Teresa Gavaruzzi - Academia.edu (original) (raw)
Papers by Teresa Gavaruzzi
Gli argomenti del manuale includono il comportamento e gli atteggiamenti del pubblico, la politic... more Gli argomenti del manuale includono il comportamento e gli atteggiamenti del pubblico, la politica, i fatti e la disinformazione (misinformation).
The European health psychologist, 2017
Background: Patients’ narratives have been suggested as a promising way to promote health, includ... more Background: Patients’ narratives have been suggested as a promising way to promote health, including colorectal cancer (CRC) screening, but evidence about their effectiveness is mixed. Aims: a) to provide a comprehensive review of the literature, and b) to investigate the effect of narratives conveying different emotions in promoting CRC screening. Methods: a) Systematic review of studies investigating narratives in CRC screening; b) Between-participant design comparing: usual leaflet (no-narrative condition), usual leaflet and one of three narratives: the character is waiting for the result (control narrative), had a negative result (reassurance-based narrative) or had a positive result and was successfully treated for early-stage cancer (anticipated regret-based narrative). Participants: 145 participants aged 45-65, with no CRC personal history (approved by local Ethic Committee). Measures: intention to undergo CRC screening, knowledge, risk perception, and informed choice. Analys...
Preventive Medicine
Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are stil... more Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are still vacillating in their decision to vaccinate. In this study, we considered the effect of two relevant contextual issues on vaccination intention: the number of people infected with COVID-19 is increasing, and the pace of vaccination is gaining speed. Specifically, we hypothesized that having already contracted SARS-CoV-2 (post-positive reluctance) could lead people to underestimate the importance of vaccination. Moreover, as the number of vaccinated people increases, more hesitant people could fall into the free-riding intention category, benefitting from the immunity provided by others' vaccinations. Vaccine hesitancy becomes more critical as the vaccination campaign proceeds: at one point, it will be inevitable to deal with hesitant people. This study is part of a WHO Regional Office for Europe project and involved a representative sample of 5006 Italians interviewed in January–February 2021. In case of post-positive reluctance, both young age and female gender increase vaccine hesitancy, while a high level of education reduces free-riding intention. Considering post-positive reluctance and free riding, a protective effect on hesitancy is associated with negative affective states, adherence to protective behaviors, trust in health information sources, and resilience. In contrast, increased vaccine hesitancy is associated with a high level of conspiracy-mindedness and trust in media information sources. Recognizing and studying the post-positive reluctance and the phenomenon of free-riding people can help us to become more efficient in combatting the virus.
European Journal of Surgical Oncology
BACKGROUND The optimal surgical treatment for colonic colorectal carcinoma (CRC) in Lynch Syndrom... more BACKGROUND The optimal surgical treatment for colonic colorectal carcinoma (CRC) in Lynch Syndrome (LS) and attenuated polyposis coli (A-FAP phenotype) patients is still debated, since there is a high risk of metachronous colonic adenomas and carcinoma after primary surgery. The aim of this study was to compare surgical outcome, functional data, and Quality of Life (QoL) after total colectomy with ileorectal anastomosis (TC-IRA) compared to right (RH) or left hemicolectomy/sigmoidectomy (LH/SI). METHODS Patients who underwent TC-IRA (ileorectal anastomosis from 8 to 15 cm from the anal verge) for CRC and/or polyposis at our Surgical Department between 2001 and 2017 were included in the study group, and were matched one-to-one by baseline and clinical characteristics with a control group of RH and LH/SI. Morbidity and mortality data were collected (Clavien-Dindo classification). International validated questionnaires were used to investigate QoL and bowel function. RESULTS Fifty-five patients were enrolled in each group. No differences were found on length of hospital stay, Clavien-Dindo grade III-IV complications and mortality (p > 0.05). TC-IRA showed a longer operative time than RH and LH/SI (p < 0.0001) and a major blood loss than RH (p < 0.0001). Worse bowel function and worse QoL, only for the bowel-related items, were recorded in TC-IRA group. The general QoL was similar among the groups. CONCLUSIONS TC-IRA and segmental resection have similar morbidity and mortality. The worse bowel function in TC-IRA group does not impact on the general QoL. These data can be useful in the setting of risk-reducing surgery decision in LS and A-FAP patients.
