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COGNITIVE APPROACH TO NUTRITION IN A PATIENT-CENTERED APPROACH: IMPLEMENTING TAILORED NUTRITION ADVICE FOR ONCOLOGY PATIENTS

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Abstract

This theoretical overview stresses the importance of a personalized approach to the study of the relationship between nutrition and prevention by the use of a cognitive approach. An adequate nutrition program should play a fundamental aspect of patient-centered care, but also is the best prevention strategy in disease-free subjects. We argue that an integrated methodology, based on a patient-centered and tailored approach, must assess all the factors involved within individual food choices in order to recognize values, beliefs and needs related to food intake, both in cancer patients and in disease-free patients. An integrated approach is advocated, since the tailoring process requires both biological and psychological data in order to appraise the individual’s needs and promote adequate action plans. This process of integrating information delivered from different sources is what we call a “cognitive approach” to nutrition
European Journal for Person Centered Healthcare Vol 1 Issue 1 pp 265-273
265
ARTICLE
Cognitive approach to nutrition in a patient-centered approach:
implementing tailored nutrition advice for oncology patients
Claudio Lucchiari PhDa, Marianna Masierob and Gabriella Pravettoni PhDc
a Professor, Department of Economics (DEMM), Università degli Studi di Milano, Milan, Italy
b PhD Candidate, Department of Economics (DEMM), Università degli Studi di Milano, Milan, Italy
c Professor of Cognitive Psychology, Department of Economics (DEMM), Università degli Studi di Milano & Director of
Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
Abstract
This theoretical overview stresses the importance of a personalized approach to the study of the relationship between
nutrition and prevention by the use of a cognitive approach. An adequate nutrition program should play a fundamental
aspect of patient-centered care, but also is the best prevention strategy in disease-free subjects. We argue that an integrated
methodology, based on a patient-centered and tailored approach, must assess all the factors involved within individual food
choices in order to recognize values, beliefs and needs related to food intake, both in cancer patients and in disease-free
patients. An integrated approach is advocated, since the tailoring process requires both biological and psychological data in
order to appraise the individual’s needs and promote adequate action plans. This process of integrating information
delivered from different sources is what we call a “cognitive approach” to nutrition.
Keywords
Behaviour, choice, clinical decision-making, genomic medicine, habit, health promotion, individualized care, interactive
games, nutrition cognition, oncology, P5 approach, patient-centered care, person-centered medicine, psychosocial factors,
quality of life,tailored care, wellbeing
Correspondence address
Professor Gabriella Pravettoni, Università degli Studi di Milano, Department of Economics (DEMM), Via Conservatorio 7,
20122 Milano, Italy. E-mail: gabriella.pravettoni@unimi.it
Accepted for publication: 19 October 2012
Introduction
In 1953, an American biologist by the name of James
Watson (1928-), with the collaboration of Francis Crick
(1916-2004), elucidated the structure of DNA. The 2
scientists were immediately hailed as the discoverers of the
“secret of life.” This was the first step towards a new
approach to the human being and the study of disease. In
fact, the human genomic project represents the official date
of birth of genomic medicine which, since the end of the
Human Genome Project (HGP) in 2003, when the DNA
sequence was finally completed, has become an important
predictive tool for many chronic diseases.
Genomic research has allowed the development
of highly effective predictive techniques and has
encouraged the adoption of tailored
therapeutic treatments according to the phenotypic
and genotypic characteristics of the patient. Genomic
medicine uses the information provided by genomes, RNA,
proteins and metabolites to support and to organize clinical
decision-making. This approach has led the origin of
personalized medicine, also called p-medicine.
Personalized medicine is based on pharmacogenomics,
which predicates the mutual interaction between genes and
drug reaction and provides a tailored treatment to the
individual characteristics of the patient. Personalized
medicine employs genomic studies to improve preventive
healthcare programs and drug treatment in 2 specific ways:
before the disease occurs and in its early stages.
