The Art of Counselling in the Treatment of Head and Neck Cancer: Explorative Investigation Among Perceptions of Health Professionals in Southern Italy.

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Raffaele Addeo, Marco Bocchetti, Francesco Perri, Angela Salvato, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-589953/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background. Recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) patients show a poor prognosis, which has not changed significantly for 30 years. Preserve the quality of life represent a primary aim for this subset of patients. Methods. A group of 19 nineteen physicians, working in South of Italy, and daily involved in H&N cancer care took an online anonymous survey aiming to disclose the knowledge level and communication techniques application in the daily patients care. Results. Several specialists consider that patient involvement in therapeutic choices is mandatory. The main obstacles for a complete and reciprocate communication still consist in the lack of time and staff but also in the need for greater organization, which goes beyond the multidisciplinary strategy already used. Conclusions . A greater impulse to training and updating on issues related to counselling my improve communication between the different clinicians involved in the treatment plan. Health Economics & Outcomes Research metastatic squamous cell carcinoma of the head and neck counselling patient preference survey open communication Figures Figure 1 Figure 2 1. Introduction Head and neck (H&N) cancers are a complex, heterogeneous group of malignancies, which require multifaceted treatment strategies and the input of several specialties. Despite the advancements in multimodality treatments, the prognosis is still dismal because of the high rate of advanced disease at diagnosis and high recurrence rate. At least 50% of patients with locally advanced disease are likely to develop loco-regional or distant relapses within the first 2 years of treatment [ 1 ]. For this subset of patients, an improved patient-physician communication is essential in the context of serious and life-limiting illnesses, with clear effects of good communication on quality of care and quality of life (QoL). Moreover, an ethical mandate by which patients are involved and participate in informed decisions regarding their care is essential, as well [ 2 ]. In advanced H&N cancer, inadequate communication about prognosis and treatment choices is frequent [ 3 ] and is related with unrealistic patient expectations regarding curability and with an aggressive treatment proposal that is not concordant with patients’ preferences [ 4 ]. In the hospital, critical conversations typically do not occur or occur shortly before the start of the treatment program. Most patients with advanced cancer want to be actively involved in their care and request frank and sensitive conversations about quality of life, prognosis, and treatment choices [ 5 ]. Patient involvement in the treatment decision improves their satisfaction and treatment adherence, positively influencing the oncologic care [ 6 ]. Multimodality treatment with a multidisciplinary team has become the standard option with a positive impact on patient assessment and management, improving the survival of stage IV patients [ 7 ]. However, this approach may represent a barrier to real patients involvement, because values and preferences are not acknowledged during multidisciplinary discussion, this has been described in the health care field as “in absentia” [ 8 ]. Clinicians often feel unprepared to have conversations that may include emotional reactions and address challenging treatment-related side-effects. These difficulties are greater in the setting of patients who need palliative care, and it is independent from the experience of doctors [ 9 ]. In clinical practice, clinicians frequently think to be better communicators than either colleagues or patients opinion [ 10 ], however it represent only an illusion and often the communication is not happening. The discussion on controversial topics, such as treatment complications and the outcomes in the lifestyle, need to be addressed with particular attention to feelings. Patients with advanced H&N cancers prefer that clinicians bring up the topic and expect they do it [ 11 ]. Among patients with head and neck cancer, those awaiting the start of palliative chemotherapy are expected to have the greatest degree of distress. Long periods of treatment, repeated hospitalization, side-effects of chemotherapy, can affect the psychological status of these patients and influence the communication with specialists. The major biggest problem with communication is the illusion that it has occurred. The knowledge of strengths and weaknesses can facilitate the development of patient-centred care [ 12 ]. The purpose of this observational study was to investigate the level of knowledge of counselling among clinicians engaged in the treatment of H&N cancer and highlight the barriers and aspects of the doctor-patient and doctor-family relationship requiring improvement. 2. Materials And Methods The data were collected between January 2020 and March 2020, using an online anonymous survey administered to 19 specialist doctors, through the SurveyMonkey ® platform. A group of 19 physicians, working in South of Italy and daily involved in H&N care, including oncologists and radiotherapists. All the investigated physicians returned the questionnaire (rate of acceptance 100%) and were hence included in the analysis and a written informed consent to participate. This survey was specifically arranged to investigate the value and the level of knowledge of shared communication and counselling in managing patients with cancer (Table 1 ). Table 1 The the questionnaire proposed to clinicians involved in the treatment of patients with metastatic Head and neck cancer. Surname: Name: Age: Sex: Specialization: Years of practice in SSCHN treatment Total number and specialization of HCP involved in patient treatment: ………………………………………………………………………………………. ………………………………………………………………………………………. To complete this survey, order by priority all the statements below, from 1 to 5, where 1 stays for “the most relevant” and 5 for “the least relevant”. Please, leave out the statement not relevant according to your experience. 1. Which are the foundations that strengthen a therapeutical alliance? Value Informed consent Clear and complete communication Organized and efficient healthcare personnel Confortable care environment Welcoming and helpful staff Others…………………………………………………….. ………………………………………………………….. 