Elisa Mazzini

Introduction: Care pathways (CPs) are essential for ensuring coordinated, high-quality healthcare, yet patient-reported experiences remain underexplored. In Italy, no validated tool exists to systematically assess persons’ perspectives on CPs. This study aimed to develop and validate a scale to measure patient-reported experiences with CPs. Methods: A mixed-method approach was used. First, a literature review, a Delphi study involving healthcare professionals, and focus groups with persons and interest-holders informed the generation of items. Next, a pilot test with 218 persons diagnosed with breast cancer refined the scale. Finally, a quantitative study involving 12 CPs across three healthcare organisations assessed the scale’s properties using exploratory and confirmatory factor analyses. Results: Factor analysis revealed a four-factor structure encompassing person-centrality, responsiveness, integration, and organisation. The scale demonstrated good internal validity, with satisfactory reliability for most factors. Correlations with overall CP evaluation, satisfaction, and self-reported health provided support for external validity. However, the organisational factor showed lower reliability, requiring further refinement. Discussion: This study provides a robust, multidimensional tool for assessing patients’ reported experiences with CPs. Its findings highlight the importance of person-centred care and integrated service delivery. Conclusion: The newly developed scale offers a validated measure to enhance CP evaluation, supporting people-centred healthcare practice and policy improvements.

Multidisciplinary team (MDT) meetings are recognized as the gold standard for care management of cancer patients, and during the COVID-19 pandemic they were considered a priority to be maintained. Due to pandemic-related restrictions, MDT meetings were forcibly converted from in-person to telematic format. This retrospective study evaluated the annual performance of four MDT meeting indicators (MDT members’ attendance, number of discussed cases, frequency of MDT meetings, and duration) between 2019 and 2022 to report on the implementation of teleconsultation in MDT meetings related to 10 cancer care pathways (CCPs). Over the study period, MDT member participation and the number of discussed cases improved or did not change in 90% (9/10) and 80% (8/10) of the CCPs, respectively. We did not observe significant differences in any of the CCPs included in the study regarding the annual frequency and duration of MDT meeting. Considering the rapidity, extent, and intensity with which telematic tools were adopted due to the COVID-19 pandemic, the results of this study showed that MDT teleconsultation supported the CCPs, and consequently, the delivery of cancer care in COVID-19 times, helping to understand the effects of telematic tools on health care performance and the parties involved.

The SARS-CoV-2 pandemic has altered how citizens engage in activities. This study describes the new activities citizens engaged in during the first lockdown, factors that helped them cope with the confinement, the supports they used the most, and which supports they would have liked to receive. This cross-sectional study consists of an online survey made of 49 questions that was completed by the citizens of the province of Reggio Emilia (Italy) from 4 May until 15 June 2020. The outcomes of this study were explored by focusing on four of the survey questions. Of the 1826 citizens who responded, 84.2% had started new leisure activities. Males, participants who lived in the plain or foothills, and those who experienced nervousness engaged less in new activities, while those whose employment status changed, whose lifestyle worsened, or whose use of alcohol increased engaged in more activities. The support of family and friends, leisure activities, continuing to work, and an optimistic attitude were perceived to be of help. Grocery delivery and hotlines providing any type of information and mental health support were used frequently; a lack of health and social care services and of support in reconciling work with childcare was perceived. Findings may help institutions and policy makers to better support citizens in any future circumstances requiring prolonged confinement.

Purpose The Core Set for Vocational Rehabilitation (CS-VR) of the International Classification of Functioning, Disability and Health (ICF) describes the work functioning of individuals in need of VR. We aimed to adapt the CS-VR from the perspective of cancer survivors (CSs) and stakeholders, developing a CS-VR-Onco. Methods We held five focus groups with 17 CSs who were employed at the time of diagnosis, to discuss their work reintegration experiences. After analyzing the focus group conversations, the CS-VR-Onco was developed. During a group interview, eleven stakeholders explored barriers/facilitations in assessing the work functioning of CSs by using the CS-VR-Onco. We applied the framework method and thematic analysis. Results For the focus groups, the CS-VR-Onco of 85 categories emerged, and the ICF chapters of Mental functions, Exercise and tolerance functions, Interpersonal interactions and relationships, Major life areas, General tasks and demands, Mobility, Support and relationships, and Attitudes were prioritized. For the group interview, stakeholders’ perspectives can be synthetized into two themes: close to the lived experience and usability criteria. Stakeholders confirmed the categories of the CS-VR-Onco, a checklist that should be used through an integrated approach across multiple disciplines. Conclusions The adapted CS-VR-Onco reflects the CSs’ lived experiences of work reintegration and the factors that have influenced this process. The CS-VR-Onco was described as complete and usable through an integrated approach.

