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Article: Hidden biases in clinical decision-making: potential solutions, challenges, and perspectives.

Vitacca, Matteo / Giardini, Anna / Gazzi, Lidia / Vitacca, Michele

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2022 Volume 93, Issue 2

Abstract: Every day, we must make decisions that range from simple and risk-free to difficult and risky. Our cognitive sources' limitations, as well as the need for speed, can frequently impair the quality and accuracy of our reasoning processes. Indeed, cognitive ...

Abstract	Every day, we must make decisions that range from simple and risk-free to difficult and risky. Our cognitive sources' limitations, as well as the need for speed, can frequently impair the quality and accuracy of our reasoning processes. Indeed, cognitive shortcuts lead us to solutions that are sufficiently satisfying to allow us to make quick decisions. Unfortunately, heuristics frequently misguide us, and we fall victim to biases and systematic distortions of our perceptions and judgments. Because suboptimal diagnostic reasoning processes can have dramatic consequences, the clinical setting is an ideal setting for developing targeted interventions to reduce the rates and magnitude of biases. There are several approaches to bias mitigation, some of which may be impractical. Furthermore, advances in information technology have given us powerful tools for addressing and preventing errors in health care. Recognizing and accepting the role of biases is only the first and unavoidable step toward any effective intervention proposal. As a result, our narrative review aims to present some insights on this contentious topic based on both medical and psychological literature.
MeSH term(s)	Humans ; Cognition ; Decision Making ; Delivery of Health Care ; Bias ; Clinical Decision-Making
Language	English
Publishing date	2022-09-07
Publishing country	Italy
Document type	Review ; Journal Article
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2022.2339
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Article ; Online: Underneath the White Coat: Risk and Protective Factors for Palliative Care Providers in Their Daily Work.

Maffoni, Marina / Argentero, Piergiorgio / Giorgi, Ines / Giardini, Anna

Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association

2020 Volume 22, Issue 2, Page(s) 108–114

Abstract: Palliative care practice is associated with risk factors linked to end-of-life, chronicity, personal, interpersonal, and work characteristics, as well as with protective factors, but how these are perceived by the health care providers themselves is not ... ...

Abstract	Palliative care practice is associated with risk factors linked to end-of-life, chronicity, personal, interpersonal, and work characteristics, as well as with protective factors, but how these are perceived by the health care providers themselves is not clear. This article aims to elaborate a theoretical framework explaining the risk and protective factors for palliative care providers in their daily practice. Nineteen providers (16 nurses, 3 physicians) working in a palliative care unit of a clinical-research institute in Northern Italy were interviewed. A Grounded Theory qualitative approach guided the data collection and analysis. From the interviews, 28 codes, subsequently organized into 11 interconnected categories, emerged. They described both stressors (emotion management regarding death/dying, conflicts, communication and relationship with patients/caregivers, discrepancies between patients' and caregivers' needs, communication of poor diagnosis/prognosis, decision making about treatment, and real-life and work interference) and protective factors (social support, positive approach and value of past experience, recognized value of/passion toward professional work, work-family balance). Experiencing these elements as positive or negative depends on the professionals' point of view, as well as their past and present experience.Understanding what dealing with life-limiting illnesses means may suggest tailored interventions to improve professionals' well-being by fostering the protective elements and combatting the risk factors.
MeSH term(s)	Adult ; Attitude of Health Personnel ; Female ; Grounded Theory ; Health Personnel/psychology ; Humans ; Interviews as Topic/methods ; Italy ; Male ; Middle Aged ; Palliative Care/methods ; Palliative Care/psychology ; Palliative Care/standards ; Protective Factors ; Qualitative Research ; Social Support
Language	English
Publishing date	2020-01-16
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2070862-2
ISSN	1539-0705 ; 1522-2179
ISSN (online)	1539-0705
ISSN	1522-2179
DOI	10.1097/NJH.0000000000000623
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Article ; Online: Back to the future: five forgotten lessons for the healthcare managers of today.