The fundamental aims of p-medicine are to improve
treatment action; enhance genetic screening and prevention
behavior in healthy populations and to support clinical and
patient decision-making about care in the face of multiple
options. Hence, a cornerstone of personalized medicine is
to understand which gene mutations causes the onset of
disease and how. More specifically, genetics-related
studies have led to the identification of several loci that are
used for genetic screening and preventive treatment
programs [1]. By way of example, let us consider the
predisposition to breast and ovarian cancer. During the last
2 decades, 2 gene mutations have been identified as
responsible for breast cancer 1 (BRAC1) and breast cancer
2 (BRAC2). Specifically, accumulated data indicate that
out of 215,000 people who have developed breast cancer,
7% relate to hereditary factors and of these, 84% are
related to genetic mutations [2].
This particular approach to prevention has resulted in
important health-related outcomes. First, it has improved
Lucchiari, Masiero and Pravettoni
Tailored nutrition in oncology patients
266
the tests aimed at evaluating the individual’s genetic risks,
which are linked to the family’s health history and the
genomic information connected with gene mutation.
Secondly, it has allowed more effective treatment action
for overt disease, as well as for the early stages of disease.
Thirdly, it has supported the creation of treatment models
tailored on the individual, that is, based not only on
epidemiologic data but also on genotypic and phenotypic
characteristics.
Personalized nutrition
Until the discovery of the genomic approach, action in
nutrition was exclusively based on epidemiological data.
Today, the personalized approach is applied to nutrition, in
order to analyze individual reactions regarding different
diets at the genetic, protein and metabolite levels [3].
These developments have encouraged a biological
approach to diet assessment and, at the same time, favored
a tailored intervention method to change food-related
habits. In this sense, an integrated approach is advanced,
since the tailoring process requires both biological and
psychological data in order to appraise the individual’s
needs and promote adequate action plans.
This process of integrating information derives from
different sources and demonstrates what we call a
“cognitive approach” to nutrition. Indeed, cognitive
science has a special interest in the analysis of knowledge
organization with the aim of supporting innovative tools in
various fields.
In fact, genetic nutrition consists of 2 main research
areas: nutrigenetics and nutrigenomics. Nutrigenomics
shows how dietary components influence gene expression,
while nutrigenetics is based on individual genetic
characteristics, relating them to diet, individual
predispositions and environmental aspects [3]. We argue
that a shifting towards implementing a cognitive approach
to the nutrition issue is necessary.
The P5 approach and personalized
nutrition
Tastes and consequently food-related choices are
established both by physiological factors (gene mutations,
olfactory and gustative sense features) and by cognitive
aspects that give rise to a hedonistic evaluation of nutrients
(likings vs dislikings). Also, environmental, cultural and
lifestyle habits are significant factors in food-related
choices.
At a physiological level, smell and taste are primarily
responsible for “flavor perception”. Smell guides
individual food preferences, while the sense of taste
determines the final decision about the intake of food or its
rejection. After the perceptive level, cognitive processing
provides a tailored flavor (liking or disliking). Both smell
and taste are mediated by transduction receptors, which
transform chemical stimuli via electric signals. These
electric signals arrive at the primary gustatory cortex and
produce a cognitive elaboration of subjective flavor [4].
Smell and taste are linked with the thalami and amygdali
and for this reason they are correlated with memory and
emotional factors. Though smell and taste are linked to
genetic variability, there is a clear learning during the first
years of life.
We argue that an integrated methodology, based on a
patient-centered approach, must assess all the factors
involved within individual food choices in order to
recognize values, beliefs and needs related to food intake,
both in cancer patients and in disease-free individuals.
The “Fifth P”, or P5 approach, is moving in this
direction, to the extent that it could be considered a
cornerstone of modern nursing practice. The traditional
approach to personalized medicine involves 4
physiological characteristics. Indeed, we often use p-
medicine expression in order to remind ourselves of the 4
basic characteristics of the clinical model: personalized,
predictive, participative and preventive [1]. Though these
qualities are related only to genetic factors, we observe that
to empower a cancer patient a personalization model is
required which involves, also, other individual dimensions.