Diseases of the Colon & Rectum
Supplemental Digital Content is available in the text. BACKGROUND: Patient-reported outcomes asso... more Supplemental Digital Content is available in the text. BACKGROUND: Patient-reported outcomes associated with different bowel reconstruction techniques following anterior resection for rectal cancer are still a matter of debate. OBJECTIVE: This study aimed to assess quality of life and bowel function in patients who underwent colonic J-pouch or straight colorectal anastomosis reconstruction after low anterior resection. DESIGN: Bowel function and quality of life were assessed within a multicenter randomized trial. Questionnaires were administered before the surgery (baseline) and at 6, 12, and 24 months after surgery. SETTINGS: Patients were enrolled by 19 centers. The enrollment started in October 2009 and was stopped in February 2016. The study was registered at www.clinicaltrials.gov (Identifier: NCT01110798). PATIENTS: Patients who underwent low anterior resection for primary mid-low rectal cancer and who were randomly assigned in a 1:1 ratio to receive either stapled colonic J-pouch or straight colorectal anastomosis were selected. MAIN OUTCOME MEASURES: The primary outcomes measured were quality of life and bowel function. RESULTS: Of the 379 patients who were evaluable, 312 (82.3%) completed the baseline, 259 (68.3%) the 6-month, 242 (63.9%) the 12-month, and 199 (52.5%) the 24-month assessment. Bowel functioning and quality of life did not significantly differ between arms for almost all domains. The total bowel function score, the urgency, and the stool fractionation scores significantly worsened after surgery and remained impaired over time in both arms (p < 0.0032), whereas constipation improved after surgery but recovered to baseline levels from 1 year onward (p < 0.0036). All patients showed a significant and continuous improvement in emotional functioning (p < 0.0013) and future perspective (p < 0.0001) from baseline to the end of the study. LIMITATIONS: Limitations of the study include missing data, which increased over time; the possibility that some treatments have slightly changed since the study was conducted; and investigators not blind to treatment allocation. CONCLUSION: The findings of this study do not support the routine use of colonic J-pouch reconstruction in patients with rectal cancer who undergo a low anterior resection. See Video Abstract at http://links.lww.com/DCR/B328. BOLSA J COLÓNICA O RECONSTRUCCIÓN COLORRECTAL RECTA DESPUÉS DE RESECCIÓN ANTERIOR BAJA PARA CÁNCER RECTAL: IMPACTO EN LA CALIDAD DE VIDA Y LA FUNCIÓN INTESTINAL: UN ESTUDIO ALEATORIZADO PROSPECTIVO MULTICÉNTRICO ANTECEDENTES: Los resultados informados por el paciente asociados con diferentes técnicas de reconstrucción intestinal después de la resección anterior para el cáncer de recto aún son tema de debate. OBJETIVO: Evaluar la calidad de vida y la función intestinal en pacientes que se sometieron a una bolsa en J colónica o reconstrucción de anastomosis colorrectal recta después de una resección anterior baja. DISEÑO: La función intestinal y la calidad de vida se evaluaron en un ensayo aleatorizado multicéntrico. Los cuestionarios se administraron antes de la cirugía (basal) y a los 6, 12 y 24 meses después de la cirugía. MARCO: Los pacientes fueron incluidos en 19 centros. La inscripción comenzó en Octubre de 2009 y se detuvo en Febrero de 2016. El estudio se registró en www.clinicaltrials.gov (Identificador: NCT01110798). PACIENTES: Pacientes que se sometieron a resección anterior baja por cáncer rectal primario medio-bajo y que fueron aleatorizados en una proporción de 1: 1 para recibir bolsa J colónica con grapas o anastomosis colorrectal recta. MEDIDAS DE RESULTADOS PRINCIPALES: calidad de vida y función intestinal. RESULTADOS: De los 379 pacientes que fueron evaluables, 312 (82.3%) completaron la evaluación inicial, 259 (68.3%) a los 6 meses, 242 (63.9%) a los 12 meses y 199 (52.5%) a los 24 meses. . El funcionamiento intestinal y la calidad de vida no difirieron significativamente entre los dos grupos en casi todos los dominios. La puntuación total de la función intestinal, la urgencia y las puntuaciones de fraccionamiento de las heces empeoraron significativamente después de la cirugía y continuaron con el tiempo extra en ambos grupos (p <0.0032), mientras que el estreñimiento mejoró después de la cirugía pero se recuperó a los niveles basales a partir de 1 año en adelante (p <0.0036). Todos los pacientes mostraron una mejora significativa y continua en el funcionamiento emocional (p <0.0013) y la perspectiva futura (<0.0001) desde el inicio hasta el final del estudio. LIMITACIONES: Datos faltantes, que aumentaron con el tiempo; la posibilidad de que algunos tratamientos hayan cambiado ligeramente desde que se realizó el estudio; investigadores no cegados a la asignación del tratamiento. CONCLUSIÓN: Los hallazgos de este estudio no respaldan el uso rutinario de la reconstrucción de la bolsa J colónica en pacientes con cáncer rectal que se someten a una resección anterior baja. Consulte Video Resumen…
Social Science & Medicine
Many countries were and are still struggling with the COVID-19 emergency. Despite efforts to limi... more Many countries were and are still struggling with the COVID-19 emergency. Despite efforts to limit the viral transmission, the vaccine is the only solution to ending the pandemic. However, vaccine hesitancy could reduce coverage and hinder herd immunity. Objective: People's intention to get vaccinated can be shaped by several factors, including risk perception which, in turn, is influenced by affect. The present work aimed at investigating how risk perception and some factors associated with the decision to comply with vaccination modulated vaccine acceptance for COVID-19 as compared to seasonal influenza, and how these have varied during the lockdown phases. Method: The study followed the main phases of the emergency in Italy, investigating the intention to get vaccinated against flu and against SARS-CoV-2 (if a vaccine was available) before, during and after the first national lockdown, covering the period from the end of February to the end of June 2020. We investigated the effect of risk perception and other predictors on the decision of getting vaccinated. Results: Compared to the pre-lockdown phase, during the lockdown more people were willing to get vaccinated for COVID-19, regardless of their beliefs about vaccines, and as risk perception increased, so did the intention to accept the vaccine. The acceptance of the flu vaccine increased after the reopening phase. In addition, the intention to get vaccinated against COVID-19 and against flu increased if there was previous flu vaccination behavior but decreased with increasing doubts about the vaccines in general. Conclusions: The observation of vaccination intentions across the three main phases of the emergency allows important considerations regarding psychological, affect, and demographic determinants useful to tailor public health communication to improve public response to future epidemics.