2. Which do you think are the aspects that make communication between patient and HCP stronger and more efficient? Value Investigate patient and caregivers expectations for the current visit, and face every point during the examination Give an exhaustive form with all the specific for therapy Constantly monitor the patient’s and caregiver’s level of understanding Pay attention to how messages are received by the patient and the caregiver, and consequentely modulate the subsequent communication Collect relevant information about patient history and lifestyle, to adapt/integrate therapy in patient’s daily life Others…………………………………………………….. ………………………………………………………….. 3. Which do you consider the better strategy to implement a care program focused on patient and patient family? Value Anticipate patient need and be proactive in care program organization Train nursing staff to provide to the patient all the required informations after medical examination Consider patient’s convenience and availability of resources when prescribing exames Use a multidisciplinary approach to reduce waiting list Adequately inform about all the successive steps and waiting times, to reduce patient and caregiver anxiety Have an efficient and organized unit Others…………………………………………………….. ………………………………………………………….. 4. Which competence would you like to improve? Value Technical skills Dialogue and patient management Ability to communicate openly with collegues Management skills Pharmacoeconomy skills Others…………………………………………………….. ………………………………………………………….. 5. Which of the following do you think is an obstacle to a patient focused care? Value Focus on therapy details and not to patient daily life and routine Daily amount of work Scientific and clinical skills Infrastructure shortage Access to care Others…………………………………………………….. ………………………………………………………….. 6. What inhibit empathic communication with patient in daily practice? Value Staff and equipement shortage Lack of information for population Lack of counselling knowledge and skills Lack of time Structure inadequacy Others…………………………………………………….. ………………………………………………………….. 7. Which is the strenght of your Unit to pursue a patient-focused care? Value Quick access Adequate equipment and environment Multidisciplinariety Patient involvement in care path Professional know-how Others…………………………………………………….. ………………………………………………………….. 8. Which is the weakness of your Unit to pursue a patient-focused care? Value Lack of time Overcrowding Inadequate equipment and environment Internal conflicts Lack of knowledge about counseling Others…………………………………………………….. ………………………………………………………….. 9. Which of the following point is the most disregarded? Value Take time listening to the patient more than talking about pathology Ability to investigate about patient doubts and anxieties Confortable environment of care Open and complete communication Clear and detailed explanation of therapeutic schedules Patient involvement Others…………………………………………………….. ………………………………………………………….. 10. Which aspect would you like to improve? Value Open multidisciplinary confrontation Dialogue skills with patient and caregivers Care and diagnostic protocols Management skills Environment improvement Specialized nursing staff Others…………………………………………………….. ………………………………………………………….. 11. Which of these needs is the most relevant for metastatic and/or recurrent SCCHN patients? Value Nutritional counselling Pain theray Depression and anxiety Open communication Therapy side effects management Talk about disease impact in patient life Others…………………………………………………….. ………………………………………………………….. 12.Which ECM updating would you more need or prefer? Value Immunotherapy Radiotherapy specific topics Pharmacoeconomy Counselling and effective comunication Legal issues Palliative care Nutrition Others…………………………………………………….. ………………………………………………………….. 13.Which is the more relevant topic in SSCHN therapy? Value Multidisciplinariety Treatment protocols specific for pathology Counselling and effective comunication Frail patient Palliative care Nutrition Others.......................................................................… ............................................................................... 14.From 1 to 10, how much are you using counselling techniques in your daily clinical practice? 1 2 3 4 5 6 7 8 9 10 15. Give a short explanation to the score of question 14 ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- 16. Shortly describe what will help you to improve the score of question 14 ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- 17. Thinking to your daily work, you will describe yourself: Value Deeply unsatisfied Fairly unsatisfied Partially satisfied Satisfied Very satisfied Why? ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- Seventeen questions, including 14 multiple choice questions, were submitted to the participants. The first part of the survey, points 1 to 6, investigated the state of the art shared with patient suffering from H&N cancers and the role of counselling. In the remaining 9 questions, we investigated the needs and critical issues that hinder and limit shared communication. 3. Results All physicians, clinical oncologist and radiotherapists, specialized in the treatment of H&N cancer, who attended a meeting about H&N cancer patients counselling in Naples during November 2019, returned the questionnaire (rate of acceptance 100%) and were hence included in the analysis. Most respondents (40%) consider a clear and complete communication as the foundation that strengthens a therapeutic alliance also pointing out the need to have organized and efficient healthcare personnel. To confirm this data, twelve out nineteen medical doctors consider that investigate patient and caregivers expectations for the current visit, and face every point during the examination represent a priority to make communication between patient and HCP stronger and more efficient. However, only five specialists consider the patient involvement in care pathway the main strength of his Unit to pursue a patient-focused care (Table 2 ). Table 2 Distribution of the response to question 7 provided by the clinicians, oncologists and radiotherapists involved in the online survey. Which is the strenght of your Unit to pursue a patient-focused care? Value ( n = 19) Quick access 6 Adequate equipment and environment 4 Multidisciplinariety 3 Patient involvement in care path 5 Professional know-how 1 Others…………………………………………………….. ………………………………………………………….. On the other hand, most interviewees, responding to question number four, aim to improve dialogue skills and patient management (Table 3 ). Table 3 Distribution of the response to question 4 provided by the clinicians, oncologists and radiotherapists involved in the online survey. Which competence