Gibiino, Giovanni / Rugo, Michele / Maffoni, Marina / Giardini, Anna

International journal for quality in health care : journal of the International Society for Quality in Health Care

2020 Volume 32, Issue 4, Page(s) 275–277

Abstract: Nowadays, political, economic and technological upheavals require the rediscovery of some elapsed soft skills by healthcare managers. These abilities are values grounded in the past and somewhat nebulous in the present. We suggest five forgotten lessons ... ...

Abstract	Nowadays, political, economic and technological upheavals require the rediscovery of some elapsed soft skills by healthcare managers. These abilities are values grounded in the past and somewhat nebulous in the present. We suggest five forgotten lessons highlighting the importance of a stronger human and self-conscious approach in today's and tomorrow's healthcare managers.
MeSH term(s)	Delivery of Health Care ; Health Facilities ; Humans
Language	English
Publishing date	2020-05-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1194150-9
ISSN	1464-3677 ; 1353-4505
ISSN (online)	1464-3677
ISSN	1353-4505
DOI	10.1093/intqhc/mzaa021
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Article ; Online: Well-Being and Professional Efficacy Among Health Care Professionals: The Role of Resilience Through the Mediation of Ethical Vision of Patient Care and the Moderation of Managerial Support.

Maffoni, Marina / Sommovigo, Valentina / Giardini, Anna / Velutti, Laura / Setti, Ilaria

Evaluation & the health professions

2021 Volume 45, Issue 4, Page(s) 381–396

Abstract: Drawing on the Conservation of Resources theory, this study analyzes whether resilience could be related to healthcare providers' wellbeing and professional self-efficacy, both directly and indirectly, as mediated by ethical vision of patient care and ... ...

Abstract	Drawing on the Conservation of Resources theory, this study analyzes whether resilience could be related to healthcare providers' wellbeing and professional self-efficacy, both directly and indirectly, as mediated by ethical vision of patient care and moderated by managerial support in dealing with ethical issues. Overall, 315 Italian healthcare professionals employed in neuro-rehabilitation medicine or palliative care specialties participated in this multi-centered cross-sectional study. The following variables were investigated: resilience (Connor-Davidson Resilience Scale), wellbeing (Maugeri Stress Index-Reduced), professional self-efficacy (Maslach Burnout Inventory-General Survey), ethical vision of patient care and managerial support in dealing with ethical issues (Italian version of the Hospital Ethical Climate Survey). Overall, resilience was positively associated with healthcare providers' wellbeing and professional self-efficacy, directly and indirectly, as mediated by ethical vision of patient care. Highly resilient healthcare professionals who perceived the presence of a positive ethical vision of patient care in their workplace were more likely to experience greater wellbeing when managerial support in dealing with ethical issues was high (vs. low). Thus, these findings provide suggestions for tailored interventions sustaining healthcare professionals along their daily activity characterized by high-demanding and challenging situations.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Burnout, Professional ; Health Personnel ; Workplace ; Patient Care
Language	English
Publishing date	2021-09-16
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	603792-6
ISSN	1552-3918 ; 0163-2787
ISSN (online)	1552-3918
ISSN	0163-2787
DOI	10.1177/01632787211042660
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Article ; Online: A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients' and healthcare professionals' perspective.

Zanatta, Francesco / Giardini, Anna / Pierobon, Antonia / D'Addario, Marco / Steca, Patrizia

BMC health services research

2022 Volume 22, Issue 1, Page(s) 523

Abstract: Background: The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no ... ...

Abstract	Background: The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet. Methods: A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized. Results: Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers. Conclusions: Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness. Trial registration: PROSPERO registration ref. CRD42021224141 .
MeSH term(s)	Delivery of Health Care ; Humans ; Motivation ; Robotics ; Technology ; Virtual Reality
Language	English
Publishing date	2022-04-20
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07821-w
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Article ; Online: How Supportive Ethical Relationships Are Negatively Related to Palliative Care Professionals' Negative Affectivity and Moral Distress: A Portuguese Sample.