Patient Education and Counseling
Розроблено структурно-логічну модель формування інформаційно-аналітичної компетентності майбутніх... more Розроблено структурно-логічну модель формування інформаційно-аналітичної компетентності майбутніх офіцерів-прикордонників, яка складається з трьох взаємопов'язаних блоків: організаційного, практичного, результативного. Апробація структурно-логічної моделі передбачала проходження таких етапів: мотиваційного, практичного, результативного. Розглянуто хід проведення експериментальної перевірки ефективності педагогічних умов формування інформаційно-аналітичної компетентності майбутніх офіцерів-прикордонників у процесі іншомовної підготовки. До комплексу діагностичних засобів включено аналіз наукової літератури, спостереження за діяльністю курсантів, анкетування, опитування курсантів і викладачів, методи математичної статистики. Зроблено висновок, що запроваджені педагогічні умови забезпечують дієвість розробленої структурно-логічної моделі формування інформаційно-аналітичної компетентності майбутніх офіцерів-прикордонників у процесі іншомовної підготовки. Ключові слова: інформаційно-аналітична компетентність, структурно-логічна модель, майбутні офіцериприкордонники, експериментальна перевірка, педагогічні умови.
... Gavaruzzi, Teresa (2010) On Context Effects in Medical Decision Making: When the Way Informat... more ... Gavaruzzi, Teresa (2010) On Context Effects in Medical Decision Making: When the Way Information is Presented Affects Patients&amp;amp;#x27; Decisions. [Tesi di dottorato]. Full text disponibile come: [img] Anteprima. Documento PDF 2369Kb. Abstract (inglese). ...
This decision aid was designed by the Yorkshire Dialysis Decision Aid (YoDDA) research group for ... more This decision aid was designed by the Yorkshire Dialysis Decision Aid (YoDDA) research group for people with worsening kidney disease, and family members, to make informed decisions between two dialysis options delivered in two ways, in the context of their lifestyle: haemodialysis, in a medical centre (CHD) or at home (HHD); peritoneal dialysis, at home in an automated (APD) or continuous ambulatory (CAPD) form. Its purpose is to a) help people reason to the best of their ability about which dialysis option suits them, or their family member, at this time, and b) support discussions with health professionals about lifestyle, values, and medical history of relevance to their choice and its integration within their kidney disease management. It can be used independently by patients, carers and their family, and/or with staff delivering predialysis care. It is 44 pages long (14 point font) with five sections: Introduction – service’s contact details, provenance, how to use YoDDA, and ...
Purpose: To determine whether the number of decimal places in a personal health risk estimate inf... more Purpose: To determine whether the number of decimal places in a personal health risk estimate influences the extent to which people believe and remember the estimate. Methods: 3422 adults in a demographically diverse US-based online sample (mean age 50, 52% female, 74% white, 56% no college degree) were asked to imagine they were visiting an online risk calculator hosted by a prominent university’s medical school. We designed a mock calculator similar to existing calculators available online. The calculator asked a series of health questions relevant to kidney cancer and returned a hypothetical estimate of lifetime risk of kidney cancer. In this between-subjects experiment, participants were assigned one of seven risk estimates close to the average lifetime risk of kidney cancer in the US. Participants who were randomized to the no decimals condition received an estimate of 2%. Those in the one, two or three decimals conditions received an estimate of 2.1% or 1.9% (one decimal), 2.1...
British Journal of Health Psychology
Current Colorectal Cancer Reports, 2013
ABSTRACT We have systematically reviewed studies published in the last three years on patients’ s... more ABSTRACT We have systematically reviewed studies published in the last three years on patients’ self-reported evaluations of quality of life (QoL) and functions after chemoradiotherapy (CRT) for rectal cancer. Overall, the findings from 13 studies confirmed that CRT negatively affect functions and, consequently, patients’ QoL, especially for bowel, role, and social function. The studies’ heterogeneity limited the possibility of comparison among findings. We discuss and comment on the ideal characteristics of studies assessing QoL and function. We emphasise how this type of evidence is relevant to decision-making at all levels of health-care practice.
ABSTRACT Purpose: To evaluate the acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) to... more ABSTRACT Purpose: To evaluate the acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) to patients with established kidney disease making decisions between dialysis treatments. Methods: a controlled before and after intervention (YoDDA) design, and a randomised controlled trial design evaluating YoDDA and YoDDA plus a value clarification task. Patients receiving pre-dialysis education in 6 renal units across Yorkshire (UK) participated, completing a consent form (C), and a questionnaire at time of education (T1) and one-month later (T2). In the after phase, predialysis education nurses chose to disseminate YoDDA in different ways: a resource for patients to read in their own time or to be used within the predialysis education consultation with the nurse. Results: 58% (range 32-97%) of invited patients participated, n=145 (before) and 127 (after); questionnaire response rates were 69% (T1) and 57% (T2). Sample characteristics were: age = 63 years (19-93); 66% male; 69% married; 43% no formal education/ qualification. Dialysis preference was 48% centre haemodialysis, 27% automated peritoneal dialysis, 15% home haemodialysis, 10% continuous ambulatory peritoneal dialysis; patients’ decisional conflict was low enough to implement the decision (<20, Decisional Conflict Scale). 97% participants read YoDDA, 66% more than once, and 72% showed YoDDA to someone else. Free text comments were positive (e.g. “useful, factual, neutral”) with suggestions for improvement (e.g. “page of FAQs”). YoDDA was rated as easy to understand, increased understanding of CKD and dialysis, helped them think about the decision, feel more in control of the decision and wanted to share the decision with family (all rated as around 5, 0-6 scale; before ratings were around 4 on the 0-6 scale). At T2, 4% of YoDDA participants had not started thinking about, 26% were thinking, and 70% had made, their decision; before participants equivalent ratings were 13%, 21% and 66%. Most patients did not think it was important to know another patient’s choice (around 2, 0-6 scale). Both YoDDA versions showed the same pattern of findings. Conclusions: YoDDA was acceptable to patients and supported their understanding of kidney disease, dialysis and decision making, over and above usual care. YoDDA can be integrated into practice as supplementary information for patients to review on their own or to help facilitate nurse-patient consultations.