would you like to improve Value ( n = 19) Technical skills 2 Dialogue and patient management 9 Ability to communicate openly with colleagues 3 Management skills 2 Pharmacoeconomy skills 2 Others…………………………………………………….. ………………………………………………………….. On the other hand, the majority of clinicians (ten out nineteen), think that overcrowding and lack of time represent the principal weakness to pursue a patient-focused care while carrying out daily work. Consequently, twelve doctors out of nineteen interviewed believe that the principal objectives not reached are: taking time listening to the patient more than talking, and the ability to investigate about patient doubts and anxieties. The open multidisciplinary confrontation and dialogue skills with patients and caregivers represent an aspect that clinicians would like to improve during daily clinical practice, as evidenced by the answers provided in the questionnaire. However, only five specialists consider “open communication” the most relevant need for metastatic and/or recurrent H&N patients. Instead, the majority continues to consider a priority need the nutritional counselling and pain therapy. The counselling and effective communication with the multidisciplinary approach represent the most peculiar topics for almost all interviewees in relation to the treatment of H&N advanced cancer, as shown in the answers to question twelve of the questionnaire. Eleven respondents continue to consider the multidisciplinary approach the more relevant topic in SSCHN therapy, but for eight of them this approach cannot be pursued without counselling and effective communication with the patient and its caregivers. 4. Discussion Squamous cell carcinoma of the head and neck remains a challenging clinical problem, with half a million new cases annually worldwide. Despite the recent development of new therapeutic option like immunotherapy, patients with advanced disease have still low chances to be cured by current therapies [ 13 ]. Several studies and research have established that HNC care delivered through an integrated Multidisciplinary Team (MDT) approach determines improved patient outcome and better survival rates [ 7 , 14 ]. This innovative approach could increase efficiency in care delivery, reduce costs and shorten the length of hospital stay [ 15 ]. This approach core is represented by the information share and dialogue between the various professionals involved in the treatment pathway. In this setting, showing respect for the patient's preferences ensuring the better quality of life, represent today the first aims that the doctor must pursue. This ought to pass through a shared communication obtained by listening to the preferences and the needs of the patient [ 16 ]. Almost all specialists who participated in the survey confirm that they are acknowledged about the techniques of counselling, however they claim to apply these counselling skills only partially, attributing the greatest difficulty to the limited time available in daily clinical practice. All participants recognized the importance and priority of the multidisciplinary approach for the treatment of these tumors. However, they confirmed the presence of a series of obstacles actually limiting its application, including some difficulties in open communication. Dialogue between physicians and patients is the core of quality health care. It is essential that patients' values are respected, it is important to elicit patients' preferences and goals [ 17 ]. Professionals with better communication and interpersonal skills provide better support to their patients. The current productivity-oriented practice environment also presents barriers to effective communication; the experts involved in this observational survey confirm the presence of several obstacles slowing down an adequate development and application of counselling techniques such as overcrowding and lack of time but also internal conflicts and lack of appropriate knowledge about counselling. 5. Conclusions The results of the present survey confirm that clinicians working in oncology tend to have a good perception of their colleagues’ communication skills. Several improvements in H&N cancer treatment recall a greater expectation of collaborative decision making, with professionals and patients participating as partners to achieve an agreement upon goals in accordance with personal beliefs, values and attitudes. The survey highlighted that there is a need for greater communication both by the patient and the doctor himself. In this field, the need to have specific training to improve the level of empathy is clear. Participants underlined how clinical practice and excessive work take away precious time from frank and constructive communication. This survey confirmed that although head and neck doctors will spend decades in medical education and advanced training to learn interventions, communication skills and instructional sessions generally are not considered of similar value. When talking about critical topic, such as advanced cancer, therapeutic options including immunotherapy or radiotherapy, and possible end-of-life decisions, patients want doctors to tell them honestly about their condition. The actual obstacles limit communication and make these decisions more difficult and often incomprehensible (Fig. 1 ). For the majority of the clinicians involved, open communication objectively represents a purpose to be achieved starting from now, avoiding the existing logistical and organizational barriers. This confirms the request for training and professional updates aiming to improve the relationship with the patients to better define their expectations and legitimate requests. Several topics discussions must be improved with the only goal of guaranteeing effective patient-centred communication (Fig. 2 ). The results of the questionnaires point out that the lack of time represents a serious obstacle to the treatment of patients with head and neck cancer. Hence, the need to implement the medical staff involved in the treatment program for those patients in southern Italy. The data confirm the importance of multidisciplinary confrontation and suggest implementing training on clear communication with the stated aim of involving both the patient and his family in therapeutic choices. Declarations Author Contributions: R.A, Conceptualization; R.A, M.B, M.C. writing—original draft preparation and revision; M.B. Figures preparation; F.P, A.S, I.B, A.L. Data Collection; All authors reviewed the manuscript. Funding: This research received no external funding. Conflicts of Interest: The authors declare no conflict of interest. Ethics approval and consent to participate : The present study does not require formal ethic approval and/or acknowledgment by local Ethics committee “Comitato Etico Campania Centro”, in compliance with Italian national regulation (Circolare Ministeriale n. 6 del 2 Settembre 2002 pubblicata sulla G.U. n. 214 del 12 settembre 2002). Written informed consent to participate was obtained by all participants. Consent for publication: Not Applicable Acknowledgments: The authors greatly thank all the Physicians and Specialists who voluntarily completed the survey. Data availability statement: All data generated or analysed during this study are included in this published article. References Argiris, A.; Karamouzis, M.V.; Raben, D.; Ferris, R.L. Head and neck cancer. 