The importance of behavioral, psychological and cognitive
aspects has been emphasized by cognitive scientists. In
personalized medicine, these parameters are fundamental
to evaluate cancer patients and chronic diseases and also to
assess patients’ coping strategies, participation and
involvement in the decision-making process, compliance
and tolerance with therapy [5].
The patient-centered approach and
nutrition
There is a bi-directional correlation between the patient-
centered approach and personalized medicine. This
expression was first articulated by the Institute of Medicine
(IoM) in 2001. Specifically, the patient-centered approach
is based on the identification of values, beliefs and the
needs of each patient. Consequently, a clinical decision is
the result not only of the physician’s view, but also of the
whole of the patient’s requirements; in other words, it is a
synthesis of clinical evidence and individual needs.
According to this model, doctors and patients must work
together to define a decision model where clinical
considerations as well as values and preferences are
included in the care process. This approach supports the
personalization of care, improving patient satisfaction,
quality of life (QoL), compliance and better chronic
disease management [6].
Accumulated scientific evidence has stressed the
importance of nutrition habits in preventing chronic
diseases. At the same time, diet and food-related choices
are considered an important issue for cancer survivors. In
fact, cancer has become in a considerable number of cases
a controllable and survivable disease, thus creating a
steadily increasing group of survivors. The increase in the
survival rate derives from cancer screening, progresses in
technology applications to detect cancer and therapies and
also health programs. Survivorship is a condition with
particular needs. Indeed, cancer treatment has long
term effects on individuals (physical health, cognitive and
European Journal for Person Centered Healthcare
267
ENVIRONMENT
Figure 1 The cognitive approach to personalized nutrition: a combined approach to personalized
nutrition, showing information tailored on each human being
emotional wellbeing and socio-economic status). Survivors
often live with the uncertainty of cancer recurrence, the so-
called “Damocles Syndrome [7]. For this reason,
survivors need methods and tools that enable them to
monitor all possible conditions and avoid behaviors that
may have a negative impact on their quality of life and
even possibly favor recurrences.
The personalized nutrition approach is based on the
awareness that energy consumption should be adapted to
the individual’s biological, physiological and psychosocial
features. The advantages of a personalized diet for the
patient and the survivor involve 2 main areas of the
individual’s wellbeing: (i) physiological wellbeing:
promoting a healthy diet improves the clinical conditions
of the patients, helps cancer patients to adjust to the side
effects of therapies and contributes in preventing
recurrences and (ii) psychological wellbeing: a proper
nutrition may have a relevant impact on QoL, both
directly, as a consequence of the effect of a healthy diet on
mood and cognitive performances and, indirectly, as a
secondary effect of the improving of physical health. Also,
the capacity to change negative habits improves
psychological wellbeing.
The use of standardized suggestions (e.g., based on
epidemiologic data) and general tools do not permit a
complete assessment of patients’ demands. Addressing this
issue involves finding proper methods and instruments,
both to monitor and also to educate patients. Indeed, a
cancer diagnosis is often defined as being a “teachable
moment”, where new horizons may be experienced. From
this perspective, even a severe diagnosis might be seen as
an opportunity for change. Although we still know little
about how to exploit this opportunity, we may argue that a
personalized approach should also help health personnel to
pursue this important goal.
A fundamental step for implementing a personalized
approach is the analysis of needs. It is both necessary to
collect data about the dietary habits of patients and to find
the cognitive, psychological and social background of
these habits. In order to analyze individual needs, a
physician should be able to use brief instruments focused
on: psychological demands, health beliefs and myths,
psychosocial context and cognitive profile.
A personalized approach toward nutrition promotes a
patient-centered approach, but also a way to the patient’s
empowerment. Empowerment, which is a critical step for a
patient, involves several dimensions: (i) awareness of the
consequences of inadequate food habits; (ii) awareness of
the disease and its future consequences; (iii) improving
cooperation in the treatment steps (before, during and
after) & (iv) improving commitment.