New Ideas in Psychology, 2014
ABSTRACT In the present study, we aimed at investigating what factors affect the judgment of a ty... more ABSTRACT In the present study, we aimed at investigating what factors affect the judgment of a typical reader when he or she deals with numerical information in an ecological context. Participants read a story about a man who was not treated with heparin after hernia surgery and then died. Their task was to assess the liability of the medical staff after receiving ambiguous numerical data based on percentages, and again after receiving unambiguous data based on frequencies. Participants also assessed the likelihood of survival/death for heparin-treated vs. not-treated patients. The unambiguous numerical information they were given was different in terms of numerousness of the reference class and framing. Results show that even when unambiguous frequency-based information is available, the participants&#39; judgments were strongly affected by both frame and reference class. Findings also indicate that likelihood and liability judgments are strongly related, and that liability is accounted for by likelihood, but not vice versa. Keywords Framing effect; Numerical information; Liability judgment; Responsibility; Frequency; Percentage
Expert Review of Anticancer Therapy, 2014
Neoadjuvant therapy followed by total mesorectal excision is standard of care for locally advance... more Neoadjuvant therapy followed by total mesorectal excision is standard of care for locally advanced rectal cancer. However, this approach has been previously shown to be associated with high rate of morbidity and it may have a negative effect on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; reported outcomes (PROs). In order to summarize findings on the effect of the neoadjuvant approach on PROs, we systematically reviewed articles published in the last five years. Thirty-five articles met the inclusion criteria. Ten articles compared the effect of surgery with and without neoadjuvant therapy, six articles compared different neoadjuvant therapies, ten articles reported on patients who were all treated with neoadjuvant therapy, and nine articles examined the effect of neoadjuvant therapy in the analyses. The results are summarized by function investigated and critically commented.
BMC Medical Informatics and Decision Making, 2013
Background: Patient decision aids support people to make informed decisions between healthcare op... more Background: Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others' experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in nonnarrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods: A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people's healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results: Of 734 citations identified, 11 were included describing 13 studies. All studies found participants' judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both "system 1" (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and "system 2" (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions: There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people's informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another's values, and c) motivates people equally to engage with healthcare resources.
BMC Medical Informatics and Decision Making, 2013
Background: Consensus guidelines have recommended that decision aids include a process for helpin... more Background: Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids. Methods: Building on the International Patient Decision Aid Standards (IPDAS) Collaboration's 2005 review of values clarification methods in decision aids, we convened a multidisciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary. Results: Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single "best" practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect. Conclusions: Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness.
Background: Online risk calculators offer different levels of precision in their risk estimates. ... more Background: Online risk calculators offer different levels of precision in their risk estimates. People interpret numbers in varying ways depending on how they are presented, and we do not know how the number of decimal places displayed might influence perceptions of risk estimates. Objective: The objective of our study was to determine whether precision (ie, number of decimals) in risk estimates offered by an online risk calculator influences users' ratings of (1) how believable the estimate is, (2) risk magnitude (ie, how large or small the risk feels to them), and (3) how well they can recall the risk estimate after a brief delay. Methods: We developed two mock risk calculator websites that offered hypothetical percentage estimates of participants' lifetime risk of kidney cancer. Participants were randomly assigned to a condition where the risk estimate value rose with increasing precision (2, 2.1, 2.13, 2.133) or the risk estimate value fell with increasing precision (2, 1.9, 1.87, 1.867). Within each group, participants were randomly assigned one of the four numbers as their first risk estimate, and later received one of the remaining three as a comparison. Results: Participants who completed the experiment (N = 3422) were a demographically diverse online sample, approximately representative of the US adult population on age, gender, and race. Participants whose risk estimates had no decimal places gave the highest ratings of believability (F 3,3384 = 2.94, P = .03) and the lowest ratings of risk magnitude (F 3,3384 = 4.70, P = .003). Compared to estimates with decimal places, integer estimates were judged as highly believable by 7%-10% more participants (χ 2 3 =17.8, P < .001). When comparing two risk estimates with different levels of precision, large majorities of participants reported that the numbers seemed equivalent across all measures. Both exact and approximate recall were highest for estimates with zero decimals. Odds ratios (OR) for correct approximate recall (defined as being within 50% of the original estimate) were, for one decimal place, OR = 0.65 (95% CI 0.49-0.86), for two decimal places, OR = 0.70 (95% CI 0.53-0.94), and for three decimal places, 0.61 (95% CI 0.45-0.81). Exact recall showed a similar pattern, with larger effects.
