Egidio A Moja

Azienda Ospedaliera San Paolo - Polo Universitario, Milano, Lombardy, Italy

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Publications (24)21.39 Total impact

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    ABSTRACT: Objectives Community pharmacists are the most accessible healthcare professionals. They interact with a large number of patients who often show emotional concern. Their stressful and complex role is widely acknowledged, nonetheless research on their personal life is practically non-existent. Thus, we set out to qualitatively explore the emotional perceptions of pharmacists. Methods Twenty experienced pharmacists were interviewed by a psychologist and a pharmacist. Data were analysed using an interpretative phenomenological analysis and coded using NVivo qualitative data analysis software. Key findingsInterviewed pharmacists admitted to different types of difficulties, mostly arising from a series of small, standalone episodes. Their stories describe intrinsic difficulties with their practice, rather than personal experiences. This study reveals the complexity of a community pharmacists' role – divided into health and hygiene advice, counselling and empathic relationships, and entrepreneurship. An important obstacle is the integration and concomitant implementation of these components. Endogenous factors such as personal experiences, personality and academic background, and exogenous factors such as social status of the patient population, legal and administrative issues and location, all affect pharmacists' ability to cope with their role. Conclusions Improving health care can be obtained by incorporating community pharmacists into the healthcare team. Technical training is important in order to improve relationship skills and personal coping strategies. Further studies are recommended to provide a simple tool for measuring aspects of the personal and emotional aspects (inner life) of a community pharmacist.
    Journal of Pharmaceutical Health Services Research. 09/2013; 4(3).
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    Daniela Leone, Egidio A Moja, Elena Vegni
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    ABSTRACT: Abstract Objective: To verify whether the patient's satisfaction with quality of life (QoL) is similar to or different from the occupational therapist's perception of the patient's satisfaction. Materials and methods: Each patient enrolled was given the Satisfaction Profile (SAT-P) questionnaire to be filled out personally; the same questionnaire, the SAT-P, was given to the respective occupational therapist who was asked to fill it out by evaluating the patient's satisfaction as perceived by the therapist. A descriptive statistic was applied for socio-demographic data to describe the cohort. Differences between patient and therapist answers to the SAT-P were evaluated using a t-test. Results: 12 occupational therapists and 69 patients participated in the study. A significant difference between occupational therapist and patient was found for Factor II (physical functioning) (p = 0.048) and for Factor V (social functioning) (p = 0.011). The comparison of patient and therapist mean scores showed that therapists had a tendency to underestimate patient satisfaction levels for all factors except Factor IV. Discussion: The results showed similarities between the therapist and the patient's view of the patient's satisfaction with QoL, confirming occupational therapy as a client-centred discipline. However, as far as physical functioning is concerned, it is possible that the professional makes an "a priori" judgement, considering the objective clinical data regardless of the patient's subjective experience of his/her illness.
    Scandinavian Journal of Occupational Therapy 04/2013; · 1.05 Impact Factor
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    ABSTRACT: There are not systematic researches about the use of metaphors in medical consultations. This work aimed to describe the use of metaphors in Italian general medicine consultations through the analysis of: the frequencies of metaphors, metaphors’ trigger, metaphors’ distribution on timing, what metaphors say, how metaphors explain their contents, the functions of the metaphors (cognitive function vs emotive function). 100 videotaped general practice outpatient consultations were considered. All the sentences where metaphors used a figurative language in which one concept is described as being equivalent to another were selected and transcribed. Data analysis was conducted using a quantitative approach (frequencies) to analyze metaphors’ trigger and timing, and a qualitative analysis was conducted first to categorize metaphors and then to create a taxonomy based on the metaphors’ categories. 280 metaphors were found: 43.2% were pronounced by physicians and 56.8% by patients. In 41 consultations the trigger was the patient (55.4%). Metaphors were pronounced on the average every 3’30’’. The taxonomy emerged overlapped partially with the existent literature. Patients used metaphors more than physicians, gathering them in the first part of the consultation, and using them with emotional goals. Metaphor is a specific linguistic feature of the physician-patient relation.
    Psicologia della Salute. 01/2013; 2:159-172.