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Effects of multidisciplinary care on the survival of patients with oral cavity cancer in Taiwan. Oral Oncol 2012, 48 , 803–810, doi: 10.1016/j.oraloncology.2012.03.023 . Prades, J.; Remue, E.; van Hoof, E.; Borras, J.M. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2015, 119 , 464–474, doi: 10.1016/j.healthpol.2014.09.006 . Saroa, O.; Molzahn, A.E.; Northcott, H.C.; Schmidt, K.; Ghosh, S.; Olson, K. A Survey of Information Needs and Preferences of Patients With Head and Neck Cancer. Oncol Nurs Forum 2018, 45 , 761–774, doi: 10.1188/18.ONF.761-774 . Beers, E.; Lee Nilsen, M.; Johnson, J.T. The Role of Patients: Shared Decision-Making. Otolaryngol Clin North Am 2017, 50 , 689–708, doi: 10.1016/j.otc.2017.03.006 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-589953","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":34620795,"identity":"41c4b65f-2856-493b-be81-cd9d1ca76288","order_by":0,"name":"Raffaele Addeo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYFACxgcfGBgsgIwEAwYGAxs5kNiBB3i1MBvOYGCQgGopSDMGa0kgXsuHw4kNIEF8WszbDzM2/KiQkONvT9744IPB4fT5YYcfAm2xk9NtwK5F5kwyY2PPGQljiTPPig1nGKTnbrydZgDUkmxsdgC7FgmG/OMPeNskEhtu5JhJ8xhY526cnQDSciBxGy4t/I8ZG//+k6iffyPH/DePAXO64ez0D/i1SCQzNvM2SCQYAG1h5jFwTpCXziFgi8RjxmaZYxKGG4F+kZxhkGa4QTqn4ECCAR6/8AO9/6bGRl7uePLGDx/+2MjLz07f/OFDhZ0cLi2YwACs0oBY5SAg30CK6lEwCkbBKBgJAADr4mPM8vf2mgAAAABJRU5ErkJggg==","orcid":"","institution":"asl napoli2 nord","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Raffaele","middleName":"","lastName":"Addeo","suffix":""},{"id":34620797,"identity":"6fcf6136-7619-46dc-81cc-9d5c53c162e9","order_by":1,"name":"Marco Bocchetti","email":"","orcid":"","institution":"University of Campania \"Luigi Vanvitelli\"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marco","middleName":"","lastName":"Bocchetti","suffix":""},{"id":34620798,"identity":"663795c6-4ac6-4969-9444-2e96854707b4","order_by":2,"name":"Francesco Perri","email":"","orcid":"","institution":"Istituto Nazionale Tumori IRCCS \"Fondazione G. 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Introduction","content":" \u003cp\u003eHead and neck (H\u0026amp;N) cancers are a complex, heterogeneous group of malignancies, which require multifaceted treatment strategies and the input of several specialties. Despite the advancements in multimodality treatments, the prognosis is still dismal because of the high rate of advanced disease at diagnosis and high recurrence rate. At least 50% of patients with locally advanced disease are likely to develop loco-regional or distant relapses within the first 2 years of treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For this subset of patients, an improved patient-physician communication is essential in the context of serious and life-limiting illnesses, with clear effects of good communication on quality of care and quality of life (QoL). Moreover, an ethical mandate by which patients are involved and participate in informed decisions regarding their care is essential, as well [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In advanced H\u0026amp;N cancer, inadequate communication about prognosis and treatment choices is frequent [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and is related with unrealistic patient expectations regarding curability and with an aggressive treatment proposal that is not concordant with patients\u0026rsquo; preferences [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the hospital, critical conversations typically do not occur or occur shortly before the start of the treatment program. Most patients with advanced cancer want to be actively involved in their care and request frank and sensitive conversations about quality of life, prognosis, and treatment choices [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Patient involvement in the treatment decision improves their satisfaction and treatment adherence, positively influencing the oncologic care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Multimodality treatment with a multidisciplinary team has become the standard option with a positive impact on patient assessment and management, improving the survival of stage IV patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, this approach may represent a barrier to real patients involvement, because values and preferences are not acknowledged during multidisciplinary discussion, this has been described in the health care field as \u0026ldquo;in absentia\u0026rdquo; [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinicians often feel unprepared to have conversations that may include emotional reactions and address challenging treatment-related side-effects. These difficulties are greater in the setting of patients who need palliative care, and it is independent from the experience of doctors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In clinical practice, clinicians frequently think to be better communicators than either colleagues or patients opinion [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], however it represent only an illusion and often the communication is not happening. The discussion on controversial topics, such as treatment complications and the outcomes in the lifestyle, need to be addressed with particular attention to feelings. Patients with advanced H\u0026amp;N cancers prefer that clinicians bring up the topic and expect they do it [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Among patients with head and neck cancer, those awaiting the start of palliative chemotherapy are expected to have the greatest degree of distress. Long periods of treatment, repeated hospitalization, side-effects of chemotherapy, can affect the psychological status of these patients and influence the communication with specialists. The major biggest problem with communication is the illusion that it has occurred. The knowledge of strengths and weaknesses can facilitate the development of patient-centred care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The purpose of this observational study was to investigate the level of knowledge of counselling among clinicians engaged in the treatment of H\u0026amp;N cancer and highlight the barriers and aspects of the doctor-patient and doctor-family relationship requiring improvement.