Perceptions of Death Among Patients with Advanced Cancer Receiving Early Palliative Care and Their Caregivers: Results from a Mixed-Method Analysis.

BACKGROUND: Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. MATERIAL AND METHODS: Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. RESULTS: Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, Ps < .0001; adjectives, Ps < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. CONCLUSIONS: EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers.

Perceptions of Hope Among Bereaved Caregivers of Cancer Patients Who Received Early Palliative Care: A Content and Lexicographic Analysis.

BACKGROUND: Oncologists' fear of taking away hope from patients when proposing early palliative care (EPC) is a barrier to the implementation of this model. This study explores hope perceptions among bereaved caregivers of onco-hematologic patients who received EPC. MATERIALS AND METHODS: Open-ended questionnaires were administered to 36 primary caregivers of patients who received EPC (26 solid and 10 hematologic cancer patients; mean age: 51.4 years, range age: 20-74), at 2 cancer centers, 2 months to 3 years after a patient death. Definitions of hope in the caregivers' narratives were analyzed through a directed approach to content analysis. Results were complemented with automated lexicographic analysis. RESULTS: Caregivers perceived hope mainly as resilience and as expectations based on what they were told about the patients' clinical conditions. Their hope was bolstered by trusting relationships with the healthcare teams. EPC interventions were recalled as the major support for hope, both during the illness and after the death of the patient. The automated quantitative lexical analysis provided deeper insights into the links between hope, truth, and trust. CONCLUSIONS: Our findings suggest that telling the truth about an incurable onco-hematologic disease and beginning EPC might be the combination of factors triggering hope in the setting of incurable cancer.

Changes in Cancer Patients' and Caregivers' Disease Perceptions While Receiving Early Palliative Care: A Qualitative and Quantitative Analysis.

BACKGROUND: Little is known about the underlying mechanisms through which early palliative care (EPC) improves multiple outcomes in patients with cancer and their caregivers. The aim of this study was to qualitatively and quantitatively analyze patients' and caregivers' thoughts and emotional and cognitive perceptions about the disease prior to and during the EPC intervention, and in the end of life, following the exposure to EPC. MATERIALS AND METHODS: Seventy-seven patients with advanced cancer and 48 caregivers from two cancer centers participated in semistructured interviews. Their reports were qualitatively and quantitatively analyzed by the means of the grounded theory and a text-analysis program. RESULTS: Participants reported their past as overwhelmed by unmanaged symptoms, with detrimental physical and psychosocial consequences. The EPC intervention allowed a prompt resolution of symptoms and of their consequences and empowerment, an appreciation of its multidimensional approach, its focus on the person and its environment, and the need for EPC for oncologic populations. Patients reported that conversations with the EPC team increased their acceptance of end of life and their expectation of a painless future. Quantitative analysis revealed higher use of Negative Affects (p < .001) and Biological Processes words (p < .001) when discussing the past; Agency words when discussing the present (p < .001); Positive Affects (p < .001), Optimism (p = .002), and Insight Thinking words (p < .001) when discussing the present and the future; and Anxiety (p = .002) and Sadness words (p = .003) when discussing the future. CONCLUSION: Overall, participants perceived EPC to be beneficial. Our findings suggest that emotional and cognitive processes centered on communication underlie the benefits experienced by participants on EPC. IMPLICATIONS FOR PRACTICE: By qualitative and quantitative analyses of the emotional and cognitive perceptions of cancer patients and their caregivers about their experiences before and during EPC interventions, this study may help physicians/nurses to focus on the disease perception by patients/caregivers and the benefits of EPC, as a standard practice. The analysis of words used by patients/caregivers provides a proxy for their psychological condition and support in tailoring an EPC intervention, based on individual needs. This study highlights that the relationship of the triad EPC team/patients/caregivers may rise as a therapeutic tool, allowing increasing awareness and progressive acceptance of the idea of death.

When emotions are expressed figuratively: Psycholinguistic and Affective Norms of 619 Idioms for German (PANIG).

Despite flourishing research on the relationship between emotion and literal language, and despite the pervasiveness of figurative expressions in communication, the role of figurative language in conveying affect has been underinvestigated. This study provides affective and psycholinguistic norms for 619 German idiomatic expressions and explores the relationships between affective and psycholinguistic idiom properties. German native speakers rated each idiom for emotional valence, arousal, familiarity, semantic transparency, figurativeness, and concreteness. They also described the figurative meaning of each idiom and rated how confident they were about the attributed meaning. The results showed that idioms rated high in valence were also rated high in arousal. Negative idioms were rated as more arousing than positive ones, in line with results from single words. Furthermore, arousal correlated positively with figurativeness (supporting the idea that figurative expressions are more emotionally engaging than literal expressions) and with concreteness and semantic transparency. This suggests that idioms may convey a more direct reference to sensory representations, mediated by the meanings of their constituting words. Arousal correlated positively with familiarity. In addition, positive idioms were rated as more familiar than negative idioms. Finally, idioms without a literal counterpart were rated as more emotionally valenced and arousing than idioms with a literal counterpart. Although the meanings of ambiguous idioms were less correctly defined than those of unambiguous idioms, ambiguous idioms were rated as more concrete than unambiguous ones. We also discuss the relationships between the various psycholinguistic variables characterizing idioms, with reference to the literature on idiom structure and processing.

Words hurt: common and distinct neural substrates underlying nociceptive and semantic pain.