Gli argomenti del manuale includono il comportamento e gli atteggiamenti del pubblico, la politic... more Gli argomenti del manuale includono il comportamento e gli atteggiamenti del pubblico, la politica, i fatti e la disinformazione (misinformation).
The European health psychologist, 2017
Background: Patients’ narratives have been suggested as a promising way to promote health, includ... more Background: Patients’ narratives have been suggested as a promising way to promote health, including colorectal cancer (CRC) screening, but evidence about their effectiveness is mixed. Aims: a) to provide a comprehensive review of the literature, and b) to investigate the effect of narratives conveying different emotions in promoting CRC screening. Methods: a) Systematic review of studies investigating narratives in CRC screening; b) Between-participant design comparing: usual leaflet (no-narrative condition), usual leaflet and one of three narratives: the character is waiting for the result (control narrative), had a negative result (reassurance-based narrative) or had a positive result and was successfully treated for early-stage cancer (anticipated regret-based narrative). Participants: 145 participants aged 45-65, with no CRC personal history (approved by local Ethic Committee). Measures: intention to undergo CRC screening, knowledge, risk perception, and informed choice. Analys...
Preventive Medicine
Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are stil... more Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are still vacillating in their decision to vaccinate. In this study, we considered the effect of two relevant contextual issues on vaccination intention: the number of people infected with COVID-19 is increasing, and the pace of vaccination is gaining speed. Specifically, we hypothesized that having already contracted SARS-CoV-2 (post-positive reluctance) could lead people to underestimate the importance of vaccination. Moreover, as the number of vaccinated people increases, more hesitant people could fall into the free-riding intention category, benefitting from the immunity provided by others' vaccinations. Vaccine hesitancy becomes more critical as the vaccination campaign proceeds: at one point, it will be inevitable to deal with hesitant people. This study is part of a WHO Regional Office for Europe project and involved a representative sample of 5006 Italians interviewed in January–February 2021. In case of post-positive reluctance, both young age and female gender increase vaccine hesitancy, while a high level of education reduces free-riding intention. Considering post-positive reluctance and free riding, a protective effect on hesitancy is associated with negative affective states, adherence to protective behaviors, trust in health information sources, and resilience. In contrast, increased vaccine hesitancy is associated with a high level of conspiracy-mindedness and trust in media information sources. Recognizing and studying the post-positive reluctance and the phenomenon of free-riding people can help us to become more efficient in combatting the virus.
European Journal of Surgical Oncology
BACKGROUND The optimal surgical treatment for colonic colorectal carcinoma (CRC) in Lynch Syndrom... more BACKGROUND The optimal surgical treatment for colonic colorectal carcinoma (CRC) in Lynch Syndrome (LS) and attenuated polyposis coli (A-FAP phenotype) patients is still debated, since there is a high risk of metachronous colonic adenomas and carcinoma after primary surgery. The aim of this study was to compare surgical outcome, functional data, and Quality of Life (QoL) after total colectomy with ileorectal anastomosis (TC-IRA) compared to right (RH) or left hemicolectomy/sigmoidectomy (LH/SI). METHODS Patients who underwent TC-IRA (ileorectal anastomosis from 8 to 15 cm from the anal verge) for CRC and/or polyposis at our Surgical Department between 2001 and 2017 were included in the study group, and were matched one-to-one by baseline and clinical characteristics with a control group of RH and LH/SI. Morbidity and mortality data were collected (Clavien-Dindo classification). International validated questionnaires were used to investigate QoL and bowel function. RESULTS Fifty-five patients were enrolled in each group. No differences were found on length of hospital stay, Clavien-Dindo grade III-IV complications and mortality (p > 0.05). TC-IRA showed a longer operative time than RH and LH/SI (p < 0.0001) and a major blood loss than RH (p < 0.0001). Worse bowel function and worse QoL, only for the bowel-related items, were recorded in TC-IRA group. The general QoL was similar among the groups. CONCLUSIONS TC-IRA and segmental resection have similar morbidity and mortality. The worse bowel function in TC-IRA group does not impact on the general QoL. These data can be useful in the setting of risk-reducing surgery decision in LS and A-FAP patients.