Rego, Francisca / Sommovigo, Valentina / Setti, Ilaria / Giardini, Anna / Alves, Elsa / Morgado, Julliana / Maffoni, Marina

International journal of environmental research and public health

2022 Volume 19, Issue 7

Abstract: In the modern healthcare landscape, moral distress has become an increasingly common phenomenon among healthcare professionals. This condition is particularly prevalent among palliative care professionals who are confronted with bioethical issues in ... ...

Abstract	In the modern healthcare landscape, moral distress has become an increasingly common phenomenon among healthcare professionals. This condition is particularly prevalent among palliative care professionals who are confronted with bioethical issues in their daily practice. Although some studies described the effects of poor ethical climate and negative affectivity on moral distress, how these variables could be incorporated into a single model is still unclear. Thus, this study aims to investigate whether ethical relationships with the hospital could be related to the intensity and frequency of moral distress, both directly and as mediated by professionals' negative affectivity. Sixty-one Portuguese palliative care professionals completed web-based self-report questionnaires. After exploring descriptive statistics, mediation analyses were performed using the partial least squares method. The results indicated that the presence of positive relationships with the hospital reduced the professionals' negative affectivity levels. This, in turn, led palliative care professionals to experience a lower frequency and intensity of moral distress. Being a physician was positively associated with negative affectivity but not with the frequency of moral distress. Considering the protective role of ethical relationships with hospitals, health organizations could consider implementing interventions to improve hospitals' ethical climate and provide staff with ethics training programs.
MeSH term(s)	Attitude of Health Personnel ; Health Personnel ; Humans ; Morals ; Palliative Care ; Portugal ; Stress, Psychological ; Surveys and Questionnaires
Language	English
Publishing date	2022-03-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19073863
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Article ; Online: Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q): development and implementation of an instrument to evaluate patients' perception during training.

Fundarò, Cira / Casale, Roberto / Maestri, Roberto / Traversoni, Silvia / Colombo, Roberto / Salvini, Silvana / Ferretti, Chiara / Bartolo, Michelangelo / Buonocore, Michelangelo / Giardini, Anna

Journal of neuroengineering and rehabilitation

2023 Volume 20, Issue 1, Page(s) 35

Abstract: Background: The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, ... ...

Abstract	Background: The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients' personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties. Methods: A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient's performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance. Results: Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach's alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded. Conclusions: The TARPP-Q highlights the importance of patients' personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients' perception of training effectiveness, helping to customize devices and interventions.
MeSH term(s)	Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Surveys and Questionnaires ; Factor Analysis, Statistical ; Gait ; Feasibility Studies ; Perception ; Reproducibility of Results
Language	English
Publishing date	2023-03-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2164377-5
ISSN	1743-0003 ; 1743-0003
ISSN (online)	1743-0003
ISSN	1743-0003
DOI	10.1186/s12984-023-01146-3
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Article ; Online: Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients.

Zanatta, Francesco / Farhane-Medina, Naima Z / Adorni, Roberta / Steca, Patrizia / Giardini, Anna / D'Addario, Marco / Pierobon, Antonia

Health and quality of life outcomes

2023 Volume 21, Issue 1, Page(s) 18

Abstract: Background: In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life ( ...