\u003c/p\u003e "},{"header":"2. Materials And Methods","content":" \u003cp\u003eThe data were collected between January 2020 and March 2020, using an online anonymous survey administered to 19 specialist doctors, through the SurveyMonkey \u0026reg; platform. A group of 19 physicians, working in South of Italy and daily involved in H\u0026amp;N care, including oncologists and radiotherapists. All the investigated physicians returned the questionnaire (rate of acceptance 100%) and were hence included in the analysis and a written informed consent to participate. This survey was specifically arranged to investigate the value and the level of knowledge of shared communication and counselling in managing patients with cancer (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe the questionnaire proposed to clinicians involved in the treatment of patients with metastatic Head and neck cancer.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurname:\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eName:\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge:\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSex:\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eSpecialization:\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYears of practice in SSCHN treatment\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal number and specialization of HCP involved in patient treatment: \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo complete this survey, order by priority all the statements below, from 1 to 5, where 1 stays for \u0026ldquo;the most relevant\u0026rdquo; and 5 for \u0026ldquo;the least relevant\u0026rdquo;.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlease, leave out the statement not relevant according to your experience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Which are the foundations that strengthen a therapeutical alliance?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eInformed consent\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eClear and complete communication\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOrganized and efficient healthcare personnel\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eConfortable care environment\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eWelcoming and helpful staff\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Which do you think are the aspects that make communication between patient and HCP stronger and more efficient?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eInvestigate patient and caregivers expectations for the current visit, and face every point during the examination\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eGive an exhaustive form with all the specific for therapy\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eConstantly monitor the patient\u0026rsquo;s and caregiver\u0026rsquo;s level of understanding\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePay attention to how messages are received by the patient and the caregiver, and consequentely modulate the subsequent communication\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eCollect relevant information about patient history and lifestyle, to adapt/integrate therapy in patient\u0026rsquo;s daily life\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Which do you consider the better strategy to implement a care program focused on patient and patient family?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eAnticipate patient need and be proactive in care program organization\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eTrain nursing staff to provide to the patient all the required informations after medical examination\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eConsider patient\u0026rsquo;s convenience and availability of resources when prescribing exames\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eUse a multidisciplinary approach to reduce waiting list\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eAdequately inform about all the successive steps and waiting times, to reduce patient and caregiver anxiety\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eHave an efficient and organized unit\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Which competence would you like to improve?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eTechnical skills\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eDialogue and patient management\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eAbility to communicate openly with collegues\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eManagement skills\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePharmacoeconomy skills\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Which of the following do you think is an obstacle to a patient focused care?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eFocus on therapy details and not to patient daily life and routine\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eDaily amount of work\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eScientific and clinical skills\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eInfrastructure shortage\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eAccess to care\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. What inhibit empathic communication with patient in daily practice?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eStaff and equipement shortage\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eLack of information for population\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eLack of counselling knowledge and skills\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eLack of time\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eStructure inadequacy\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Which is the strenght of your Unit to pursue a patient-focused care?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eQuick access\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eAdequate equipment and environment\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eMultidisciplinariety\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePatient involvement in care path\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eProfessional know-how\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Which is the weakness of your Unit to pursue a patient-focused care?