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Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality and Patient Safety".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 30516

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Special Issue Editors

Prof. Federica Galli

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Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi, 78-00185 Rome, Italy
Interests: psychosomatic; clinical psychology; patient-centred medicine; shared decsion making; psychocardiology; psychoncology
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Vittorio Lingiardi

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Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi, 78 - 00185 Rome, Italy
Interests: personality disorders; psychotherapy research; therapeutic alliance; eating disorders; gender incongruence; sexuality

Special Issue Information

Dear Colleagues,

The patient-centered model of care aims to overcome the boundaries between medicine and psychology in clinical settings, focusing on the importance of taking into account not only the disease but also the patients’ characteristics (in terms of needs, preferences, values, personalities, psychopathologies, and so on). In this framework, personalised medicine addresses the urgent need to tailor medical treatments to the patients’ psychological features. It is interesting to think that psychological factors will be progressively recognised as part of the clinical and diagnostic decision process.

Starting from these premises, we call for papers addressing the role of the patients’ psychological and psychodynamic factors in influencing the onset, adjustment, and clinical response to their treatments, with particular attention on the doctor–patient relationship and therapy adherence. Papers on the efficacy/effectiveness of psychotherapy in medical settings are welcomed as well.

Prof. Federica Galli
Prof. Dr. Vittorio Lingiardi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

patient-centered care
personality
psychopathology
psychocardiology
psychoncology
psychotherapy
medical settings
disease

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Published Papers (11 papers)

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Research

10 pages, 831 KiB

Open AccessArticle

Living with Epilepsy in Adolescence in Italy: Psychological and Behavioral Impact

by Katherine Turner, Francesca La Briola, Aglaia Vignoli, Elena Zambrelli, Valentina Chiesa, Laura Fongoni, Olivia Baldi and Maria Paola Canevini

Healthcare 2023, 11(5), 687; https://doi.org/10.3390/healthcare11050687 - 25 Feb 2023

Cited by 1 | Viewed by 1760

Abstract

Background: People with epilepsy have a higher prevalence of behavioral and neuropsychiatric comorbidities compared to the general population and those with other chronic medical conditions, although the underlying clinical features remain unclear. The goal of the current study was to characterize behavioral profiles of adolescents with epilepsy, assess the presence of psychopathological disorders, and investigate the reciprocal interactions among epilepsy, psychological functioning, and their main clinical variables. Methods: Sixty-three adolescents with epilepsy were consecutively recruited at the Epilepsy Center, Childhood and Adolescence Neuropsychiatry Unit of Santi Paolo e Carlo hospital in Milan (five of them were excluded) and assessed with a specific questionnaire for psychopathology in adolescence, such as the Questionnaire for the Assessment of Psychopathology in Adolescence (Q-PAD). Q-PAD results were then correlated with the main clinical data. Results: 55.2% (32/58) of patients presented at least one emotional disturbance. Body dissatisfaction, anxiety, interpersonal conflicts, family problems, uncertainty about the future, and self-esteem/well-being disorders were frequently reported. Gender and poor control of seizures are associated with specific emotional features (p < 0.05). Conclusions: These findings highlight the importance of screening for emotional distress, recognition of the impairments, and provision of adequate treatment and follow-up. A pathological score on the Q-PAD should always require the clinician to investigate the presence of behavioral disorders and comorbidities in adolescents with epilepsy. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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14 pages, 1460 KiB

Open AccessArticle

Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic

by Valeria Carola, Cristina Vincenzo, Chiara Morale, Valentina Cecchi, Monica Rocco and Giampaolo Nicolais

Healthcare 2022, 10(11), 2201; https://doi.org/10.3390/healthcare10112201 - 2 Nov 2022

