[Awareness of diagnosis and prognosis in patients with unfavorable prognosis: perception of the attitudes of a group of doctors and nurses]. / La consapevolezza della diagnosi e della prognosi nella persona con malattia a prognosi infausta:la percezione negli atteggiamenti di un gruppo di medici e infermieri.

In oncological patients , communication of the diagnosis of the disease or its regression and the patient's awareness of both diagnosis and prognosis, plays a central role. Up to a few decades ago , it was common practice not to reveal the diagnosis of cancer. Nowadays, the situation has changed owing to radical socio-cultural changes. However, in daily practice, the most frequent impression is that the patient does not entirely realize the implications of diagnosis and prognosis and health workers find it difficult to inform patients clearly and honestly so that they can decide which cures to accept or decline. An observational study was performed on a group of 153 doctors and nurses to identify their opinions and attitudes regarding how to inform cancer patients, in terms of diagnosis and prognosis, and how they perceived the level of awareness in such patients. The results of the study partly confirmed published data , in that both doctors and nurses thought it best to inform the patient of the oncological pathology, keeping back the unfavorable prognosis and that the percentage of patients really made aware of these implications was lower than officially declared.

Qualitative pain classification in hospice and pain therapy unit.

In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram."

Death representation of caregivers in hospice.

In this study, we investigated caregiver's death representation in hospice. The results presented here are a further analysis of the data collected in our previous study, concerning the evaluation of the caregiver in hospice. The data analysis of 24 caregivers of patients hospitalized in Rimini Hospice (Italy) underlined that caregivers avoiding death representation of the patient admitted to hospice had fewer protective factors (52.3%) and more risk factors (47.7%) than caregivers nonavoiding (66.5% and 33.5%, respectively). Caregivers avoiding death representation, moreover, experienced a greater distress (58%) than those nonavoiding (42%).

Caregiver evaluation in hospice: application of a semi-structured interview.

In this study we report the results of construction and administration of a semi-structured interview for the evaluation of caregivers in hospice. The results presented here are related to interviews (n = 25) that were administered at Rimini Hospice. According to the interview coding system, it was possible to identify thematic areas of the interviews where the caregiver's distress was mainly concentrated. As concerning the care burden, greater distress was detected in areas relating to the change in the rhythm of life (38%) and in social network (26%); whereas, as concerning the psychological burden, a greater distress was detected in the area related to the caregiver role (51%). In conclusion, a singular element identified as a source of distress in, our study, is that of social network.

Illness awareness in hospice: application of a semi-structured interview.

This study describes the results of a semi-structured interview to assess the illness awareness of cancer patients in Hospice. The results of this study are based on the interviews made in Rimini and Savignano sul Rubicone Hospices (n = 51). Psychologists evaluated illness awareness of the participants interviewed independently from the code system that is provided for the interview. According to the psychologists, 18 patients (35%) were aware, 11 patients (22%) were unaware, and 22 patients (43%) were aware with defense mechanisms. According to the code system of the interview, the results were the following: 18 patients (35%) were aware, 2 patients (4%) were unaware, and 29 patients (57%) were aware with defense mechanisms. Two participants had to be reassessed because of inconsistency in some factors. In conclusion, the data analysis underlined that the congruence of the 2 assessment methods was found in 33 of the 51 patients examined (65%) and that the degree of concordance was rather low (kappa = .46; 95% CI = 0.24-0.68).

Illness awareness of patients in hospice: psychological evaluation and perception of family members and medical staff.

BACKGROUND: Despite the widespread belief that patients should be given full information about their disease and prognosis, they actually they know very little. The purpose of this study was to evaluate the awareness of 100 patients (from the Hospices of Rimini and Savignano-Rubicone) about their diagnoses and prognoses. It is also investigated staff and relatives perceptions of patients' awareness. METHODS: A semistructured interview of patients was performed by psychologists to evaluate their awareness about diagnosis and prognosis. Then psychologists completed a questionnaire about their own evaluation of patients' disease awareness. Moreover, the same questionnaire was completed by family members and by staff members (doctors and nurses) about their perceptions of patients' awareness. Doctors and nurses gave their answers based on their routine interactions with patients. RESULTS: Despite the fact that patients in hospice were in the terminal phase of disease, 30% of patients had no diagnosis awareness, and an even higher percentage of patients (62%) who had no prognosis awareness.