[BRCA mutations and decision regret: a comprehensive analysis of existing research through a scoping review and reflections from a nursing perspective.] / Mutazioni BRCA e rimpianto decisionale: un'analisi approfondita della ricerca esistente tramite scoping review e riflessioni da una prospettiva infermieristica.

INTRODUCTION: Given the significance of healthcare decisions in women with BRCA1 and BRCA2 mutations and their impact on patients' lives, this study aims to map the existing literature on decision regret in women with BRCA1 and BRCA2 mutations. METHODS: A scoping review was conducted in the following databases: PubMed, Embase, Scopus, CINAHL, Cochrane, and Google Scholar. Inclusion criteria focused on decision regret in the female population with BRCA1 and/or BRCA2 mutations, with no restrictions on the methodologies of the included studies, but only in the English language. The selection process led to the inclusion of 13 studies. RESULTS: The analysis revealed a significant trend toward decision regret among patients facing complex medical choices. The quality of healthcare communication, decision support, and genetic counselling emerged as key factors influencing patients' perceptions and experiences, with direct implications for their quality of life and psychological well-being. The results suggest that these decisions considerably impact patients, both in terms of clinical outcomes and emotional experiences. DISCUSSION: The investigation highlights the vital importance of a personalized care approach, emphasizing the critical role of managing patients' emotional and psychological complexity. Managing decision regret requires acute attention to individual needs and effective communication to mitigate emotional impact and improve patient outcomes. CONCLUSIONS: Insights from a nursing perspective in the analysis of results indicate the need for informed, empathetic, and integrated care that considers the emotional complexity of women with BRCA1 and/or BRCA2 mutations in their lives and health choices.

Peristomal Skin Complications: Detailed Analysis of a Web-Based Survey and Predictive Risk Factors.

Patients with a stoma are at risk of developing peristomal skin complications (PSCs) that can negatively impact their quality of life. This study aims to identify potential risk factors for dermatitis, pruritis/xerosis, infections, and ulcerations among patients with a stoma and evaluate preventive measures. This cross-sectional study involved data regarding 232 Italian patients with a stoma. A questionnaire was used to collect patient characteristics, comorbidities, and stoma management data. The most frequent PSCs observed were dermatitis and pruritis/xerosis in approximately 60% of patients. Psoriasis was strongly correlated with dermatitis, while being overweight or obese increased the risk of pruritis/xerosis. Class 2 obesity and atopic dermatitis were associated with an increased risk of infections. Being underweight, completely nonautonomous, and having inflammatory bowel disease were associated with a higher risk of ulcerations, while radiotherapy was a strong risk factor for ulceration. Preventive measures such as using hydrocolloid barriers, TNT gauze cleansing, and low pH detergent were effective in preventing dermatitis. Appropriate stoma care and maintenance, including the use of protective film and careful monitoring of weight and comorbidities, are crucial in minimizing the risk of complications associated with a stoma.

Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis.

OBJECTIVE: The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. METHODS: A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). RESULTS: Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. CONCLUSIONS: The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.

Predictors of Adjustment to Living with an Ostomy: Results of a Cross-sectional Study.

OBJECTIVE: To describe predictors of adjustment to living with an ostomy among Italian adults with an enterostomy or a colostomy. METHODS: A multicenter, cross-sectional design was performed, sampling 403 patients with an ostomy in three different outpatient clinics of northern Italy between April 2018 and December 2020. Data were collected by stoma therapists in ambulatory settings using the Italian version of the Ostomy Adjustment Inventory-23 and patient medical records. RESULTS: Acceptance was lower among women, patients who underwent emergency surgery, those with a urostomy, and those with a body mass index of less than or equal to 25 kg/m2. Negative feelings were associated with higher body mass index, colostomies, shorter length of time of living with an ostomy, and emergency ostomy creation. CONCLUSIONS: Being young and having a high level of education are protective against psychosocial problems and help promote acceptance and social engagement. The findings of this study help identify patients who are likely to be more vulnerable and need greater support through specific educational and motivational interventions.

A multi-phase study for the development of a self-efficacy measuring scale for ostomy care nursing management.

AIM: To develop and psychometrically test a self-efficacy scale for ostomy care nursing management. DESIGN: This study adopted a multi-method and multi-phase design. METHOD: Phase 1 of the study was comprised of the developmental tasks, where items were generated based on the emergent themes from literature. The items were then discussed with a panel of experts. Phase 2 focused on the validation process of the scale, where its content validity, construct and concurrent validity, and its internal consistency were assessed. The validation process was conducted between January 2018 - January 2019. RESULTS: The final version of the self-efficacy scale in ostomy care nursing management encompasses 24 items in three domains, namely the clinical assessment domain, the education and relationship domain, and the teamwork domain. The scale showed the evidence of face and content validity, adequate construct and concurrent validity, and adequate internal consistency. CONCLUSION: The developed scale can be used in clinical and educational research. IMPACT: This study presents the development and validation of the first valid and reliable self-reporting measurement for nurses' self-efficacy in ostomy care nursing management. Self-efficacy ostomy care nursing management encompasses 24 items and three domains, which are clinical assessment, education and relationship, and teamwork. This research will have an impact on nursing education, as it addresses the need for a specific self-efficacy assessment of ostomy care nursing management. Self-efficacy ostomy care nursing management will have an impact on nurses and patients, as it can be used to improve nurses' self-efficacy and clinical outcomes for patients in ostomy care.

Ostomy Adjustment Inventory-23 (OAI-23): Development and Testing of the Italian Version.

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Italian version of the Ostomy Adjustment Inventory-23 (OAI-23). DESIGN: This is a methodological study evaluated psychometric properties of the OAI-23. SUBJECTS AND SETTING: A sample of 230 patients with an ostomy was enrolled in an Italian university hospital from May to September 2017. METHODS: This study comprised two phases; during phase 1, the cultural-linguistic translation of the OAI-23 into Italian was completed. In addition, content and face validity were tested. In phase 2, psychometric testing of the OAI-23 was conducted in a cross-section sample of 258 Italian patients with a fecal ostomy. RESULTS: The Italian version of the OAI-23 presents 23 items giving a 3-dimensional structure: acceptance, negative feelings, and social engagement. Accordingly, this 3-dimensional structure arise from an exploratory factorial analysis with the maximum likelihood robust estimator (RMSEA = 0.089 [95% CI = 0.063-0.113; P = .05], and CFI = 0.901, explaining 44% of the total variance). The internal consistency of the OAI-23 was good (Cronbach α for acceptance = 0.91; for negative feelings = 0.87; for social engagement = 0.93; for overall scale = 0.91). CONCLUSIONS: The OAI-23 provides a valid and reliable assessment of patients' psychosocial adjustment to an ostomy. It provides important resource for clinical decision-making; for example, it may be used to design or tailor educational strategies to enhance psychosocial adjustment following creation of an ostomy.