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    ABSTRACT: INTRODUCTION: The literature on the psychological effects of thrombophilia testing is unclear. Little is known about the complex world of significance subjects construct around the test. OBJECTIVE: The study explored the peculiar network of implicit meanings that may be linked to the experience of being tested. MATERIALS AND METHODS: The research was designed according to Interpretative Phenomenological Analysis (IPA). 19 patients were interviewed. Integral verbatim reports of the interviews were analyzed through an inductive process aimed at gaining a holistic understanding of the narratives. RESULTS: Two main issues were identified, each with sub-issues: (1) the clinical problem: (1.1) unhealthy blood and (1.2) the family issue; (2) the test: (2.1) knowing for the sake of knowing; (2.2) knowing for the sake of doing; (2.3) not knowing. CONCLUSIONS: The thrombophilia test is part of a larger network of meanings, where information about the test and its results seem to be lost. PRACTICE IMPLICATION: The study suggests the importance of paying greater attention to the process of doctor-patient communication at the time of the test. The theme of being informed is important for patients, yet often they are not able to understand or retain the information they receive, increasing the risk of misunderstandings.
    Patient Education and Counseling 12/2011; · 2.60 Impact Factor
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    ABSTRACT: Sudden unexpected death in epilepsy (SUDEP) is a syndrome where a person with epilepsy dies suddenly and no other cause of death is found. The question of informing patients and their families about SUDEP remains a problematic issue. The aim of this study is to explore whether Italian physicians interested in epilepsy believe that they should discuss SUDEP with patients and/or their families. A total of 315 questionnaire were distributed, of which 195 (61.9%) were returned. Seventeen respondents (8.76%) discussed SUDEP with all of their patients, 38 (19.59%) with the majority of patients, 120 (61.85%) with very few of their patients and 15 (7.73%) with none of their patients. No statistical differences among groups were found for gender, professional age (≤ 10 years; ≥ 11 years ≤ 20 years; ≥ 21 years ≤ 30 years; ≥ 31 years) and medical specialty (neurologists vs. others). Open questions offered insights into the physicians' problem of managing the negative emotions of patients/family and why the physicians decided to give information.
    Neurological Sciences 04/2011; 32(2):331-5. · 1.41 Impact Factor
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    ABSTRACT: A great deal of what medical students learn in terms of behaviors, values, and attitudes related to their profession is conveyed by the hidden curriculum. To explore the messages conveyed by the hidden curriculum as perceived by third-year students of the Milan School of Medicine, Italy, following their first clinical internship. Three group interviews were conducted. Students were asked to reflect on values, attitudes, and implicit rules they noticed during their internship experiences. Verbatim transcripts of the group interviews were analyzed through content analysis using Nvivo8. Of the 81 students, 57 (70%) participated in the group interviews. Six themes were identified within the hidden curriculum: Physicians reassure and protect patients; power differential between physicians and patients; variable respect for patients; disease-centered medicine; respect for hierarchies; and delegation of patients' emotional needs to nurses. Our findings suggest that the hidden curriculum has a strong cultural component. In our students' experience, the hidden curriculum conveyed a paternalistic model of physician-patient relationships. Some of the messages conveyed by the actual hidden curriculum may compromise the standards formally taught in medical schools about doctor-patient relationships. Organizational culture change and student empowerment could be fostered to counteract the negative effects of the hidden curriculum.
    Medical Teacher 01/2011; 33(12):989-96. · 1.82 Impact Factor
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    ABSTRACT: The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians' preparedness to engage in difficult conversations. To describe the implementation of PERCS in an Italian hospital and assess the program's efficacy. The Italian PERCS program featured 4-h experiential workshops enrolling 10-15 interdisciplinary participants. The workshops were organized around the enactment and debriefing of realistic case scenarios portrayed by actors and volunteer clinicians. Before and after the workshop, participants rated their perceived preparation, communication and relational skills, confidence, and anxiety on 5-point Likert scales. Open-ended questions explored their reflections on the learning. T-tests and content analysis were used to analyze the quantitative and qualitative data, respectively. 146 clinicians attended 13 workshops. Participants reported better preparation, confidence, and communication skills (p < 0.001) after the workshops. The program had a different impact depending on the discipline. Participants valued the emphasis on group feedback, experiential and interdisciplinary learning, and the patient's perspective, and acquired: new communication skills, self-reflective attitude, reframed perspective, and interdisciplinary teamwork. PERCS proved culturally adaptable to the Italian context and effective in improving participants' sense of preparation, communication skills, and confidence.