Using a personalized approach requires the adoption of
methods and strategies which enable the ability to tailor
interventions on individuals [5,8]. This aim requires taking
into consideration specific demands, needs and personal
values as part of the contextual factors of clinical practice.
We suggest that in order to help individuals to opt for a
healthier diet that would enhance his/her quality of life, it
is fundamental to create a personalized process to assess
habits, attitudes and behaviors. The more we know about
the personal world of each subject, the better we will be
able to identify strategies to improve healthy food choices.
GENETICS
LIFESTYLE
COGNITIVE
PSYCHOSOCIAL
METABOLISM
Genomic Information
Psychosocial
information
Lucchiari, Masiero and Pravettoni
Tailored nutrition in oncology patients
268
Cognitive characteristics of food-
related choices
Subjects that adopt unhealthy food intake tend to fall into a
cognitive trap called ‘optimistic bias’, an effect similar to
that observed in tobacco addiction. Individuals tend to
represent unrealistically their health condition, while
changing their attitude towards other people. In others
words, the optimistic bias implies judging personal risk
less than the risk of other people [9]. For instance, subjects
that habitually eat a lot of fat can think that their diet has a
poor fat intake per day. In this case, the subject is not
unaware of the cardiovascular risk related to his/her diet
habits. Raats and Sparks noted that subjects involved in
their experimental protocol reported a lower fat intake than
the average individual. This attitude has been observed in
other nutrition-related risk factors, for example, those
involving blood-cholesterol level [10,11] and those caused
by eating red meat and sweets, drinking alcohol, etc.
Tools
In order to implement a truly personalized and patient-
centered approach, we need to identify first-person tools,
that is, instruments that a patient may use day-to-day,
hence enriching both personal experience and a shared
knowledge within the medical setting. In this sense, the
personalization of medicine and, in particular, of
behavioral interventions, requires individuals not only to
take their own responsibilities, but also a specific,
idiosyncratic perspective. To enable this process, it is
necessary to develop and implement instruments and tools
characterized by their being interactive, portable and easy
to use. In particular, nutrition tools should be developed as
part of more general personal health records aimed to track
the individuals’ health history and to improve their
behavior, both to prevent diseases and to enhance quality
of life.
Interactive tools
A new strategy exploited at improving a personalized
nutrition advice is based on the development of
instruments. This approach is being empowered by the
technological development of electronic, portable devices
with high usability, real time features and interactive
interfaces. The combination of technological tools and
personalization is a strong strategy to achieve patient
empowerment. For instance, in one clinical trial it has been
observed that personalized newsletters exert a significant
effect on behavior and may lead to a permanent lifestyle
shift in terms of physical activity and healthy eating [12].
Only in this way will a patient be actually empowered,
because he/she will have the possibility to monitor his/her
food intake behavior, interacting with health personnel in
real time, thus obtaining automatic or on demand
feedback to adjust behavior and modify bad habits.
Additionally, physicians would be able to monitor the
ongoing situation, with respect to dietary behavior, using
simple applications by computer or other already available
devices.
In real clinical settings, such instruments can be used
without the interviewer’s intervention; beside this, they can
also be used at home. Brug and collaborators have
implemented an interesting experimental protocol [13]. In
their research, a computer-based personalized nutrition
program was used. The program followed 3 steps:
A screening tool to evaluate energy balance: it
included a questionnaire composed of 121 items
aimed at formulating a tailored nutrition diagnosis.
The tool was divided into 2 sections: the first section
was composed of 30 items that evaluated fat, fruit and
vegetable intake per day; while the second section
evaluated psychosocial factors involved in food choice
(attitude, social support or influence and self-efficacy).
The screening tool is important because it allows
measuring the degree of awareness about personal risk
and the increase in nutritional awareness is an
important clinical target. Within the program, the
individuals were divided according to personal food
consumption (dietary habits, makeup meal and so on)
awareness levels and personal beliefs [13].