BACKGROUND: Return to work (RTW) is a major goal to promote cancer survivors’ social participation. OBJECTIVE: This study describes the multidisciplinary social-healthcare pathway called UNAMANO, conceived to support RTW in this population. METHODS: UNAMANO was developed by the Azienda USL-IRCCS di Reggio Emilia, in partnership with the local branch of the Italian Medical Association, nonprofit associations, vocational training institutions, social cooperatives, a labour union, and a chartered accounting firm. RESULTS: UNAMANO is directed towards employed individuals diagnosed with cancer living in the province of RE. It was developed through four actions: A) training healthcare professionals on work-related occupational rehabilitation; B) dissemination among community and stakeholders; C) recruitment and training of volunteers; D) cancer survivor engagement and provision of a personalized comprehensive intervention. This consists in providing information and either occupational therapy to overcome barriers and facilitate RTW or social support through re-training and tailored job search strategies based on individual risk of job loss. CONCLUSIONS: UNAMANO is the first Italian multidisciplinary social-healthcare pathway supporting RTW of cancer survivors. Addressing a wide area of cancer survivors’ needs, it provides personalized intervention to resolve work-related issues. We propose this patient-centred RTW model to promote an easier transition from hospital to community.

A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP. A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts. Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations. The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.

Lockdowns to contain the spread of the SARS-CoV-2 have disrupted routines and behaviors, which could lead to a worsening of lifestyle and an increase in the burden of non-communicable diseases. This study aimed to describe the changes in physical activity, diet, alcohol drinking, and cigarette smoking during lockdown. A self-administered online survey addressing adults living in a province in northern Italy was advertised through websites and social media. Citizens could access the survey in anonymity from 4 May until 15 June 2020. A total of 1826 adults completed the survey, with a worsening of physical activity (35.1%), diet (17.6%), alcohol drinking (12.5%), and cigarette smoking (7.7%) reported. In contrast, 33.5% reported an improvement in diet, 12.6% in alcohol drinking, 5.3% in physical activity and 4.1% in cigarette smoking. Female sex, young adult age, suspension of work activity, and symptoms of psychological distress were the factors associated with a greater likelihood of change, which was frequently for the worse. Lockdown had an impact on lifestyle, with some net beneficial effects on diet and mostly negative effects on physical activity. Public health measures should be implemented to avoid long-term negative effects of the lockdown, supporting individuals more prone to change for the worse.

The restrictions enacted during lockdown to limit the spread of the novel coronavirus (SARS-CoV-2) have led to changes in people’s lifestyle habits. In Italy, these restrictions have dramatically changed the way people work and spend their leisure time, also with repercussions on diet and physical activity. An anonymous survey was disseminated via websites and social media to a convenience sample of the Italian population during and immediately after the first lockdown (10 March–18 May 2020). Data collected on 1826 individuals show that lockdown might have worsened the quality of sleep of almost half of the participants in this cross-sectional study. This worsening was associated with a deterioration in crucial determinants of health, such as physical activity and diet (OR 1.68; 95% CI 1.18–2.40 and OR 4.19; 95% CI 2.51–6.96, respectively), with symptoms of psychological distress, such as tension (OR 3.88; 95% CI 2.74–5.52) and loneliness (OR 3.27; 95% CI 2.23–4.79), and with the presence of financial problems (some OR 1.86; 95% CI 1.27–2.72; many OR 7.27; 95% CI 3.59–14.73). The multivariate regression analysis models confirmed these associations. This impact on sleep quality was seen especially among females, those with low education level, and those who experienced financial problems.