    Medical Teacher 01/2011; 33(2):e57-64. · 1.82 Impact Factor
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    ABSTRACT: It has been shown that the pineal gland plays a fundamental role in mediating either the spiritual perception or the anticancer immunity by stimulating the endogenous production of anticancer cytokine interleukin (IL)-2. The present study was performed to evaluate the impact of a spiritual approach consisting of Kriya Yoga program alone or in association with melatonin (MLT) or low-dose IL-2 plus MLT on the survival time in a group of metastatic cancer patients with life expectancy less than 1 year. A case-control study was carried out in 240 patients (M/F: 146/94; median age: 62 years, range: 34-71, suffering from non-small-cell lung cancer or gastrointestinal tumors) who were subdivided into 6 groups of 40 patients, treated with supportive care alone as a control group, supportive care plus Yoga, MLT alone, MLT plus Yoga, inteleukin-2 plus MLT, or IL-2 plus MLT plus Yoga. The best results in terms of increased survival time were obtained by the association between neuroimmunotherapy with MLT plus IL-2 and Yoga program (2 years), which was significantly longer with respect to that achieved by supportive care alone, Yoga alone, or IL-2 plus MLT alone (1 year). This study would suggest that a spiritual therapeutic approach may improve the survival time of untreatable metastatic solid tumor patients.
    International Journal of Yoga 01/2011; 4(1):33-8.
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    ABSTRACT: The purpose of this pilot study was to assess the feasibility of a quantitative approach to study occupational therapist-client interactions. Role plays were videotaped in which 10 therapists met three client-actors. A questionnaire assessed the occupational therapists' and the patient-actors' opinion of the role-play experience. A modified version of the Roter Interaction Analysis System (RIAS), OT-RIAS, was used to analyse data. Occupational therapists considered the role play experience to be "highly realistic" (mean score 5.4 on a 1-6 Likert scale). The actors' comfort role playing clients was also high (mean = 4.0; range 1-5). Inter-coder reliability for the OT-RIAS was highly significant (r = 0.919; p = 0.000). The modified version of this system fits well in an occupational therapy context. The quantitative approach used in this study to explore the therapist-client relationship appears to be effective. The role plays and RIAS may be useful in research exploring correlation between the OT communication style and outcome measures such as client satisfaction or comprehension, or in order to assess and offer feedback in teaching communication skills programmes.
    Scandinavian Journal of Occupational Therapy 02/2010; 17(3):217-24. · 1.05 Impact Factor
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    ABSTRACT: This article describes the adaptation and implementation of the Program to Enhance Relational and Communication Skills (PERCS) in Italy. PERCS was originally developed at Children's Hospital Boston and aims to enhance clinicians' preparedness to engage in difficult conversations with patients/families. After a period of collaboration by the first author with the Children's Hospital Boston, PERCS was launched at San Paolo Hospital, Milan, in 2008. To date, over 80 participants have voluntarily attended the program. The program features monthly 4-hour workshops geared around the enactment of a case scenario by trained actors and participants. Each workshop enrolls 10-13 interdisciplinary participants. After each enactment, participants receive feedback by actors, other participants and facilitators on the challenging junctures of the conversation. Pedagogical principles include: creating safety for learning; emphasizing moral and relational dimensions of care; suspending hierarchy among participants; valuing self-reflection; honoring multiple perspectives; and offering continuity of the educational offering. Implementing PERCS in Italy has demonstrated that it is possible to culturally adapt learning opportunities that embrace the relational and ethical experience of learners. The positive response of participants affirms that relational learning is meaningful and needed.
    Recenti progressi in medicina 05/2009; 100(5):239-46.
