RESUMO
Objectives: Disclosing information on diagnosis, prognosis and treatment is a delicate process in oncology, although awareness levels have over time increased in people with cancer. However, individual characteristics should be considered when communicating difficult information. We conducted a multicentric study to explore the moderating role of coping styles on the relationship between information about cancer, quality of life and psychological distress. Methods: In the period between October 2015 and February 2016, 288 patients with a diagnosis of a solid tumor were recruited from seven Italian oncology units. All participants were administered the Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC), the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30), and the EORTC QLQ 25-item information module (INFO25). We explored the moderating effect of coping style with quality of life (QoL) and distress (DT) as dependent variables and information on cancer treatment as independent variable. Results: Low levels of anxious preoccupation significantly moderated the relationship between information on treatment and QoL (R2 6%, p < 0.001), while low and medium levels of hopelessness significantly moderated the relationship between information on treatment and DT (R2 = 14%, p = 0.033). Adaptive coping strategies, such as fighting spirit and fatalism, and borderline strategies such as avoidance, did not play a role in this relationship. Conclusion: Taking into account and evaluating coping mechanisms in cancer care is a priority when disclosing information on treatments, in order to tailor communication style to individual features.
RESUMO
Background and objectives Individuals with schizophrenia display language impairments involving pragmatics, semantics and syntax. Language impairments may show diagnostic specificity and could relate to the ability of engaging in psychotherapy. This pilot study sought to: (1) identify linguistic features that might differentiate individuals with schizophrenia from distressed controls without psychotic symptoms; and (2) examine the association between linguistic abilities and clinical changes during psychotherapy. Methods We recruited patients with schizophrenia and a comparison group of individuals with demoralization and distress due to cancer. Participants underwent Dignity Therapy (DT), an existentially-oriented brief psychotherapy focused on legacy and subjective dignity. Verbatim transcripts of the DT sessions were analysed using Natural Language Processing (NLP). In addition, we measured changes in levels of demoralization and dignity-related distress before and after DT, exploring the association with linguistic variables with network analysis. Results Patients with schizophrenia could be differentiated from those with cancer-related distress using only three out of 141 linguistic variables: total number of words, number of prepositional chains and conversational elements. Across groups, better levels of discourse coherence and higher number of arguments controlled by a predicate (verb arity) were associated with larger improvements in demoralization and, indirectly, dignity-related distress. Conclusions Reproducible linguistic markers may be able to differentiate individuals with schizophrenia from those with less severe psychopathology, and to predict better uptake of psychotherapy independent from diagnosis. Future studies should explore whether linguistic features derived from NLP may be exploited as accessible diagnostic or prognostic markers to tailor psychotherapy and other interventions in schizophrenia. (AU)