Cited by 4 | Viewed by 2642

Abstract

Background: Although the COVID-19 pandemic had an impact on the general population, health care workers (HCWs) constituted one of the groups that were most adversely affected by the associated risks, owing to the significant consequences on their mental health. This study examined these psychological effects on HCWs who cared for COVID-19 patients who were admitted to the intensive care unit in an Italian hospital. Methods: Subjects were administered several self-reported questionnaires: Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI), as well as two open-ended questions oriented toward understanding their positive and negative emotional experience and differentiating between two phases of the emergency. Results: Overall, 45% of HCWs showed medium-to-high anxiety/depressive symptoms, whereas 60% presented with medium-to-high levels of perceived stress. In addition, 37% of subjects developed symptoms of PTSD and 50% showed post-traumatic growth in the “appreciation of life” and “new possibilities” dimensions. With regard to the open-ended questions, three themes were identified: quality of workplace relationships, sense of emotional-relational competence, and sense of clinical-technical competence. In addition, two macrocategories of responses were identified in the answers: growth and block. Conclusions: The mental health of HCWs who are involved in the front line of COVID-19 was significantly impacted by this experience, showing high levels of post-traumatic stress and anxiety and depressive symptoms more than 1 year after the emergency began. A qualitative analysis of staff experiences can be a useful guide for structuring interventions and prevention. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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13 pages, 281 KiB

Open AccessArticle

The Relationship between Physiotherapist and Patient: A Qualitative Study on Physiotherapists’ Representations on This Theme

by Silvia Monaco, Alessia Renzi, Beatrice Galluzzi, Rachele Mariani and Michela Di Trani

Healthcare 2022, 10(11), 2123; https://doi.org/10.3390/healthcare10112123 - 25 Oct 2022

Cited by 2 | Viewed by 3384

Abstract

The physiotherapist represents a resource for the psychophysical well-being of an individual. Specific characteristics of the physiotherapist–patient relationship can influence the outcome of rehabilitation. This study aimed to explore physiotherapists’ representations on how they perceive their relationship with their patients, in order to highlight helpful elements in promoting the outcome of the intervention. In this study, 50 physiotherapists (27 females and 23 males; mean age = 42 years; sd = 12.2) participated in an individual interview, conducted remotely via videocall. Socio-demographic and occupational data were collected. The interviews were recorded and transcribed. Texts were analyzed using emotional text mining (ETM). Participants organized their work by means of three categories: (1) work with the patient, in which the physiotherapists described two complementary elements of the therapy, which are the observable-technical aspects of their work and the internal predispositions; (2) the healing process, highlighting the aims of their intervention, including the physical pathology and the relationship with the patients; (3) physiotherapist as a psychologist, describing the attempt to understand patients’ emotional experience to gradually transition to the practical intervention. Understanding the emotional and relational processes that form the basis of physiotherapist practice can contribute to the development of interventions in which the body and the mind can be integrated, resulting in a real person-centered point of view. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

13 pages, 890 KiB

Open AccessArticle

Effectiveness of Expressive Writing in Kidney Transplanted Patients: A Randomized Controlled Trial Study

by Laura Pierro, Giulia Servidei, Renzo Pretagostini, Davide Stabile, Francesco Nudo, Silvia Lai, Paola Aceto, Luca Poli, Erika Fazzari and Carlo Lai

Healthcare 2022, 10(8), 1559; https://doi.org/10.3390/healthcare10081559 - 17 Aug 2022

Cited by 1 | Viewed by 1564

Abstract

The present study aimed to assess the effectiveness of an expressive writing (EW) intervention on psychological and physiological variables after kidney transplant. The final sample of 26 were randomly assigned to an expressive writing group (EWG) and control group (CG). Outcomes were focused on depression, anxiety, alexithymia, empathy, resilience, locus of control, creatinine, CDK-EPI, and azotemia. Depressive symptoms and alexithymia levels decreased in the EWG, with better adherence. Resilience declined over time in both groups. The EWG showed a significantly higher CDK-EPI, indicating better renal functioning. EW seems an effective intervention to improve the psychological health of transplanted patients, with a possible effect on renal functioning. These findings open the possibility of planning brief psychological interventions aimed at processing emotional involvement, in order to increase adherence, the acceptance of the organ, and savings in healthcare costs. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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18 pages, 1225 KiB