Diseases of the Colon & Rectum
Supplemental Digital Content is available in the text. BACKGROUND: Patient-reported outcomes asso... more Supplemental Digital Content is available in the text. BACKGROUND: Patient-reported outcomes associated with different bowel reconstruction techniques following anterior resection for rectal cancer are still a matter of debate. OBJECTIVE: This study aimed to assess quality of life and bowel function in patients who underwent colonic J-pouch or straight colorectal anastomosis reconstruction after low anterior resection. DESIGN: Bowel function and quality of life were assessed within a multicenter randomized trial. Questionnaires were administered before the surgery (baseline) and at 6, 12, and 24 months after surgery. SETTINGS: Patients were enrolled by 19 centers. The enrollment started in October 2009 and was stopped in February 2016. The study was registered at www.clinicaltrials.gov (Identifier: NCT01110798). PATIENTS: Patients who underwent low anterior resection for primary mid-low rectal cancer and who were randomly assigned in a 1:1 ratio to receive either stapled colonic J-pouch or straight colorectal anastomosis were selected. MAIN OUTCOME MEASURES: The primary outcomes measured were quality of life and bowel function. RESULTS: Of the 379 patients who were evaluable, 312 (82.3%) completed the baseline, 259 (68.3%) the 6-month, 242 (63.9%) the 12-month, and 199 (52.5%) the 24-month assessment. Bowel functioning and quality of life did not significantly differ between arms for almost all domains. The total bowel function score, the urgency, and the stool fractionation scores significantly worsened after surgery and remained impaired over time in both arms (p < 0.0032), whereas constipation improved after surgery but recovered to baseline levels from 1 year onward (p < 0.0036). All patients showed a significant and continuous improvement in emotional functioning (p < 0.0013) and future perspective (p < 0.0001) from baseline to the end of the study. LIMITATIONS: Limitations of the study include missing data, which increased over time; the possibility that some treatments have slightly changed since the study was conducted; and investigators not blind to treatment allocation. CONCLUSION: The findings of this study do not support the routine use of colonic J-pouch reconstruction in patients with rectal cancer who undergo a low anterior resection. See Video Abstract at http://links.lww.com/DCR/B328. BOLSA J COLÓNICA O RECONSTRUCCIÓN COLORRECTAL RECTA DESPUÉS DE RESECCIÓN ANTERIOR BAJA PARA CÁNCER RECTAL: IMPACTO EN LA CALIDAD DE VIDA Y LA FUNCIÓN INTESTINAL: UN ESTUDIO ALEATORIZADO PROSPECTIVO MULTICÉNTRICO ANTECEDENTES: Los resultados informados por el paciente asociados con diferentes técnicas de reconstrucción intestinal después de la resección anterior para el cáncer de recto aún son tema de debate. OBJETIVO: Evaluar la calidad de vida y la función intestinal en pacientes que se sometieron a una bolsa en J colónica o reconstrucción de anastomosis colorrectal recta después de una resección anterior baja. DISEÑO: La función intestinal y la calidad de vida se evaluaron en un ensayo aleatorizado multicéntrico. Los cuestionarios se administraron antes de la cirugía (basal) y a los 6, 12 y 24 meses después de la cirugía. MARCO: Los pacientes fueron incluidos en 19 centros. La inscripción comenzó en Octubre de 2009 y se detuvo en Febrero de 2016. El estudio se registró en www.clinicaltrials.gov (Identificador: NCT01110798). PACIENTES: Pacientes que se sometieron a resección anterior baja por cáncer rectal primario medio-bajo y que fueron aleatorizados en una proporción de 1: 1 para recibir bolsa J colónica con grapas o anastomosis colorrectal recta. MEDIDAS DE RESULTADOS PRINCIPALES: calidad de vida y función intestinal. RESULTADOS: De los 379 pacientes que fueron evaluables, 312 (82.3%) completaron la evaluación inicial, 259 (68.3%) a los 6 meses, 242 (63.9%) a los 12 meses y 199 (52.5%) a los 24 meses. . El funcionamiento intestinal y la calidad de vida no difirieron significativamente entre los dos grupos en casi todos los dominios. La puntuación total de la función intestinal, la urgencia y las puntuaciones de fraccionamiento de las heces empeoraron significativamente después de la cirugía y continuaron con el tiempo extra en ambos grupos (p <0.0032), mientras que el estreñimiento mejoró después de la cirugía pero se recuperó a los niveles basales a partir de 1 año en adelante (p <0.0036). Todos los pacientes mostraron una mejora significativa y continua en el funcionamiento emocional (p <0.0013) y la perspectiva futura (<0.0001) desde el inicio hasta el final del estudio. LIMITACIONES: Datos faltantes, que aumentaron con el tiempo; la posibilidad de que algunos tratamientos hayan cambiado ligeramente desde que se realizó el estudio; investigadores no cegados a la asignación del tratamiento. CONCLUSIÓN: Los hallazgos de este estudio no respaldan el uso rutinario de la reconstrucción de la bolsa J colónica en pacientes con cáncer rectal que se someten a una resección anterior baja. Consulte Video Resumen…
Social Science & Medicine
Many countries were and are still struggling with the COVID-19 emergency. Despite efforts to limi... more Many countries were and are still struggling with the COVID-19 emergency. Despite efforts to limit the viral transmission, the vaccine is the only solution to ending the pandemic. However, vaccine hesitancy could reduce coverage and hinder herd immunity. Objective: People's intention to get vaccinated can be shaped by several factors, including risk perception which, in turn, is influenced by affect. The present work aimed at investigating how risk perception and some factors associated with the decision to comply with vaccination modulated vaccine acceptance for COVID-19 as compared to seasonal influenza, and how these have varied during the lockdown phases. Method: The study followed the main phases of the emergency in Italy, investigating the intention to get vaccinated against flu and against SARS-CoV-2 (if a vaccine was available) before, during and after the first national lockdown, covering the period from the end of February to the end of June 2020. We investigated the effect of risk perception and other predictors on the decision of getting vaccinated. Results: Compared to the pre-lockdown phase, during the lockdown more people were willing to get vaccinated for COVID-19, regardless of their beliefs about vaccines, and as risk perception increased, so did the intention to accept the vaccine. The acceptance of the flu vaccine increased after the reopening phase. In addition, the intention to get vaccinated against COVID-19 and against flu increased if there was previous flu vaccination behavior but decreased with increasing doubts about the vaccines in general. Conclusions: The observation of vaccination intentions across the three main phases of the emergency allows important considerations regarding psychological, affect, and demographic determinants useful to tailor public health communication to improve public response to future epidemics.
