Background: Eye Movement Desensitization and Reprocessing (EMDR) therapy is an evidence-based intervention for trauma-related disorders and other psychological conditions, including depression. Although the positive effects of EMDR in treating depressive symptoms have been empirically supported under controlled conditions, little is known about individual and process-related factors associated with treatment outcome for depression. Objective: This study aims to present a protocol for evaluating factors associated with EMDR therapy effectiveness for depressive symptoms in real-world clinical settings. The primary objective is to identify individual characteristics that may predict treatment response. Secondly, we aim to examine potential moderating factors of EMDR for depressive symptoms, including psychologically associated symptoms and therapeutic relationship. Methods: A prospective observational design that combines a series of N-of-1 trials will be conducted in thirty-two patients presenting with clinically significant levels of anxiety, depressive, dissociative, or post-traumatic stress symptoms in at least one domain. Italian EMDR therapists voluntarily participate in the study and enroll one patient each who meets the inclusion criteria. Data will be collected via REDCap at different timepoints, from baseline to the end of therapy. A Bayesian multilevel random-effects meta-analysis and meta-regression will be conducted. This design allows for analysis of model parameters to generate direct probabilistic statements about scientific hypotheses, extending beyond treatment efficacy. Conclusion: Results will provide insights into factors influencing the effectiveness of EMDR therapy for depressive symptoms. The understanding of predictors and process moderators is expected to improve clinical interventions and contribute to bridging the current gap between research and clinical practice. Findings are expected to contribute to a promising line of research aimed to advance clinical practice through the systematic collection of real-world data. Moreover, the results may strengthen the evidence on EMDR therapy in real-world settings, and support the optimization of treatment based on individual patient characteristics. Clinical trial registration: ClinicalTrials.gov , identifier NCT07033741.

Background: The safety and restriction regulations implemented to contain the COVID-19 pandemic significantly impacted people’s quality of life compromising the perception of dignity. Preserving dignity for end-of-life patients remains a paramount objective in palliative care. This study aimed to compare dignity levels in terminal cancer patients between pre- and during-pandemic periods. Methods: Dignity was assessed by the Italian version of the Patient Dignity Inventory (PDI-IT) in both pre- and during-pandemic groups of terminal cancer inpatients (hospitalized or admitted in hospice). The 2 groups were compared using non-parametric tests and a multivariate logistic regression analysis to estimate the association of the different dimensions of dignity with COVID-19 period, adjusting for other confounders. The study involved 2 groups of end-of-life cancer patients with a Karnofsky Performance Status (KPS) index less than 50. The first group included 506 patients before COVID-19, and the second group consisted of 156 patients enrolled during pandemic. Results: Existential Distress, Loss of Purpose and Meaning, Physical Symptoms and Dependency, Social Support PDI subscales and PDI Total score were higher in the during-pandemic group. The multivariate regression model partially supported the previous results as Loss of Purpose and Meaning, Social Support, and Existential Distress PDI subscales were associated with during-pandemic period, whereas PDI Physical Symptoms and Dependency and PDI Psychological Distress were not. Conclusion: Social isolation and other restrictions put in place to contain the COVID-19 pandemic may have had a negative impact on the perception of dignity in cancer patients at the end of life.

Spirituality is widely recognized to play an important role in the experience of terminally ill cancer patients, and several studies have shown that spiritual dimensions in their care can significantly enhance their quality of life and emotional well-being. The FICA© Spiritual History Tool, developed by Dr. Christina Puchalski, provides clinicians with a framework for addressing patients’ spiritual histories. The aim of this study was to translate, culturally adapt, and apply the FICA© Spiritual History Tool in a sample of Italian end-of-life cancer patients and to identify the spirituality-related themes that emerge. The cultural adaptation process included forward–backward translations of the FICA© Spiritual History Tool, followed by its application through in-person conversations. Of the 95 eligible participants, 80 terminally ill cancer patients (84%) were included. A thematic analysis of the responses was conducted. Findings indicated that spirituality can provide a source of support for many Italian patients coping with terminal cancer. Spirituality was most frequently reflected with the Catholic faith. Some participants reported not belonging to any specific religious community; instead, they primarily relied on the support received from family and friends. The Italian version of the FICA© Spiritual History Tool is clear, understandable and focused on exploring spirituality and its relevance in end-of-life conversations. Healthcare providers (HCPs) should be informed about and encouraged to use this tool to gather essential information about their patients’ spiritual history and perspectives, supporting personalized care beyond their physical illness.

Dissociation is typically defined as a disruption or discontinuity in the integrated functions of consciousness, memory, identity, emotion, perception, motor control, and behavior (American Psychia...

Objectives: Existential distress is a debilitating condition in end-of-life cancer patients. The Psycho-existential Symptom Assessment Scale (PeSAS) was developed to screen psycho-existential symptoms in palliative care, but limited research has examined its use. This study aimed to implement the Italian version of the PeSAS in palliative care services and to evaluate changes in healthcare providers’ (HCPs) competence after experiential training. It also aimed to estimate the frequency of psycho-existential symptoms and explore the scale structure using network analysis. Methods: Two-hour experiential workshops were conducted in 5 Italian palliative care services by a clinical psychologist specialized in psycho-oncology and palliative care. Training covered psycho-existential distress, role-play, and feedback. Pre- and post-workshop questionnaires assessed clinicians’ self-efficacy in evaluating physical, psycho-existential, and suicidal symptoms, managing distress, and providing psychosocial support. Patient cross-sectional data were analyzed with descriptive statistics, t -tests, chi-square tests, and exploratory graph analysis. Results: One hundred one clinicians from 3 services participated. Significant results were found in HCPs’ self-efficacy, with the largest effect in assessing suicidal symptoms (Cohen’s d = 0.54), followed by managing distress ( d = 0.47) and evaluating psycho-existential symptoms ( d = 0.40). Of 210 patients screened, 194 were included. PeSAS scores were strongly associated with Hopelessness (strength = 1.30) and depression (1.18), while being trapped by illness (−1.64) and wishing to die (−1.12) had weaker associations. Significance of results: The Italian PeSAS is feasible for integration into palliative care. Strong associations highlight targets for interventions, while weaker associations suggest the need for additional approaches. PeSAS enhances HCPs’ ability to address the psycho-existential needs in end-of-life care.