Abstract	Background: In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life (HRQoL) has been investigated across neurological populations but still remains unclear. The present study aimed to systematically review the studies investigating the effects of RAT alone and with VR on HRQoL in patients with different neurological diseases. Methods: A systematic review of the studies evaluating the impact of RAT alone and combined with VR on HRQoL in patients affected by neurological diseases (i.e., stroke, multiple sclerosis, spinal cord injury, Parkinson's Disease) was conducted according to PRISMA guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsychINFO (2000-2022) were performed. Risk of bias was evaluated through the National Institute of Health Quality Assessment Tool. Descriptive data regarding the study design, participants, intervention, rehabilitation outcomes, robotic device typology, HRQoL measures, non-motor factors concurrently investigated, and main results were extracted and meta-synthetized. Results: The searches identified 3025 studies, of which 70 met the inclusion criteria. An overall heterogeneous configuration was found regarding the study design adopted, intervention procedures and technological devices implemented, rehabilitation outcomes (i.e., related to both upper and lower limb impairment), HRQoL measures administered, and main evidence. Most of the studies reported significant effects of both RAT and RAT plus VR on patients HRQoL, whether they adopted generic or disease-specific HRQoL measures. Significant post-intervention within-group changes were mainly found across neurological populations, while fewer studies reported significant between-group comparisons, and then, mostly in patients with stroke. Longitudinal investigations were also observed (up to 36 months), but significant longitudinal effects were exclusively found in patients with stroke or multiple sclerosis. Finally, concurrent evaluations on non-motor outcomes beside HRQoL included cognitive (i.e., memory, attention, executive functions) and psychological (i.e., mood, satisfaction with the treatment, device usability, fear of falling, motivation, self-efficacy, coping, and well-being) variables. Conclusions: Despite the heterogeneity observed among the studies included, promising evidence was found on the effectiveness of RAT and RAT plus VR on HRQoL. However, further targeted short- and long-term investigations, are strongly recommended for specific HRQoL subcomponents and neurological populations, through the adoption of defined intervention procedures and disease-specific assessment methodology.
MeSH term(s)	Humans ; Quality of Life ; Accidental Falls ; Robotics ; Fear ; Stroke/psychology ; Stroke Rehabilitation/methods ; Virtual Reality
Language	English
Publishing date	2023-02-21
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2098765-1
ISSN	1477-7525 ; 1477-7525
ISSN (online)	1477-7525
ISSN	1477-7525
DOI	10.1186/s12955-023-02097-y
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Article ; Online: ICF framework in cardiac rehabilitation: a real-life implementation in post-cardiac surgery and chronic heart failure patients.

Scalvini, Simonetta / Olivares, Adriana / Giardini, Anna / Comini, Laura / Zanelli, Emanuela / Corica, Giacomo / Tarro Genta, Franco

European journal of physical and rehabilitation medicine

2023 Volume 59, Issue 5, Page(s) 605–614

Abstract: Background: The International Classification of Functioning, Disability, and Health (ICF) is growing in importance in cardiac rehabilitation (CR) as the number of elderly comorbid patients increases.: Aim: To classify through the ICF framework a ... ...