Open AccessArticle

Giving Meaning to Non-Communicable Illness: Mixed-Method Research on Sense of Grip on Disease (SoGoD)

by Assunta Maiello, Ersilia Auriemma, Raffaele De Luca Picione, Daniela Pacella and Maria Francesca Freda

Healthcare 2022, 10(7), 1309; https://doi.org/10.3390/healthcare10071309 - 14 Jul 2022

Cited by 1 | Viewed by 1856

Abstract

When people receive a diagnosis of chronic or non-communicable disease, they need to reorganize their lives to understand and accommodate the changes associated with the new health condition. This reorganization, which involves the activation of a process through which meaning is given to the illness, could be fostered by narrative methods also in the context of Primary Care. The Sense of Grip on Disease (SoGoD) model intends to focus on the role of sense-meaning-making processes in the psychological adjustment to non-communicable illness, emphasizing the patients’ role in managing their own health condition. In this study, the authors propose a mixed-method research method which implies the adaptation of the narrative interview on the Sense of Grip on Disease. The interview was administered to 31 adults suffering from non-communicable diseases and has been analyzed with a theory-driven approach, which aims to explore the modalities of five narrative functions: organization of temporality, integration of illness, expression of emotions, social sharing and orientation to action. Through a Multiple Correspondence Analysis and a Cluster Analysis, the authors have identified two different ‘Grip Profiles’, called “Dynamic Profile” and “Compliant Profile”, representative of different degrees of flexibility, integration and adjustment to disease. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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21 pages, 842 KiB

Open AccessArticle

Affect and Cognitive Closure in Students—A Step to Personalised Education of Clinical Assessment in Psychology with the Use of Simulated and Virtual Patients

by Maciej Walkiewicz, Bartosz Zalewski and Mateusz Guziak

Healthcare 2022, 10(6), 1076; https://doi.org/10.3390/healthcare10061076 - 9 Jun 2022

Cited by 2 | Viewed by 2077

Abstract

Introduction: Since there was no general model of competencies to determine a successful clinical assessment, we based our study on the many skills that are needed to perform one. We analysed students’ learning performance based on inner determinants, such as affect and cognitive closure, with the use of two teaching methods (i.e., simulated patient (SP) or virtual patient (VP)). Methods: The sample comprised 56 fifth-year clinical psychology students. The need for closure (NFC) and efficacy in fulfilling the need for closure (EFNC) were measured using standardised questionnaires. The authors’ VP and SP tools were used to teach and measure the effectiveness of learning psychological interview techniques and clinical reasoning. Clinical interview skills included building contact with the patient, gathering important information and making mistakes. Clinical reasoning skills were divided into eight dimensions for the assessment of mental health. Results: Affect and cognitive closure are important psychological variables in anticipating and developing interview and clinical reasoning skills for psychology students. The simulated patient was more effective for interview skills, while the virtual patient was a beneficial teaching tool for most clinical reasoning skills. Virtual patient training was a useful teaching method for students with a low EFNC, probably because it provided a stable and strong structure. Simulated patient training was effective for people with a high EFNC, presumably because it allowed them to build on their advanced structuring skills. Conclusions: Affect and cognitive closure can be used to identify students’ learning abilities to provide a more personalised education. The results of the present study may be useful for evaluating different teaching methods, monitoring their effectiveness and enhancing students’ performance. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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12 pages, 317 KiB

Open AccessArticle

Differences in Resilience, Psychological Well-Being and Coping Strategies between HIV Patients and Diabetics

by Cristina Rivera-Picón, María Hinojal Benavente-Cuesta, María Paz Quevedo-Aguado and Pedro Manuel Rodríguez-Muñoz

Healthcare 2022, 10(2), 266; https://doi.org/10.3390/healthcare10020266 - 29 Jan 2022

