The Art of Counseling in the Treatment of Head and Neck Cancer: Exploratory Investigation among Perceptions of Health Professionals in Southern Italy.

(1) Background: Recurrent and/or metastatic patients with head and neck squamous cell carcinoma show a poor prognosis, which has not changed significantly in 30 years. Preserving quality of life is a primary goal for this subset of patients; (2) Methods: A group of 19 physicians working in South Italy and daily involved in head and neck cancer care took an anonymous online survey aimed at revealing the level of knowledge and the application of communication techniques in daily patient care; (3) Results: Several specialists, 18 out 19 (95%), considered that patient participation in therapeutic choices is mandatory. The main obstacles to complete and reciprocate communication still consist of lack of time and staff, but also in the need for greater organization, which goes beyond the multidisciplinary strategy already used; (4) Conclusions: A greater impulse to training and updating on issues related to counseling can improve communication between the different clinicians involved in the treatment plan.

[Policy changes introduced by the national vaccine prevention plan and the mandatory vaccination law of 2017: opinions and attitudes of Italian healthcare workers]. / Dal Piano Nazionale di Prevenzione Vaccinale alla legge sull'obbligo: opinioni ed attitudini di un campione di operatori sanitari.

The Italian National Vaccine Prevention Plan (PNPV) of 2017-19 and subsequent mandatory vaccination law (Law 119/2017) both occurred in the context of a progressive decrease in vaccine coverage levels in Italy and led to important policy changes, including the introduction of new vaccine recommendations and increasing the number of mandatory vaccinations in childhood from four to ten. A survey on a sample of 446 Italian health care workers (HCW) was carried out in order to assess their opinions on policy changes introduced by the PNPV and by the mandatory vaccination law. The convenience sample was selected among participants in a training course on vaccination counselling. The large majority of participants expressed overall satisfaction about the policy changes introduced by the PNPV but some highlighted pitfalls related to its implementation. Moreover, the majority of HCW believe that vaccination coverage for both recommended and mandatory vaccinations has increased thanks to Law 119/2017, therefore expressing a positive attitude towards the enforcement of vaccine mandates.

Empathy in vaccination counselling: a survey on the impact of a three-day residential course.

BACKGROUND: In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS: The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children. Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups. RESULTS: Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course. CONCLUSIONS: This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents' adherence to vaccination programs.

Measuring empathy in pediatrics: validation of the Visual CARE measure.

BACKGROUND: Empathy is a key element of "Patient and Family Centered Care", a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED). METHODS: The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7-11, the 10Q version to those older than 11, and the 10Q-Parent questionnaire to parents of children younger than 7. The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q-Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated. RESULTS: Seven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach's alpha was 0.95 for the 10Q/10Q-Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor. Physicians' empathy scores correlated with patients' satisfaction for both the 10Q and 10Q-Parent questionnaires (Spearman's rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman's rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20-0.93). CONCLUSIONS: The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics.

Italian Physicians' Opinions on Rotavirus Vaccine Implementation.

Rotavirus (RV) infection is the main cause of severe acute gastroenteritis (GE) in the pediatric population and has a major impact in both developing and industrialized countries. The reduction of severe RVGE cases, followed by death or hospitalization, is considered the main benefit of RV vaccination, even though its implementation often faces obstacles. In Italy, the recently approved National Immunization Plan aims to overcome the differences among regions, offering a universal free RV vaccination. The aim of the study was to evaluate the opinions on benefit and acceptability of RV vaccination related to the perception of the burden of RV disease. Data were collected from 108 physicians in 2015 by a questionnaire consisting of 12 questions; some answers were compared with those obtained with a similar tool in 2011. The majority of respondents (76.2%) was convinced of the benefit of the vaccine and 57.4% recommended it routinely, but more than half indicated a <25% adherence to RV vaccination among their patients. As the main reasons of vaccine refusal, skepticism about the vaccine (60.4%) and its cost (34.1%) were indicated. Our data confirm that more information and counselling are needed to increase RV vaccine coverage.

[Communicating the benefits and risks of vaccination: a focus on the PFCC (Patient and Family Centered Care) approach]. / I segreti della comunicazione in ambito vaccinale.

In recent years an important reduction in the access to vaccination was noticed in Italy. Health care workers involved in health promotion must necessarily find new strategies to overcome the mistrust of the population. The application of some instruments of counselling in the vaccination field can improve the therapeutic alliance, making users to take the best decisions for their own wellness. The approach called Patient- and Family-Centered Care includes the relational processes within the skills of the health care worker.

Attitude of Italian physicians toward pertussis diagnosis.

Resurgence of pertussis has been observed in several countries whereas Italy continues to be a low incidence country. We hypothesize that the low reported incidence of pertussis in Italy could be biased by the attitude of physicians to suspect and diagnose pertussis in different age groups. We investigated the attitude of Italian physicians toward pertussis diagnosis through clinical scenarios. A cross-sectional study was conducted in June 2012 sending online questionnaires to pediatricians and general practitioners (GPs) involved in ambulatory primary care. The questionnaire included five clinical scenarios of patients of different ages (45 d, 5 y, 11 y, 24 y, 58 y) with prolonged cough of at least 2 weeks. Respondents were asked to choose a diagnosis among a list of 14. We observed a decreasing trend of suspected pertussis diagnosis with increasing age of the patient (from 46% at 45 d to 0 at 58 y). In Italy pertussis is seldom suspected in the differential diagnosis of cough particularly in adults. This may cause a significant under-notification of pertussis, with a higher impact in older age groups. Educational programs should be reinforced to consider the differential diagnosis of pertussis in individuals with atypical presentation and in older age groups.

Pediatric sentinel surveillance of vaccine-preventable diseases in Italy.

BACKGROUND: Planning and evaluating vaccination programs depend on reliable systems of monitoring disease incidence in the community. In Italy vaccine-preventable diseases are subject to statutory notification, but they are often unreported. In January, 2000, a pediatric sentinel network was launched, with the aim of monitoring in a timely and accurate way the geographic and temporal trends of vaccine-preventable diseases. METHODS: The network consists of National Health System primary care pediatricians; participation is voluntary. The diseases under surveillance include measles, mumps, rubella, pertussis and varicella. Case definitions are based on specific clinical criteria, and pediatricians report cases on a monthly basis. Incidence rates are estimated and compared with those obtained by statutory notifications. The proportion of vaccinated cases is also computed. RESULTS: In 2000 an average of 468 pediatricians participated each month of a total of 7276 pediatricians under contract for primary care by the National Health System. The population under surveillance consisted of 371 670 children younger than 15 years (of a national total of 8.347.804 children of the same age). The annual national incidence per 100.000 children was estimated at 5345 for varicella, 1972 for mumps, 279 for pertussis, 108 for rubella and 62 for measles, although wide variations were observed among geographic areas. The national estimates are 3 to 7 times higher than those obtained through statutory notifications. For all of the diseases the ratio between the two sources of data was significantly higher in southern Italy, compared with the rest of the country. The proportion of vaccinated cases was similar for measles and rubella (21 and 17%) but was approximately 3 times higher for mumps (59%). Most (74%) of the vaccinated mumps cases had received the Rubini vaccine strain. CONCLUSIONS: The sentinel surveillance system is considerably more sensitive than statutory notifications, particularly in southern Italy. The high percentage of mumps cases vaccinated with the Rubini strain indicates a reduced effectiveness of this vaccine. Although further improvements are needed, pediatrician-based sentinel surveillance is a useful tool for evaluating vaccine-preventable disease trends.