Abstract	Background: The International Classification of Functioning, Disability, and Health (ICF) is growing in importance in cardiac rehabilitation (CR) as the number of elderly comorbid patients increases. Aim: To classify through the ICF framework a group of post-cardiac surgery (CS) and chronic heart failure (CHF) patients undergoing rehabilitation. Then, to compare the two groups and identify possible factors at admission that could affect ICF evaluations at discharge. Design: Observational retrospective real-life study. Setting: Two inpatient CR units. Population: Consecutive CS and CHF patients admitted for CR (January-December 2019). Methods: Clinical, anthropometric data and functional status at admission and discharge were extracted from patient health records. A set of 26 ICF codes regarding body functions (b) and activities (d) was analyzed to identify: 1) the qualifiers attributed (from 0=no impairment to 4=severe impairment) for each code, 2) the percent distribution of qualifiers (0/1/2/3/4) attributed per patient. We then evaluated changes in both (1) and (2 - defined as ICF Delta%) from admission to discharge. Results: All patients (55% males; mean age 73±12 years) showed an improvement post-rehabilitation in the ICF qualifiers attributed (P<0.0001 for all codes). CS patients (N.=150) were less functionally impaired at admission than CHF (N.=194) (P<0.05 for all codes), and at discharge showed greater Delta% in the qualifiers 0/1/2 attributed than CHF (P<0.0001 for b codes; P<0.05 for d codes). Delta% for qualifiers 3 and 4 was similar in the two groups. No impairment at admission (qualifier 0), CS group, and presence/complexity of comorbidities were identified as possible covariates influencing ICF qualifiers at discharge, impacting the rate of both no/mild impairment (ICF% aggregate 0+1 - adjusted R Conclusions: CHF patients showed a worse ICF picture at admission and less improvement at discharge than CS. The presence and complexity of comorbidities negatively influenced the ICF classification at discharge, especially in CHF patients. Clinical rehabilitation impact: This study shows the utility of ICF classification in CR as a means for describing, measuring, and comparing patient functioning across the care continuum.
MeSH term(s)	Male ; Humans ; Aged ; Middle Aged ; Aged, 80 and over ; Female ; Activities of Daily Living ; Disability Evaluation ; Cardiac Rehabilitation ; Retrospective Studies ; Cardiac Surgical Procedures ; Heart Failure ; Chronic Disease ; International Classification of Functioning, Disability and Health
Language	English
Publishing date	2023-06-28
Publishing country	Italy
Document type	Observational Study ; Journal Article
ZDB-ID	2426908-6
ISSN	1973-9095 ; 1973-9087
ISSN (online)	1973-9095
ISSN	1973-9087
DOI	10.23736/S1973-9087.23.07666-9
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Article ; Online: Healthcare professionals' perceptions about the Italian law on advance directives.

Maffoni, Marina / Argentero, Piergiorgio / Giorgi, Ines / Giardini, Anna

Nursing ethics

2019 Volume 27, Issue 3, Page(s) 796–808

Abstract: Background: In the variegated legislative framework on advance directives, the first specific regulation in Italy on this issue came into force only in 2018.: Research objective: This qualitative study aimed to investigate the implications of the new ...

Abstract	Background: In the variegated legislative framework on advance directives, the first specific regulation in Italy on this issue came into force only in 2018. Research objective: This qualitative study aimed to investigate the implications of the new Italian law on advance directives in clinical practice from the perspective of those who deal with this delicate ethical issue on an everyday basis, that is, Italian healthcare professionals. Research design: A qualitative research design using semi-structured audio-recorded interviews was adopted. The data collection and analysis were performed according to the Grounded Theory approach. Participants: Nineteen healthcare professionals (16 nurses, 3 physicians) working in a palliative care unit of a research and clinical institute in Italy. Ethical considerations: The study is part of the WeDistress HELL Project (WEllness and DISTRESS in HEalth care professionals dealing with end of Life and bioethicaL issues) approved by the Ethical Committee of ICS Maugeri - Institute of Pavia (Italy). Findings: The authors identified a main overall category, 'Pros and Cons of the Italian law on advance directives', composed of six constituent categories: Positive welcome, Self-determination and protection, Prompts for future betterment, Uncertainties, Lack of knowledge, and Neutrality and no suggestions. Discussion: The Italian law n. 219/2017 on advance directives was seen as a legal instrument possessing both strengths and weaknesses, but able to guarantee the patient's self-determination and support healthcare professionals in providing care according to patients' wishes. Conclusion: An understanding of the healthcare providers' perspective may support the discussion on advance directives and bridge the gaps that currently persist in handling ethical issues.
MeSH term(s)	Adult ; Advance Directives/legislation & jurisprudence ; Advance Directives/psychology ; Advance Directives/trends ; Female ; Grounded Theory ; Health Personnel/psychology ; Health Personnel/trends ; Humans ; Interviews as Topic/methods ; Italy ; Jurisprudence ; Male ; Middle Aged ; Perception ; Personal Autonomy ; Qualitative Research
Language	English
Publishing date	2019-10-20
Publishing country	England
Document type	Journal Article
ZDB-ID	1200467-4
ISSN	1477-0989 ; 0969-7330
ISSN (online)	1477-0989
ISSN	0969-7330
DOI	10.1177/0969733019878831
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