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    ABSTRACT: Major cross-cultural differences in truth-telling attitudes and practices have been demonstrated. Until recently, in Italy the doctor could conceal both diagnosis and prognosis to seriously ill patients out of beneficence. Signs of change have been reported, but the extent and way patients would be informed is still unknown. The aim of the study was to assess Italian patients' preferences regarding how they would like to be told about their cancer and its treatment. We examined the factor structure of the Measure of Patients' Preferences--Italian version (MPP-It) and whether demographical and medical variables were associated with the dimensions of patients' preferences. Patients were invited to participate during a visit to the oncology department of the Lecco hospital (Italy) for chemotherapy or follow-up. An Italian version of the MPP-It was administered. Data were analyzed through a factor analysis. A total of 210 cancer patients agreed to participate. Three main factors were identified: (1) Information (Talking About the Disease). Items in this factor were concerned with the dialogue about the disease and treatment options; (2) Support (The Emotional World of the Patient). These items referred to the supportive and relational aspects of the physician-patient encounter; (3) Care (The Ideal Doctor). These items related to the patients' desires about the doctor's personal attributes. The first two factors, information and support, were comparable to those of similar American and Asian studies. The study suggests a cross-cultural uniformity among cancer patients who appreciate the informative and clearness of the communication aspects as being primarily important, while also giving high points to relationship aspects. The third factor appears unique to the Italian context.
    Supportive Care in Cancer 05/2009; 17(12):1523-30. · 2.09 Impact Factor
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    ABSTRACT: The authors discuss the creation of a psycho-educational course based on emotions in a group of diabetes type 2 patients. Its effects were assessed : biologically, by measuring blood sugar levels and body weight; cognitively, by behavioral tests; psycho-emotionally, by Moreno's Social Atom test that evaluates the patient's personal life in the light of his/her pathological conditions. 12 subjects were studied (10 patients and 2 spouses). Results showed: significant improvement in life-style; a marginal improvement of weight and level of coping with the illness; a non-significant improvement in blood sugar levels. The study showed that one particularly important aspect regards the role of nurses within the multidisciplinary team conducting the study.
    Professioni infermieristiche 01/2009; 62(2):78-83.
  • Daniela Leone, Egidio Aldo Moja, Elena Vegni
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    ABSTRACT: A 24 hrs optional course was realized with 15 students at the Medical School of Milan, with the aim of undertaking the management of the emotional aspects in a difficult communication in medicine. The course was realized through the use of active teaching tools; issues resulted from what literature consider as "difficult communication". Photolangage was used as pre-post test to assess the effects of the course; a satisfaction questionnaire was also used. From the content analysis of the data the course resulted effective both for the students' satisfaction and for the enhancing of their self reflective skills.
    Recenti progressi in medicina 11/2008; 99(10):485-91.
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    ABSTRACT: To examine how patient-centredness is understood and enacted in an American (US) and an Italian group of health care professionals. An action research methodology was used. Two interprofessional groups of US (n = 4) and Italian (n = 5) health care professionals independently wrote a patient-centred dialogue between a doctor and a patient based on the same scenario. The dialogues were then translated and exchanged. Both groups independently commented on the patient-centred aspects of the other's dialogue by completing a written questionnaire. Their respective comments were then shared by international videoconference. The transcript of the videoconference was analysed via content analysis. The participants' opinions about the study were then evaluated. Exploring the patient's illness experience and handling the patient's emotions were identified as core components of patient-centred care by both the US and Italian groups, but were expressed differently in their respective dialogues. Respecting the patient's autonomy was recognised as a component of patient-centred care only by the US group. The Italian group demonstrated a more implicitly paternalistic approach. Participants highlighted the usefulness of one another's feedback to uncover cultural assumptions of patient-centred care and increase self-awareness. Results suggest that the concept and practice of patient-centred care is variable and may be influenced by culture. The study methodology improved participants' self-awareness of cultural values, and has potential as a cost-effective, experiential educational approach.
    Medical Education 08/2008; 42(7):712-20. · 3.55 Impact Factor
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    ABSTRACT: The aim of the study is to describe the doctor-patient-companion interaction in the Italian General Practice compared to dyadic encounters. 819 videorecorded visits were included. 650 (79.4%) were dyadic visits. 153 (18.7%) were doctor-patient-companion encounters in which the third party was a legitimate companion (n = 24; 15.7%), or an "illegitimate" one (n = 77; 50.3%) or a patient him/herself (n = 52; 34%). In 16 visits (1.9%) more than two people interact with the doctor. The study constitutes a stimulus in order to favour an Italian contribution about a new international perspective on the doctor-patient relation that is clinically relevant.
    Recenti progressi in medicina 04/2007; 98(3):160-5.