Introduction: Recent studies have shown that processing semantic pain, such as words associated with physical pain, modulates pain perception and enhances activity in regions of the pain matrix. A direct comparison between activations due to noxious stimulation and processing of words conveying physical pain may clarify whether and to what extent the neural substrates of nociceptive pain are shared by semantic pain. Pain is triggered also by experiences of social exclusion, rejection or loss of significant others (the so-called social pain), therefore words expressing social pain may modulate pain perception similarly to what happens with words associated with physical pain. This event-related fMRI study aims to compare the brain activity related to perceiving nociceptive pain and that emerging from processing semantic pain, i.e., words related to either physical or social pain, in order to identify common and distinct neural substrates. Methods: Thirty-four healthy women underwent two fMRI sessions each. In the Semantic session, participants were presented with positive words, negative pain-unrelated words, physical pain-related words, and social pain-related words. In the Nociceptive session, participants received cutaneous mechanical stimulations that could be either painful or not. During both sessions, participants were asked to rate the unpleasantness of each stimulus. Linguistic stimuli were also rated in terms of valence, arousal, pain relatedness, and pain intensity, immediately after the Semantic session. Results: In the Nociceptive session, the 'nociceptive stimuli' vs. 'non-nociceptive stimuli' contrast revealed extensive activations in SI, SII, insula, cingulate cortex, thalamus, and dorsolateral prefrontal cortex. In the Semantic session, words associated with social pain, compared to negative pain-unrelated words, showed increased activity in most of the same areas, whereas words associated with physical pain, compared to negative pain-unrelated words, only activated the left supramarginal gyrus and partly the postcentral gyrus. Discussion: Our results confirm that semantic pain partly shares the neural substrates of nociceptive pain. Specifically, social pain-related words activate a wide network of regions, mostly overlapping with those pertaining to the affective-motivational aspects of nociception, whereas physical pain-related words overlap with a small cluster including regions related to the sensory-discriminative aspects of nociception. However, most regions of overlap are differentially activated in different conditions.

Investigating the impact of offer frame manipulations on responders playing the ultimatum game.

The present study was designed to test the impact of frame manipulations on the decision-making of responders playing the ultimatum game. Experiment 1 investigated responders' event-related potentials (ERPs) measured in response to the offers as a function of the frame (i.e., negative: "the proposer keeps" versus positive: "the proposer offers"). While no difference in acceptation rate was found as a function of the offer's frame, electrophysiological results suggest that the stronger negative affective response to the offers in the negative frame (N400) was successfully reappraised by the responders (P600), possibly explaining why the offer frame manipulation did not modulate acceptation rates. No framing effect was found when the ultimatum game was played in its one-shot version (Experiment 2), suggesting that repeated measurements did not affect responders' behavior. However, an offer framing effect was found in female (but not in male) responders, when the complexity of the game statement increased, presumably recruiting more cognitive resources and taxing the reappraisal process (Experiment 3). Taken together, these results suggest that framing manipulations are associated with complex affective and cognitive processes, supporting the cognitive-affective tradeoff model.

Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals.

Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

Predictive mechanisms in idiom comprehension.

Prediction is pervasive in human cognition and plays a central role in language comprehension. At an electrophysiological level, this cognitive function contributes substantially in determining the amplitude of the N400. In fact, the amplitude of the N400 to words within a sentence has been shown to depend on how predictable those words are: The more predictable a word, the smaller the N400 elicited. However, predictive processing can be based on different sources of information that allow anticipation of upcoming constituents and integration in context. In this study, we investigated the ERPs elicited during the comprehension of idioms, that is, prefabricated multiword strings stored in semantic memory. When a reader recognizes a string of words as an idiom before the idiom ends, she or he can develop expectations concerning the incoming idiomatic constituents. We hypothesized that the expectations driven by the activation of an idiom might differ from those driven by discourse-based constraints. To this aim, we compared the ERP waveforms elicited by idioms and two literal control conditions. The results showed that, in both cases, the literal conditions exhibited a more negative potential than the idiomatic condition. Our analyses suggest that before idiom recognition the effect is due to modulation of the N400 amplitude, whereas after idiom recognition a P300 for the idiomatic sentence has a fundamental role in the composition of the effect. These results suggest that two distinct predictive mechanisms are at work during language comprehension, based respectively on probabilistic information and on categorical template matching.

Author Correction: A consensus-based transparency checklist.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The Comprehension of Metaphorical Descriptions Conveying Gender Stereotypes. An Exploratory Study.

In this adjective elicitation study, we investigated the comprehension of Italian sentences where a metaphorically intended noun (e.g., butterfly, nightmare) was used to describe a gender-stereotyped or stereotype-neutral individual (e.g., flute player, engineer, person). Specifically, we explored whether and to what extent meaning availability and the affective valence of these metaphorical descriptions (e.g., This flute player is a butterfly) varied as a function of the stereotypical or stereotype-neutral nature of the sentential subject, the male vs. female direction of the stereotype, and the grammatical gender marked in the subject noun phrase. Our goals were to test whether the meaning of metaphorical descriptions was equally available regardless of the presence and direction of the gender stereotype and of the grammatical gender of the subject, and whether the adjectives expressing the sentential meaning had the same affective valence no matter who was the subject. The results showed that it was easier (i.e., more adjectives came up to mind) to express the sentence meaning when the sentences described male stereotyped individuals than female stereotyped or stereotype-neutral individuals. The adjective valence did not significantly change according to the subject type. Participants produced adjectives with the wrong grammatical gender more often for males in stereotypically female occupations than for females in stereotypically male occupations. These gender errors occurred also when the sentences described females engaged in stereotypically female occupations. Overall, these results extend to metaphorical descriptions previous findings showing that a social group (males) is seen as more normative than another (females), and acts as the unmarked normative group.