Feedback: the program predicted a personalized
feedback of the screening score; the goal was to
reduce fat intake and increase fruit and vegetable
intake per day. Moreover, communication was
personalized to fit with personal beliefs and
awareness. For instance, different feedbacks were
delivered to subjects who made unrealistic
assessments of their own fat habitual intake and for
subjects with realistic self-assessments [13].
Finally, the participants received personalized
nutrition advice aimed at changing and improving
dietary habits.
In 2000, an interactive CD-ROM for screening and
monitoring food intake in the American population was
developed by the Food and Nutrition Service of the
Department of Agriculture. The tool was based on 4
principles. First, the subjects could choose their own
specific focus of interest; second, they must receive an on-
time tailored feedback; third, the message must be related
to the awareness of the need to change and fourth, the
nutritional advice must be related to an individual’s goal
setting [14]. Two modules composed this CD-ROM: one
module was related to fat consumption, while the second
one was related to fruit and vegetable intake per day. The
total score (concerning individual fat, fruit and vegetable
intake) was compared to nutritional guidelines. After the
screening a personal feedback was sent, which highlighted
the nutritional deficit and the way to change an unhealthy
diet. The program asked users to identify various aspects
of their lifestyle and was programmed to propose issues
with respect to that lifestyle [14].
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269
Another program is the so-called FRESH START
program, financed by the National Institutes of Health for
cancer survivors. It is directed at cancer survivors,
particularly, breast and prostate cancer patients. Cancer
survivorship is a specific condition, which implies the need
to monitor recurrence risk and the developing of
comorbidity, for instance, cardiovascular disease and
diabetes. As already discussed, a cancer diagnosis may be
a “teachable moment”, often leading survivors to make
constructive changes in eating habits and lifestyle [15,16].
For this reason, survivors have a higher degree of interest
and have high motivation to appraise healthy behaviors
and monitor their clinical condition.
FRESH START includes a personalized workbook and
a newsletter. For each unit of the workbook, the diet habits
of the patient are compared with a healthy behavior and the
subject is invited to change bad habits. The workbook also
includes cancer-related information, other than advices for
physical activity, fruit and vegetable intake and promoting
a diet with low fat consumption.
The program works as an interactive game, in which
patients may give rise to a personal testimonial (a sort of
avatar) with some specific characteristics related to
patients’ habits and data (age, weight and like that).
Participants have as their goal the need to change this
testimonial so as to achieve a healthier status. During the
entire program, participants received 6 tailored e-mails.
These e-mails contained information about personal goals,
barriers to change, individual progress, future goals and an
analogical information carrier, the testimonial of the
patient indicating the ongoing situation in at-glance
representation [17,18]. Combining verbal and analogical
information may help achieving the goal, activating both
the emotional and cognitive appraisal of the situation while
in addition improving data understanding. Data collected
showed that FRESH START enhanced lifestyle shifting,
especially increasing physical activity and energy
expenditure, intake of fruits and vegetables, reducing
consumption of fat of participants (prostate and breast
cancer patients).
Other applications that can be used for nutrition
monitoring are interactive games. These tools are
particularly important in health education, even though
little research is available in the field of patient
empowerment. For instance, Lieberman [19] employed the
game titled “Bronkie the Bronchiasaurus” to help the self-
management of asthma in young patients.
IGs are useful and flexible tools to emphasize
awareness and shifting in dietary habits. They allow a
patient to be involved in stimulating tasks, where
participants can experiment a diet management program.
The foremost outcome is that IGs provide subjects
personalized advice, but also the possibility to experience
the consequences of their food choice using a trial and
error approach. According to previous research, IGs
increase motivation and attention [19].
An interactive game titled Right Way Café by Peng
[20], has recently been developed at The University of
Michigan, USA. In this game, participants acquire an
avatar and have the possibility to choose meals and
experiment with different diet styles. Each avatar is
developed with reference to the individual characteristics
of the player (age, gender, weight, height and so on). This
interactive game assesses energy intake and simulates
weight gain or loss. So, the individuals will learn to choose
healthier food and to use strategies to achieve a correct
dietary balance. The storyboard is based on a reality TV
show [20]. When the players choose food they have the
possibility to monitor nutrition labels by clicking the image
of the food on a screen. Using a trial and error approach,
individuals may experience each consequence of a food
choice.