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    ABSTRACT: The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP). The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 21), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP. Both groups were administered a questionnaire at two points in time (before the counseling and 1 month later) which evaluated participants' knowledge, attitudes and use of contraception (the latter was also followed up 3 months later). The counseling intervention lasted 30 min and was carried out by a psychologist and a gynaecologist. It was found that knowledge, favorable attitudes and use of effective contraception increased significantly for the experimental group, whereas there was no significant change for the control group. The counseling intervention was therefore found to be efficacious in improving understanding and use of contraception in women who have undergone a TOP. The hope is that this will contribute to increased use of effective contraception in the future. Following the principles of patient-centered medicine, this study provides evidence for the importance of exploring woman's feelings, beliefs, wishes and expectations regarding contraception within a contraceptive counseling intervention.
    Patient Education and Counseling 04/2007; 65(3):361-8. · 2.60 Impact Factor
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    ABSTRACT: The literature about the physician emotional life underlined how to care a collegue generates stress. However this situation is not so much investigated. The aim of this article is to investigate the nature of the relation and of the physician inner life when the doctor meets a patient-doctor, by means of narratives and a qualitative analysis. Having a colleague as patient seems to be very challenging and to evocke struggling feelings difficult to handle with well known stategies.
    Recenti progressi in medicina 03/2007; 98(2):79-82.
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    ABSTRACT: The aim of this study was to explore the physician's communication pattern when breaking a bad unexpected news. 30 videotaped consultations (VRM) were collected in which the physicians met an actress as a patient. The doctors received the x-ray report in which an apical mass was detected before (condition A) or during (condition B) the consultation. The VRM were analysed through the Roter Interaction Analysis System (RIAS). Data suggested in condition B a significant decrease in "process", "counselling" and "emotional" categories. In consultation where a bad unexpected news is communicated doctors seem to be less directive in the content and more emotionally defended.
    Recenti progressi in medicina 01/2006; 96(12):594-8.
  • Cristina Nova, Elena Vegni, Egidio Aldo Moja
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    ABSTRACT: The aim of the present study was to explore (1) how and with which specificity the young patient contributes to the visit; (2) the communicative-relational manner with which adults handle the child's interventions. Ten videoed visits with patients aged 2-6 years were selected. A content and discourse analysis was realized. Results showed three macro-categories that seem to fully describe the young patient interventions: (1) The subjective experience regarding the illness; (2) The child's own learning process; (3) The child's medical knowledge. These contributions seem to be handled by the adults in processes that may or may not integrate the patient contributions. Results confirmed the quantitatively limited child's contribution, but they also showed an active child, who communicates with the adults about the subjective experience of the visit or the illness, and who autonomously handle the learning process about the roles in the visit. Physicians should improve their communication skills to integrate the child's interventions.
    Patient Education and Counseling 10/2005; 58(3):327-33. · 2.60 Impact Factor
  • Elena Vegni, Sonia Visioli, Egidio A Moja
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    ABSTRACT: The aim of the study was to analyze the difficult doctor-patient relationship from a doctor's perspective. A qualitative-interpretative approach was employed to analyze representations of difficult visits collected by means of written narrations. Two main scenarios were identified: (i) a 'personal scenario' in which the doctor had difficulties from a purely personal perspective; and (ii) a 'professional scenario' in which the doctor had difficulties as a professional when the 'other' resists or in facing the 'other' who resists. A further scenario was identified in which problems were generated by the family of the patient. Results suggest that the relation between doctor and patient may be very complex. Difficulties may be internal to the doctor, hence intra-psychic, depending on being both a professional and a human being. Difficulties may also be external between two psychological subjects (labeled as inter-psychic), where interaction of the 'you' and the 'other' becomes a battleground, a wall of opposition, or alternatively a place of experimentation with relationships. Furthermore, external difficulties may also be between more than two persons (labeled as inter-personal), by the possible multiplicity of the 'other'. This happens in particular when the 'other' is represented by the family.
    Communication & Medicine 02/2005; 2(1):69-76.

Publication Stats

101 Citations
21.39 Total Impact Points

Institutions

  • 2013
    • Azienda Ospedaliera San Paolo - Polo Universitario
      Milano, Lombardy, Italy
  • 2011
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      Milano, Lombardy, Italy
  • 2004–2011
    • University of Milan
      • • Department of Health Science - DISS
      • • Faculty of Medicine
      Milano, Lombardy, Italy