Critical Competences for the Management of Post-Operative Course in Patients with Digestive Tract Cancer: The Contribution of MADIT Methodology for a Nine-Month Longitudinal Study

There is a high postoperative morbidity rate after cancer surgery, that impairs patients' self-management, job condition and economic strength. This paper describes the results of a peculiar psychological intervention on patients undergoing surgery for esophageal, gastric and colorectal cancer. The intervention aimed to enhance patients' competences in the management of postoperative daily life. A narrative approach (M.A.D.I.T.-Methodology for the Analysis of Computerised Text Data) was used to create a questionnaire, Health and Employment after Gastro-Intestinal Surgery-Dialogical Questionnaire, HEAGIS-DQ, that assesses four competences. It was administered to 48 participants. Results were used as guidance for specific intervention, structured on patients' competence profiles. The intervention lasted nine months after surgery and was structured in weekly to monthly therapeutic sessions. Quality of Life questionnaires were administered too. At the end of the intervention, 94% of patients maintained their job and only 10% of patients asked for financial support. The mean self-perception of health-related quality of life was 71.2. The distribution of three of four competences increased after nine months (p < 0.05). Despite economic difficulties due to lasting symptoms after surgery, and to the current pandemic scenario, a structured intervention with patients let them to resume their jobs and continue activities after surgery

Intervening on Global Emergencies: The Value of Human Interactions for People's Health

Literature about global emergencies and their impact on people's health underlines the need to improve the social cohesion of human community and the availability of tools to support people and foster community interactions. This paper illustrates research aimed at describing and measuring human interactions in the Veneto community and its changing during the COVID-19 pandemic. 50,000 text occurrences from social media and newspapers about these topics were analyzed between December 2021 and January 2022. People present themselves as members of different teams, pursuing conflicting aims, and attributing the decision-making responsibility of emergencies management exclusively to governments, without considering themselves as active parts of the community. This delegation process on citizens' behalf can affect their health: by taking minor responsibility in handling the repercussions of these events on the community and by arguing over the most effective way to deal with them, they risk freezing and waiting for action by third parties, thus leaving mutual interactions and the promotion of their own health at a standstill. Local institutions can use these data to shape prevention policies to manage the community's emergencies and use them as opportunities to promote public health

How could patients support surgeons? Analysis of patient's skills before and after oesophagogastric surgery and impact on quality of life

The role of hospital case volume and surgeon expertise in improving results after esophagectomy is well known. However, health-professionals expertise and hospital volume are not enough. Prehabilitation trials outlined that patient involvement is mandatory to improve adherence to therapeutic programs. This study aims to identify what are patient’s modalities of dealing with postoperative course, supporting surgical outcomes with a psychological intervention and to evaluate his effect in the medium-term postoperative period. Literature analysis was conducted to identify specific patient’s skills supporting the postoperative course. Sixteen peculiar dimensions were identified, considering four patients skills applied to clinical, daily activities, family and work areas. Patients textual data were collected by a sixteen-questions interview. Methodology for the Analysis of Computerized Text Data was used to identify discursive repertoires used by esophageal cancer patients. These textual data let construct a closed-ended questionnaire used to assess patient’s skills in the early postoperative course. A psychological intervention aimed at enhancing competencies was conducted. Skills were re-assessed and quality of life (QOL) data were collected 9-months after intervention. In this study 28 consecutive gastroesophageal cancer patients were enrolled within a larger group of patients undergone major surgery for gastrointestinal tumours. Low/medium/high levels were detected for each of the four skills. Wilcoxon signed-rank test showed that three of the four skills levels increased after the supportive intervention. Analysis revealed no differences in relation to diagnosis, oncological treatment and demographic variables. Compared to other patients, skills levels showed no differences in gastroesophageal patients. Furthermore, quality of life at 9-months after esophagectomy was comparable to date reported in current literature in the medium-long term period after surgery for digestive tract cancer. In these preliminary data, even with poorer prognosis, gastroesophageal patients deal with major surgery side effects using the same skills levels used by other gastrointestinal cancer patients. Results show that skills evaluation during hospital stay can reveal the lacking modalities of dealing with the postoperative problems due to patients’ wrong beliefs about surgical results and physical recovery. When aimed at improving surgical outcomes and based on surgeon’s indications, even patients can support surgical outcomes