We may describe at least 10 major upshots of the IG-
based health programs: an increase in accessibility,
dissemination, compliance, cooperation and empathy; data
personalization; variability reduction; low literacy
requirements; a decreasing of violation rates [21]. Another
example of IG tailored to dieting patients’ needs is the
Patient-Centered Assessment and Counseling Mobile
Energy Balance (PmEB). It is a mobile application that is
able to elaborate caloric balance, caloric consumption and
caloric expenditure day-per-day [22].
A cognitive model of a patient-
centered tool
The need for time- and cost-effective lifestyle, with
particular reference to diet, is evident in recent approaches
to healthcare which emphasize the need to tailor lifestyle
counseling messages to individual patients. Individual
desires and needs are increasingly becoming the method of
choice in research. However, this is not yet the standard
procedure in realclinical settings. The effectiveness of
interventions can be increased by tailoring counseling to
individuals levels of knowledge, awareness and
motivation [23-25]. Furthermore, excluding unmotivated
individuals from counseling programs can save general
practitioners considerable amounts of time.
Kahn [26] formulated the optimal matching theory as
the expectation that positive effects would be maximized
when the kind of support offered was congruent with the
requirement of the situation and the needs of the person.
Tailoring the frequency, types, sources and media of social
and cognitive support to individual patients may, therefore,
retain its promise for the future. Even though there are a
number of ways to build up a patient-centered tool aimed
at promoting better food-related choices, we argue that a
theoretical scheme should be followed. In particular, a
socio-cognitive approach should be integrated into an
Interactive online tool, so that a person could experience
control over the process of change. A similar tool should
be aimed at developing trust in the information given,
empathy, motivation, fidelity and confidence.
To use a socio-cognitive approach as the basis for
counseling, it is necessary accurately to assess individual
readiness to change. In the research field, this is often
achieved using single question or multiple-item algorithms
that are completed by patients. In practice, the use of these
algorithms is limited and it is reasonable to assume that
physicians often act upon their perception of patient
Lucchiari, Masiero and Pravettoni
Tailored nutrition in oncology patients
270
readiness to change. The use of a first-person tool should
contribute to the overcoming of this bias, that often leads
physicians to wrong judgments, for instance,
overestimating patientsreadiness to change dietary habits.
The importance of an accurate assessment of
motivation for lifestyle change is evident, as inaccuracy
would lead to referral of unmotivated patients. A socio-
cognitive nutrition intervention can increase the rate of
movement from intention to action stage of dietary change.
Over the past 2 decades, numerous programs aimed at
improving health and preventing disease through
promotion of more desirable fat consumption patterns have
been developed and evaluated [23,27-34]. These programs
are likely to be more effective if they are based on both the
theory and practice of changing health-related behaviors,
adapting them to real clinical settings through adequate
interactive tools. Several theories are commonly used in
understanding and predicting such human health behaviors
as the reduction of fat intake. The terms used for the
psychosocial determinants of behavior differ for the
various theories. Nevertheless, there is substantial overlap
among the underlying constructs [35-42]. The constructs
most commonly used are attitude, self-efficacy, subjective
norm (also known as perceived social support) and health
threat (or susceptibility). Numerous studies have shown the
importance of these determinants in relation to intention to
change behavior and current or future behavior [43,44].
Most contemporary social psychological models of
human behavior emphasize the conscious nature of
behavior choice [45-47]. It is argued, however, that
repeated activities (e.g., food choice, fat consumption)
become habitual, rather than conscious and rational
[46,48]. They are therefore less likely to be controlled
solely by the behavioral determinants involved in
conscious decision-making. This led Triandis in 1977 to
includehabitas a determinant in a behavior model for the
first time [49]. Since then, the importance of habit for the
prediction of current or future behavior has been shown
several times [46-48,50,51]. However, it is still
questionable whether previous behavior influences
subsequent behavior directly, or through feedback that
influences attitudes, self-efficacy, subjective norm and
health threat [45-47,51]. Hence, the socio-cognitive
approach strongly suggests that the best way to promote a
safer diet in patients is to gain a detailed knowledge of
their habits, values and psychological characteristics in
order totailor an intervention based on a calibrated
feedback system. The only way to implement this system
easily is to build up fully usable electronic tools.
