific evidences. That is the reason why it's a necessity to improve the knowledge about the importance that spiritual assistance can offer within the current health service. The aim of this work is to show the relevance of the integration of spiritual perspectives in the hospital setting according to a multidisciplinary point of view. In this work many data that emerge from the international scientific literature, as well as the definition that is given to the concept of "spirituality" are analyzed; about this definition in fact there is not unanimous consent even today. It is also analyzed the legal situation in force within the European territory according to the different laws and social realities. Finally, the possible organizational practices related to spiritual support are described and the opportunity to specific accreditation pathways and careful training of chaplains able to integrate traditional religious practices with modern spiritual perspectives is discussed.

[Italian version of the Defense Mechanisms Rating Scales for Clinicians: a tool for the assessment of defense mechanisms in medical oncology]. / Versione italiana della Defence Mechanisms Rating Scales for Clinicians: uno strumento per la valutazione dei meccanismi di difesa del medico in oncologia.

INTRODUCTION: Facing distress situations arising from the interaction with the patient in oncology, eg breaking bad news, clinicians also, such as patients, protect themselves using unconscious defense mechanisms. Clinicians' psychic defenses topic is related to the clinicians training on communication with patients and to clinicians' individual characteristics issues. For clinicians the defensive functioning can be adaptive when mature defenses are activated or maladaptive if the defensive mode is immature, with implications on medical care effectiveness. It is therefore important to identify, assess and intervene on clinicians' defense mechanisms. The Defense Mechanisms Rating Scales for Clinicians (DMRS-C) is a tool developed as an addendum to the DMRS (originally created by Perry), for the assessment of clinician defenses. It is an assessment tool based on the observer, which can be applied to audio or video recordings, interviews transcripts or medical - psychotherapy sessions. This tool is currently available in French language only. AIM: The aim of this work is to translate and adapt DMRS-C in Italian. METHOD: The DMRS-C has been translated into Italian and back-translated into French in order to verify the correspondence with the original language. Psychometric properties of the scale has been investigated, in terms of face validity and reliability among judges, by calculating the intraclass coefficients Correlation, based on videotaped interviews of oncology visits from the Milan San Paolo Hospital video recordings Archive. RESULTS: The assessment tool has had positive findings for the purposes of intra-judges reliability (ICC=4.73; sd mean=80,33) and face validity. CONCLUSIONS: The consistency of the italian version with the original makes it suitable to highlight the frequency and variety of clinician defenses. This is the first study on medical oncologists defenses in real interviews. This tool will be useful to the fields of training and research on defenses in clinical care settings treating severe conditions such as oncology.

Modern computer technologies facilitate communication with a young cancer patient.

AIM: The aim of this paper is to show how new technologies may help the communication process in clinical practice in a department providing supportive care to patients undergoing cancer treatment. METHOD: Communication via Internet chat between the psychologist and a young man who sees chatting on the Internet as a natural and familiar mode of expression was shown to be useful. RESULTS: The Internet link enabled us to open a communication channel with the patient and to have a conversation that would otherwise have been impossible. CONCLUSIONS: Although verbal communication is the most important way to communicate among people, Internet communications are certainly an opportunity worth exploring, because they may open up new channels for cancer patients whose ability to speak is restricted. We might imagine using this approach in pediatric oncology, with adolescents and preadolescents, and with young adults like the patient discussed here. The case discussed highlights the enormous difference between the mere transfer of information and genuine communication, the latter involving an encounter with the patient.

Hope in severe disease: a review of the literature on the construct and the tools for assessing hope in the psycho-oncologic setting.

AIMS AND BACKGROUND: Research on the topic of hope began a long time ago but, more recently, interest in this construct has focused mainly on the development of psychometric tools for its assessment. The 2 steps of the present article are defining the construct of hope by completing a preliminary review of the literature and analyzing the tools used to assess hope in the setting of oncologic medicine, conducting a systematic review of the existing scientific literature. METHODS AND STUDY DESIGN: Our study was conducted in 2 stages. The first stage involved a nonsystematic preliminary review of the literature, the second a systematic search in all the medical journals contained in the Medline database as of 2012. The literature identified at the first stage was divided according to several topical categories, i.e., theoretical, empirical, and clinical works on the construct of hope. In the second systematic search, we identified the main psychometric tools used to measure hope in the field of clinical oncology and assessed their validity. RESULTS: A total of 22 articles were identified. What emerged when we pooled the findings of our 2 lines of research was that, despite its broad theoretical definitions, the construct of hope can be broken down to a few constituent elements when hope is studied using currently available psychometric tools. In particular, these identified constituent elements were coping, spiritual well-being, quality of life, distress, and depression. CONCLUSIONS: The factors contained in the construct of hope include temporality, future, expectancy, motivation, and interconnectedness. The review of the scientific literature does not reveal a clear definition of hope. Multidisciplinary studies are needed to communicate different perspectives (medical, psychological, spiritual, theological) among each other for better definition of the constituent elements of hope in order to support the hope with specific interventions.

Pastoral care in hospitals: a literature review.

AIMS AND BACKGROUND: This literature review investigates the potential contribution of the pastoral care provided in hospitals by hospital chaplains, as part of an integrated view of patient care, particularly in institutions dealing with severe disease. METHODS AND STUDY DESIGN: A search was conducted in the Medline database covering the last 10 years. RESULTS: Ninety-eight articles were considered concerning the modern hospital chaplains' relationships and the principal procedures and practices associated with their roles, i.e., their relations with the scientific world, with other religious figures in the community, with other faiths and religious confessions, with other public health professionals and operators, with colleagues in professional associations and training activities, and with the hospital organization as a whole, as well as their patient assessment activities and the spiritual-religious support they provide, also for the patients' families. CONCLUSIONS: Improvements are needed on several fronts to professionalize the pastoral care provided in hospitals and modernize the figure of the hospital chaplain. These improvements include better relations between modern chaplains and the hospital organization and scientific world; more focus on a scientific approach to their activities and on evaluating the efficacy of pastoral care activities; greater clarity in the definition of the goals, methods and procedures; the design of protocols and a stance on important ethical issues; respect for the various faiths, different cultures and both religious and nonreligious or secularized customs; greater involvement in the multidisciplinary patient care teams, of which the hospital chaplains are an integral part; stronger integration with public health operators and cooperation with the psychosocial professions; specific training on pastoral care and professional certification of chaplains; and the development of shared ethical codes for the profession.