Cited by 3 | Viewed by 2668

Abstract

The aim of the study was to determine the differences in resilience, psychological well-being and coping strategies between patients with HIV and diabetics. The sample included a total of 400 subjects (199 patients with HIV and 201 subjects with diabetes). The instruments applied for data collection were a sociodemographic data questionnaire, the Resilience Scale (Wagnild and Young), the Ryff Psychological Well-being Scale and the Coping Strategies Questionnaire (Sandín and Chorot). The data collection period was approximately 2 years (between February 2018 and January 2020). Based on the results of our work it was found that the subjects with HIV had lower scores than the diabetic subjects in all the resilience factors, except for the factor “feeling good alone”. In addition, the subjects with HIV scored significantly lower than the diabetic subjects on all the variables of psychological well-being. Subjects with HIV used problem-solving coping, social support seeking, positive reappraisal, religious coping and avoidance coping with less frequency than diabetic subjects. However, they used more negative auto-focused coping compared to diabetic subjects. Therefore, subjects with HIV show a different psychological pattern in relation to resilience, psychological well-being and use of coping strategies compared to diabetic subjects. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

13 pages, 258 KiB

Open AccessArticle

Perceptions of Practicing Physicians and Members of the Public on the Attributes of a “Good Doctor”

by Keren Dopelt, Yaacov G. Bachner, Jacob Urkin, Zehava Yahav, Nadav Davidovitch and Paul Barach

Healthcare 2022, 10(1), 73; https://doi.org/10.3390/healthcare10010073 - 31 Dec 2021

Cited by 14 | Viewed by 3227

Abstract

Since physician–patient relationships are a central part of the medical practice, it is essential to understand whether physicians and the general public share the same perspective on traits defining a “good doctor”. Our study compared the perceptions of physicians and members of the public on the essential traits of a “good doctor.” We conducted parallel surveys of 1000 practicing specialist-physicians, and 500 members of the public in Israel. Respondents were asked about the two most important attributes of a “good doctor” and whether they thought the physicians’ role was to reduce health disparities. Many physicians (56%) and members of the public (48%) reported that the role of physicians includes helping to reduce health disparities. Physicians emphasized the importance of non-technical skills such as humaneness and concern for patients as important traits of a “good doctor,” while the public emphasized professional and technical skills. Internal medicine physicians were more likely than surgeons to emphasize humaneness, empathy, and professionalism. Future research should focus on actionable approaches to bridge the gap in the perceptions between the groups, and that may support the formation of caring physicians embedded in a complex array of relationships within clinical and community contexts. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

17 pages, 720 KiB

Open AccessArticle

Effect of Practice Environment on Nurse Reported Quality and Patient Safety: The Mediation Role of Person-Centeredness

by Mu’taman Jarrar, Mohammad Al-Bsheish, Badr K. Aldhmadi, Waleed Albaker, Ahmed Meri, Mohammed Dauwed and Mohd Sobri Minai

Healthcare 2021, 9(11), 1578; https://doi.org/10.3390/healthcare9111578 - 18 Nov 2021

Cited by 27 | Viewed by 5213

Abstract

This study aims to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety. A quantitative cross-sectional survey collected data from 1055 nurses, working in medical and surgical units, in twelve Malaysian private hospitals. The data collection used structured questionnaires. The Hayes macro explored the mediation effect of person-centeredness between the associations of work environment dimensions and care outcomes, controlling nurses’ demographics and practice characteristics. A total of 652 nurses responded completely to the survey (61.8% response rate). About 47.7% of nurses worked 7-h shifts, and 37.0% were assigned more than 15 patients. Higher workload was associated with unfavorable outcomes. Nurses working in 12-h shifts reported a lower work environment rating (3.46 ± 0.41, p < 0.01) and person-centered care (3.55 ± 0.35, p < 0.01). Nurses assigned to more than 15 patients were less likely to report a favorable practice environment (3.53 ± 0.41, p < 0.05), perceived lower person-centered care (3.61 ± 0.36, p < 0.01), and rated lower patient safety (3.54 ± 0.62, p < 0.05). Person-centeredness mediates the effect of nurse work environment dimensions on quality and patient safety. Medical and surgical nurses, working in a healthy environment, had a high level of person-centeredness, which, in turn, positively affected the reported outcomes. The function of person-centeredness was to complement the effects of the nurse work environment on care outcomes. Improving the nurse work environment (task-oriented) with a high level of person-centeredness (patient-oriented) was a mechanism through which future initiatives could improve nursing care and prevent patient harm. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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11 pages, 232 KiB