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eLack of time\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOvercrowding\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eInadequate equipment and environment\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eInternal conflicts\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eLack of knowledge about counseling\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Which of the following point is the most disregarded?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eTake time listening to the patient more than talking about pathology\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eAbility to investigate about patient doubts and anxieties\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eConfortable environment of care\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOpen and complete communication\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eClear and detailed explanation of therapeutic schedules\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePatient involvement\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e10. Which aspect would you like to improve?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabk\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOpen multidisciplinary confrontation\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eDialogue skills with patient and caregivers\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eCare and diagnostic protocols\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eManagement skills\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eEnvironment improvement\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eSpecialized nursing staff\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e11. Which of these needs is the most relevant for metastatic and/or recurrent SCCHN patients?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabl\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eNutritional counselling\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePain theray\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eDepression and anxiety\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOpen communication\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eTherapy side effects management\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eTalk about disease impact in patient life\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e12.Which ECM updating would you more need or prefer?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabm\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eImmunotherapy\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eRadiotherapy specific topics\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePharmacoeconomy\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eCounselling and effective comunication\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eLegal issues\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePalliative care\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eNutrition\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e13.Which is the more relevant topic in SSCHN therapy?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabn\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eMultidisciplinariety\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eTreatment protocols specific for pathology\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eCounselling and effective comunication\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eFrail patient\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePalliative care\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eNutrition\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eOthers.......................................................................\u0026hellip;\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e...............................................................................\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e14.From 1 to 10, how much are you using counselling techniques in your daily clinical practice?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabo\" border=\"1\"\u003e \u003ccolgroup cols=\"10\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e1\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e2\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e3\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e4\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e5\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e6\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e7\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e8\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e9\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003e10\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Give a short explanation to the score of question 14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Shortly describe what will help you to improve the score of question 14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Thinking to your daily work, you will describe yourself:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabp\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eDeeply unsatisfied\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eFairly unsatisfied\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003ePartially satisfied\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eSatisfied\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cem\u003eVery satisfied\u003c/em\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhy?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-------------------------------------------------------------------------------------------------------\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSeventeen questions, including 14 multiple choice questions, were submitted to the participants. The first part of the survey, points 1 to 6, investigated the state of the art shared with patient suffering from H\u0026amp;N cancers and the role of counselling. In the remaining 9 questions, we investigated the needs and critical issues that hinder and limit shared communication.