Patient Education and Counseling
Розроблено структурно-логічну модель формування інформаційно-аналітичної компетентності майбутніх... more Розроблено структурно-логічну модель формування інформаційно-аналітичної компетентності майбутніх офіцерів-прикордонників, яка складається з трьох взаємопов'язаних блоків: організаційного, практичного, результативного. Апробація структурно-логічної моделі передбачала проходження таких етапів: мотиваційного, практичного, результативного. Розглянуто хід проведення експериментальної перевірки ефективності педагогічних умов формування інформаційно-аналітичної компетентності майбутніх офіцерів-прикордонників у процесі іншомовної підготовки. До комплексу діагностичних засобів включено аналіз наукової літератури, спостереження за діяльністю курсантів, анкетування, опитування курсантів і викладачів, методи математичної статистики. Зроблено висновок, що запроваджені педагогічні умови забезпечують дієвість розробленої структурно-логічної моделі формування інформаційно-аналітичної компетентності майбутніх офіцерів-прикордонників у процесі іншомовної підготовки. Ключові слова: інформаційно-аналітична компетентність, структурно-логічна модель, майбутні офіцериприкордонники, експериментальна перевірка, педагогічні умови.
... Gavaruzzi, Teresa (2010) On Context Effects in Medical Decision Making: When the Way Informat... more ... Gavaruzzi, Teresa (2010) On Context Effects in Medical Decision Making: When the Way Information is Presented Affects Patients&amp;amp;#x27; Decisions. [Tesi di dottorato]. Full text disponibile come: [img] Anteprima. Documento PDF 2369Kb. Abstract (inglese). ...
This decision aid was designed by the Yorkshire Dialysis Decision Aid (YoDDA) research group for ... more This decision aid was designed by the Yorkshire Dialysis Decision Aid (YoDDA) research group for people with worsening kidney disease, and family members, to make informed decisions between two dialysis options delivered in two ways, in the context of their lifestyle: haemodialysis, in a medical centre (CHD) or at home (HHD); peritoneal dialysis, at home in an automated (APD) or continuous ambulatory (CAPD) form. Its purpose is to a) help people reason to the best of their ability about which dialysis option suits them, or their family member, at this time, and b) support discussions with health professionals about lifestyle, values, and medical history of relevance to their choice and its integration within their kidney disease management. It can be used independently by patients, carers and their family, and/or with staff delivering predialysis care. It is 44 pages long (14 point font) with five sections: Introduction – service’s contact details, provenance, how to use YoDDA, and ...
Purpose: To determine whether the number of decimal places in a personal health risk estimate inf... more Purpose: To determine whether the number of decimal places in a personal health risk estimate influences the extent to which people believe and remember the estimate. Methods: 3422 adults in a demographically diverse US-based online sample (mean age 50, 52% female, 74% white, 56% no college degree) were asked to imagine they were visiting an online risk calculator hosted by a prominent university’s medical school. We designed a mock calculator similar to existing calculators available online. The calculator asked a series of health questions relevant to kidney cancer and returned a hypothetical estimate of lifetime risk of kidney cancer. In this between-subjects experiment, participants were assigned one of seven risk estimates close to the average lifetime risk of kidney cancer in the US. Participants who were randomized to the no decimals condition received an estimate of 2%. Those in the one, two or three decimals conditions received an estimate of 2.1% or 1.9% (one decimal), 2.1...
British Journal of Health Psychology
Current Colorectal Cancer Reports, 2013
ABSTRACT We have systematically reviewed studies published in the last three years on patients’ s... more ABSTRACT We have systematically reviewed studies published in the last three years on patients’ self-reported evaluations of quality of life (QoL) and functions after chemoradiotherapy (CRT) for rectal cancer. Overall, the findings from 13 studies confirmed that CRT negatively affect functions and, consequently, patients’ QoL, especially for bowel, role, and social function. The studies’ heterogeneity limited the possibility of comparison among findings. We discuss and comment on the ideal characteristics of studies assessing QoL and function. We emphasise how this type of evidence is relevant to decision-making at all levels of health-care practice.
ABSTRACT Purpose: To evaluate the acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) to... more ABSTRACT Purpose: To evaluate the acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) to patients with established kidney disease making decisions between dialysis treatments. Methods: a controlled before and after intervention (YoDDA) design, and a randomised controlled trial design evaluating YoDDA and YoDDA plus a value clarification task. Patients receiving pre-dialysis education in 6 renal units across Yorkshire (UK) participated, completing a consent form (C), and a questionnaire at time of education (T1) and one-month later (T2). In the after phase, predialysis education nurses chose to disseminate YoDDA in different ways: a resource for patients to read in their own time or to be used within the predialysis education consultation with the nurse. Results: 58% (range 32-97%) of invited patients participated, n=145 (before) and 127 (after); questionnaire response rates were 69% (T1) and 57% (T2). Sample characteristics were: age = 63 years (19-93); 66% male; 69% married; 43% no formal education/ qualification. Dialysis preference was 48% centre haemodialysis, 27% automated peritoneal dialysis, 15% home haemodialysis, 10% continuous ambulatory peritoneal dialysis; patients’ decisional conflict was low enough to implement the decision (<20, Decisional Conflict Scale). 97% participants read YoDDA, 66% more than once, and 72% showed YoDDA to someone else. Free text comments were positive (e.g. “useful, factual, neutral”) with suggestions for improvement (e.g. “page of FAQs”). YoDDA was rated as easy to understand, increased understanding of CKD and dialysis, helped them think about the decision, feel more in control of the decision and wanted to share the decision with family (all rated as around 5, 0-6 scale; before ratings were around 4 on the 0-6 scale). At T2, 4% of YoDDA participants had not started thinking about, 26% were thinking, and 70% had made, their decision; before participants equivalent ratings were 13%, 21% and 66%. Most patients did not think it was important to know another patient’s choice (around 2, 0-6 scale). Both YoDDA versions showed the same pattern of findings. Conclusions: YoDDA was acceptable to patients and supported their understanding of kidney disease, dialysis and decision making, over and above usual care. YoDDA can be integrated into practice as supplementary information for patients to review on their own or to help facilitate nurse-patient consultations.