We argue that it would be advisable to integrate a
dietary monitoring tool within a general electronic personal
health record. In this way, both physicians and patients
could have at a glance a picture of the whole situation,
suggesting possible interventions in real time and with
little effort. These tailored tools could be very important in
enhancing the quality of life of both cancer patients and
survivors, separate from and in addition to promoting a
healthier lifestyle in the general population. These tools
could play an important role both in primary prevention
and in secondary prevention. In primary prevention,
personalized tools can help promote healthy behavior
(nutrition, smoking cessation and physical activity) within
the whole population. Also, they could contribute to the
support and development of correct knowledge of better
health practice, helping subjects to overcome cognitive
distortions and limits (e.g., memory failures).
For example, for an individual who wishes to eat
healthily (a correct portion per day of fat, fruit and
vegetables), it is very important to have a portable tool
which assesses energy consumption and expenditure,
evaluates caloric intake, portion and the composition of
each meal. Additionally, these tools enable subjects to
check for errors and to indicate false beliefs about food-
related choices, potentially modulating attitudes and
behaviors.
However, the personalization process must be the chief
aim within nutritional education. The more we know about
the personal world of each person, the better we will be
able to identify strategies to improve healthy food choices.
In conclusion, we argue that a physician must
recognize nutritional needs of patients and could orient
towards healthier nutrition choices. But in order to practise
this patient-centered approach, physicians must have
proper methods to measure and monitor the nutritional
needs of a patient and adequate instruments to implement
on-time interventions.
Conclusion
The clinical decision-making process in healthcare is a
complex process which involves medical, ethical,
individual, social and cultural factors. The progress of this
approach will be accelerated by technological development
in electronics, in particular portable devices with high
usability, real time applications and interactive interfaces.
Nowadays, due to technological improvement in research
and to the different kinds of approach to the treatment of
disease, a physician becomes the recipient and “carrier” of
very complex scientific knowledge, much more than in the
past [52]. Furthermore, the patient’s role during care is
now increasingly given primary relevance. These changes
have created greater awareness of the need to tailor
interventions specific to the individual.
As we have observed, preventive actions against
cancer may be enhanced by the acquisition of personal
healthy habits (adequate diet, smoking cessation, alcohol
reduction, regular physical activity and so on). Particularly,
it is important to note that good nutrition has a relevant
impact on QoL. Indeed, a proper diet may positively affect
both physical health and psychological wellbeing,
emphasizing the need for clinicians to understand how to
help healthy people and cancer patients adopt a healthy
lifestyle.
In this short overview we have identified different
interactive tools. However, the principal drawback of these
tools is that they are not always applicable in real life,
since they are calibrated to specific clinical settings and are
not tailored on the subjects. Our cognitive approach
suggests that a personalized strategy requires instruments
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271
Figure 2 A conceptual schema of first-person tool design. For discussion, see text.
that can be used more easily by both oncologists and
patients as schematized above in Figure 2.
Personalized tools should include and integrate diverse
domains: a section that evaluates physiological parameters
(weight, height, BMI, age, race, genomic characteristics
and so on); a section that assesses energy consumption and
energy expenditure on a daily basis; a section that
evaluates lifestyle and correlates it to an adequate diet; a
section that involves different food categories and
nutritional properties and a section that gives tailored
nutrition advice through the implementation of an on-line
feedback system, which could even develop, for instance, a
link to appropriate and healthy recipes. All these
interactive tools could be used to achieve personalization
not only in clinical trials, but in real life settings
everywhere.
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11.
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