\u003c/p\u003e "},{"header":"3. Results","content":" \u003cp\u003eAll physicians, clinical oncologist and radiotherapists, specialized in the treatment of H\u0026amp;N cancer, who attended a meeting about H\u0026amp;N cancer patients counselling in Naples during November 2019, returned the questionnaire (rate of acceptance 100%) and were hence included in the analysis. Most respondents (40%) consider a clear and complete communication as the foundation that strengthens a therapeutic alliance also pointing out the need to have organized and efficient healthcare personnel. To confirm this data, twelve out nineteen medical doctors consider that investigate patient and caregivers expectations for the current visit, and face every point during the examination represent a priority to make communication between patient and HCP stronger and more efficient. However, only five specialists consider the patient involvement in care pathway the main strength of his Unit to pursue a patient-focused care (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the response to question 7 provided by the clinicians, oncologists and radiotherapists involved in the online survey.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich is the strenght of your Unit to pursue a patient-focused care?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue ( n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eQuick access\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAdequate equipment and environment\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMultidisciplinariety\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePatient involvement in care path\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eProfessional know-how\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn the other hand, most interviewees, responding to question number four, aim to improve dialogue skills and patient management (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the response to question 4 provided by the clinicians, oncologists and radiotherapists involved in the online survey.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich competence would you like to improve\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue ( n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTechnical skills\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDialogue and patient management\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAbility to communicate openly with colleagues\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eManagement skills\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePharmacoeconomy skills\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOthers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn the other hand, the majority of clinicians (ten out nineteen), think that overcrowding and lack of time represent the principal weakness to pursue a patient-focused care while carrying out daily work. Consequently, twelve doctors out of nineteen interviewed believe that the principal objectives not reached are: taking time listening to the patient more than talking, and the ability to investigate about patient doubts and anxieties. The open multidisciplinary confrontation and dialogue skills with patients and caregivers represent an aspect that clinicians would like to improve during daily clinical practice, as evidenced by the answers provided in the questionnaire. However, only five specialists consider \u0026ldquo;open communication\u0026rdquo; the most relevant need for metastatic and/or recurrent H\u0026amp;N patients. Instead, the majority continues to consider a priority need the nutritional counselling and pain therapy. The counselling and effective communication with the multidisciplinary approach represent the most peculiar topics for almost all interviewees in relation to the treatment of H\u0026amp;N advanced cancer, as shown in the answers to question twelve of the questionnaire. Eleven respondents continue to consider the multidisciplinary approach the more relevant topic in SSCHN therapy, but for eight of them this approach cannot be pursued without counselling and effective communication with the patient and its caregivers.\u003c/p\u003e "},{"header":"4. Discussion","content":" \u003cp\u003eSquamous cell carcinoma of the head and neck remains a challenging clinical problem, with half a million new cases annually worldwide. Despite the recent development of new therapeutic option like immunotherapy, patients with advanced disease have still low chances to be cured by current therapies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies and research have established that HNC care delivered through an integrated Multidisciplinary Team (MDT) approach determines improved patient outcome and better survival rates [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This innovative approach could increase efficiency in care delivery, reduce costs and shorten the length of hospital stay [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This approach core is represented by the information share and dialogue between the various professionals involved in the treatment pathway.\u003c/p\u003e \u003cp\u003eIn this setting, showing respect for the patient's preferences ensuring the better quality of life, represent today the first aims that the doctor must pursue. This ought to pass through a shared communication obtained by listening to the preferences and the needs of the patient [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Almost all specialists who participated in the survey confirm that they are acknowledged about the techniques of counselling, however they claim to apply these counselling skills only partially, attributing the greatest difficulty to the limited time available in daily clinical practice.\u003c/p\u003e \u003cp\u003eAll participants recognized the importance and priority of the multidisciplinary approach for the treatment of these tumors. However, they confirmed the presence of a series of obstacles actually limiting its application, including some difficulties in open communication. Dialogue between physicians and patients is the core of quality health care. It is essential that patients' values are respected, it is important to elicit patients' preferences and goals [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Professionals with better communication and interpersonal skills provide better support to their patients. The current productivity-oriented practice environment also presents barriers to effective communication; the experts involved in this observational survey confirm the presence of several obstacles slowing down an adequate development and application of counselling techniques such as overcrowding and lack of time but also internal conflicts and lack of appropriate knowledge about counselling.\u003c/p\u003e "},{"header":"5. Conclusions","content":" \u003cp\u003eThe results of the present survey confirm that clinicians working in oncology tend to have a good perception of their colleagues\u0026rsquo; communication skills. Several improvements in H\u0026amp;N cancer treatment recall a greater expectation of collaborative decision making, with professionals and patients participating as partners to achieve an agreement upon goals in accordance with personal beliefs, values and attitudes.