Open AccessArticle

Mental Health Practitioners’ Understanding of Speech Pathology in a Regional Australian Community

by Tina Janes, Tania Signal and Barbra Zupan

Healthcare 2021, 9(11), 1485; https://doi.org/10.3390/healthcare9111485 - 1 Nov 2021

Cited by 2 | Viewed by 2323

Abstract

(1) Background: This study aimed to determine the level of knowledge and the perceptions of speech pathology held by a sample of regional mental health practitioners and to explore factors that facilitate understanding of the roles of speech pathologists in mental health. While mental health is recognised as an area of practice by Speech Pathology Australia, the inclusion of speech pathologists in mental health teams is limited. (2) Methods: An anonymous online survey was created using previously validated surveys and author generated questions and distributed to mental health practitioners in Central Queensland, Australia. (3) Results: Mental health practitioners had difficulty identifying speech pathology involvement when presented with case scenarios. Accuracy was poor for language-based cases, ranging from 28.81% to 37.29%. Participants who reported having worked with a speech pathologist were more likely to demonstrate higher scores on the areas of practice questions, [r(53) = 0.301, p = 0.028], and the language scenarios [r(58) = 0.506, p < 0.001]. They were also more likely to agree to statements regarding the connection between speech pathology and mental health, r(59) = 0.527, p < 0.001. (4) Conclusions: As found in this study, contact with speech pathologists is a strong predictor of mental health providers’ knowledge of the speech pathology profession. Thus, the challenge may be to increase this contact with mental health providers to promote inclusion of speech pathologists in the mental health domain. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

10 pages, 268 KiB

Open AccessArticle

The Relationship between the Second-Generation Antipsychotics Efficacy and the Traditional Chinese Medicine Body Constitutions in Patients with Schizophrenia

by Tzu-Pei Yeh, Li-Chi Huang, Yu-Fen Chen and Jui-Fen Cheng

Healthcare 2021, 9(11), 1480; https://doi.org/10.3390/healthcare9111480 - 31 Oct 2021

Cited by 3 | Viewed by 2195

Abstract

Background: Schizophrenia requires lifelong treatment; Second-generation Antipsychotics (SGAs) have become the most prescribed medication for schizophrenia patients. The efficacy of various SGAs treatment may differ in schizophrenia patients with various traditional Chinese medicine (TCM) body constitution (BC) types. Method: This study applied a longitudinal quantitative research design, where a total of 66 participants were recruited. The Positive and Negative Symptom Scale (PANSS) and the Clinical Global Impression (CGI) score were used to evaluate patients’ psychopathology status in hospitalization, and body constitution questionnaires were conducted by face-to-face interviews in the 1st, 3rd, and 6th week of hospitalization. Results: More than 60% of schizophrenia patients who were treated with SGAs were classified to have unbalanced BC types including Yin-Xu, Yang-Xu and Stasis. Generalized estimating equation analysis revealed significant time effects in CGI and PANSS score improvements in both unbalanced and gentleness (balance) BC types, but no significant changes in the group and group-time interaction in the CGI and PANSS scores in different BC type groups. Conclusions: Schizophrenia patients under SGAs treatment had a higher proportion of unbalanced BC types which may lead to poorer physical or mental statuses, such as overweight problems. Health care providers could apply interventions according to patients’ BC types for disease prevention. Full article

(This article belongs to the Special Issue Clinical and Dynamic Psychology in Medical Settings: The Patient-Centered Care)

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