New Ideas in Psychology, 2014
ABSTRACT In the present study, we aimed at investigating what factors affect the judgment of a ty... more ABSTRACT In the present study, we aimed at investigating what factors affect the judgment of a typical reader when he or she deals with numerical information in an ecological context. Participants read a story about a man who was not treated with heparin after hernia surgery and then died. Their task was to assess the liability of the medical staff after receiving ambiguous numerical data based on percentages, and again after receiving unambiguous data based on frequencies. Participants also assessed the likelihood of survival/death for heparin-treated vs. not-treated patients. The unambiguous numerical information they were given was different in terms of numerousness of the reference class and framing. Results show that even when unambiguous frequency-based information is available, the participants&#39; judgments were strongly affected by both frame and reference class. Findings also indicate that likelihood and liability judgments are strongly related, and that liability is accounted for by likelihood, but not vice versa. Keywords Framing effect; Numerical information; Liability judgment; Responsibility; Frequency; Percentage
Expert Review of Anticancer Therapy, 2014
Neoadjuvant therapy followed by total mesorectal excision is standard of care for locally advance... more Neoadjuvant therapy followed by total mesorectal excision is standard of care for locally advanced rectal cancer. However, this approach has been previously shown to be associated with high rate of morbidity and it may have a negative effect on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; reported outcomes (PROs). In order to summarize findings on the effect of the neoadjuvant approach on PROs, we systematically reviewed articles published in the last five years. Thirty-five articles met the inclusion criteria. Ten articles compared the effect of surgery with and without neoadjuvant therapy, six articles compared different neoadjuvant therapies, ten articles reported on patients who were all treated with neoadjuvant therapy, and nine articles examined the effect of neoadjuvant therapy in the analyses. The results are summarized by function investigated and critically commented.
BMC Medical Informatics and Decision Making, 2013
Background: Patient decision aids support people to make informed decisions between healthcare op... more Background: Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others' experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in nonnarrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods: A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people's healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results: Of 734 citations identified, 11 were included describing 13 studies. All studies found participants' judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both "system 1" (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and "system 2" (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions: There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people's informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another's values, and c) motivates people equally to engage with healthcare resources.
BMC Medical Informatics and Decision Making, 2013
Background: Consensus guidelines have recommended that decision aids include a process for helpin... more Background: Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids. Methods: Building on the International Patient Decision Aid Standards (IPDAS) Collaboration's 2005 review of values clarification methods in decision aids, we convened a multidisciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary. Results: Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single "best" practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect. Conclusions: Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness.
Background: Online risk calculators offer different levels of precision in their risk estimates. ... more Background: Online risk calculators offer different levels of precision in their risk estimates. People interpret numbers in varying ways depending on how they are presented, and we do not know how the number of decimal places displayed might influence perceptions of risk estimates. Objective: The objective of our study was to determine whether precision (ie, number of decimals) in risk estimates offered by an online risk calculator influences users' ratings of (1) how believable the estimate is, (2) risk magnitude (ie, how large or small the risk feels to them), and (3) how well they can recall the risk estimate after a brief delay. Methods: We developed two mock risk calculator websites that offered hypothetical percentage estimates of participants' lifetime risk of kidney cancer. Participants were randomly assigned to a condition where the risk estimate value rose with increasing precision (2, 2.1, 2.13, 2.133) or the risk estimate value fell with increasing precision (2, 1.9, 1.87, 1.867). Within each group, participants were randomly assigned one of the four numbers as their first risk estimate, and later received one of the remaining three as a comparison. Results: Participants who completed the experiment (N = 3422) were a demographically diverse online sample, approximately representative of the US adult population on age, gender, and race. Participants whose risk estimates had no decimal places gave the highest ratings of believability (F 3,3384 = 2.94, P = .03) and the lowest ratings of risk magnitude (F 3,3384 = 4.70, P = .003). Compared to estimates with decimal places, integer estimates were judged as highly believable by 7%-10% more participants (χ 2 3 =17.8, P < .001). When comparing two risk estimates with different levels of precision, large majorities of participants reported that the numbers seemed equivalent across all measures. Both exact and approximate recall were highest for estimates with zero decimals. Odds ratios (OR) for correct approximate recall (defined as being within 50% of the original estimate) were, for one decimal place, OR = 0.65 (95% CI 0.49-0.86), for two decimal places, OR = 0.70 (95% CI 0.53-0.94), and for three decimal places, 0.61 (95% CI 0.45-0.81). Exact recall showed a similar pattern, with larger effects.