\u003c/p\u003e \u003cp\u003eThe survey highlighted that there is a need for greater communication both by the patient and the doctor himself. In this field, the need to have specific training to improve the level of empathy is clear. Participants underlined how clinical practice and excessive work take away precious time from frank and constructive communication. This survey confirmed that although head and neck doctors will spend decades in medical education and advanced training to learn interventions, communication skills and instructional sessions generally are not considered of similar value.\u003c/p\u003e \u003cp\u003eWhen talking about critical topic, such as advanced cancer, therapeutic options including immunotherapy or radiotherapy, and possible end-of-life decisions, patients want doctors to tell them honestly about their condition. The actual obstacles limit communication and make these decisions more difficult and often incomprehensible (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor the majority of the clinicians involved, open communication objectively represents a purpose to be achieved starting from now, avoiding the existing logistical and organizational barriers. This confirms the request for training and professional updates aiming to improve the relationship with the patients to better define their expectations and legitimate requests. Several topics discussions must be improved with the only goal of guaranteeing effective patient-centred communication (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of the questionnaires point out that the lack of time represents a serious obstacle to the treatment of patients with head and neck cancer. Hence, the need to implement the medical staff involved in the treatment program for those patients in southern Italy. The data confirm the importance of multidisciplinary confrontation and suggest implementing training on clear communication with the stated aim of involving both the patient and his family in therapeutic choices.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e R.A, Conceptualization;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eR.A, M.B, M.C. writing\u0026mdash;original draft preparation and revision;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eM.B. Figures preparation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eF.P, A.S, I.B, A.L. Data Collection;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e The present study does not require formal ethic approval and/or acknowledgment by local Ethics committee \u0026ldquo;Comitato Etico Campania Centro\u0026rdquo;, in compliance with Italian national regulation (Circolare Ministeriale n. 6 del 2 Settembre 2002 pubblicata sulla G.U. n. 214 del 12 settembre 2002). Written informed consent to participate was obtained by all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors greatly thank all the Physicians and Specialists who voluntarily completed the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eAll data generated or analysed during this study are included in this published article.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArgiris, A.; Karamouzis, M.V.; Raben, D.; Ferris, R.L. 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A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. \u003cem\u003eHealth Policy\u003c/em\u003e 2015, \u003cem\u003e119\u003c/em\u003e, 464\u0026ndash;474, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.healthpol.2014.09.006\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaroa, O.; Molzahn, A.E.; Northcott, H.C.; Schmidt, K.; Ghosh, S.; Olson, K. A Survey of Information Needs and Preferences of Patients With Head and Neck Cancer. \u003cem\u003eOncol Nurs Forum\u003c/em\u003e 2018, \u003cem\u003e45\u003c/em\u003e, 761\u0026ndash;774, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1188/18.ONF.761-774\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeers, E.; Lee Nilsen, M.; Johnson, J.T. The Role of Patients: Shared Decision-Making. \u003cem\u003eOtolaryngol Clin North Am\u003c/em\u003e 2017, \u003cem\u003e50\u003c/em\u003e, 689\u0026ndash;708, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.otc.2017.03.006\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"metastatic squamous cell carcinoma of the head and neck, counselling, patient preference; survey, open communication","lastPublishedDoi":"10.21203/rs.3.rs-589953/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-589953/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground. \u003c/strong\u003eRecurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) patients show a poor prognosis, which has not changed significantly for 30 years. Preserve the quality of life represent a primary aim for this subset of patients.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods. \u003c/strong\u003eA group of 19 nineteen physicians, working in South of Italy, and daily involved in H\u0026amp;N cancer care took an online anonymous survey aiming to disclose the knowledge level and communication techniques application in the daily patients care. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003e Several specialists consider that patient involvement in therapeutic choices is mandatory. The main obstacles for a complete and reciprocate communication still consist in the lack of time and staff but also in the need for greater organization, which goes beyond the multidisciplinary strategy already used. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e.\u0026nbsp;A greater impulse to training and updating on issues related to counselling my improve communication between the different clinicians involved in the treatment plan.\u003c/p\u003e","manuscriptTitle":"The Art of Counselling in the Treatment of Head and Neck Cancer: Explorative Investigation Among Perceptions of Health Professionals in Southern Italy.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-06-23 20:17:46","doi":"10.21203/rs.3.rs-589953/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bf783a2-df7b-4fd0-9ad0-e773148b4e73","owner":[],"postedDate":"June 23rd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":5231297,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2022-02-11T05:59:13+00:00","versionOfRecord":[],"versionCreatedAt":"2021-06-23 20:17:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-589953","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-589953","identity":"rs-589953","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}