Psychosocial Context Research Articles

Multidisciplinary Diagnostic Reconciliation as a Domain of Hospital Physical Therapist Practice

An axiom repeated in health care is that they eyes are unable to see what the mind does not yet know. As diagnosticians trained to evaluate functional capacity, identify the impairments that produce functional limitations, and synthesize knowledge of pathophysiology and psychosocial context, physical therapists enjoy opportunities to function as clinicians uniquely valuable to their patients. The more information that a therapist possesses about a disease state or movement disorder, the better-informed will be their patient examinations, the more readily will they identify the subtle abnormalities that become persuasive constellations, and the greater will become their capacity to help their patients.

Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations.

It is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this. To establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so. This was a qualitative study. Data were collected in the Netherlands in 2015. GPs' consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS. A total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings. Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients' symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process.

Psychospołeczne aspekty pracy zdalnej. Wyniki badań przeprowadzonych w trakcie trwania pandemii COVID-19

Objective: The aim of the article is to explore the psychosocial context of remote work. There is a particular focus on engagement and the inconvenience caused by a non-standard work format.Research Design & Methods: The study was conducted on a sample of 201 employees engaged in digital output and able work remotely.Findings: The study showed that non-remote workers exhibit greater vigour, dedication and absorption than those working remotely. The lack of social contact was recognised as the most significant drawback of remote work.Implications / Recommendations: Compared to standard work, long-term remote work can have a negative impact on individuals’ engagement in three dimensions – vigour, dedication and absorption.Contribution: The research results provide the basis for further exploration of psychosocial aspects of remote work.

The Spiritual Dimensions of Healing Rituals in Ancient Mesopotamia.

The spell formula called the Marduk-Ea incantation from ancient Mesopotamia is unique in history of medicine due to its documented use of almost 3000years. The incantation was recited in exorcistic healing rituals. The formal structure of the spell is studied from the point of view of neuroscience of doctor-patient relationship and in the context of the decentring mechanism of religious experiences. The incantation structure is also analysed for decentring phenomenology in dreams. The structure of this incantation enables religious and spiritual experiences to occur both to healer and patient. These experiences generated a positive psychosocial context and facilitated placebo effects. The incantation structure is bound to stimulate brain mechanisms in prefrontal cortex that promote both executive functions and placebo responsiveness.

Innovations in Curriculum Designs Do Not Guarantee Students’ Patient-Centered Attitudes Running Title: Curricula and Patient-Centered Attitudes

ABSTRACT Background Medical schools all around the world are engaged in curricular reforms aimed at fostering patient- and learner-centeredness, implementing curricular transformations in order to counterbalance the erosion of humanistic and professional values and the loss of idealism of recent graduate physicians. In Brazil, medical schools are facing the challenge of redesigning medical curricula towards more learner-centered and patient-centered approaches, stimulated by recent national medical education guidelines. However, desirable outcomes towards medical education have not been fully achieved. Aim To access medical students’ attitudes and determine predictors of medical students’ patient-centered attitudes among students from different curricular designs (traditional, innovative and advanced). Methods Medical students from 1st to 6th year from 21 Brazilian medical schools participating in the project for evaluating change and trends proposed by the Brazilian Association of Medical Education, with different stages of curricular designs (traditional, innovative and advanced), answered the Brazilian version of the Patient–Practitioner Orientation Scale (B-PPOS) and a questionnaire with curricular and sociodemographic variables. Results Brazilian medical students care more than they share information, power and responsibility (p < 0.001; d = 0.599). They are more concerned with the psychosocial context than with patient’s perspective (p < 0.001; d = 0.797) and share more power and responsibility than understanding (p < 0.001, d = 0.455). Female gender (B = 0.180), students from public schools (B = 0.132), year of medical training (B = 0.021), preference for future medical practice in public services (B = 0.053) and extracurricular activities (B = 0.068) were predictors of patient-centered attitudes among medical students (p < 0.05). Meanwhile, the father’s educational level and choice to study surgical specialties (p < 0.05) were predictors of less patient-centered attitudes among students. Different curricular designs were not associated with students’ patient-centered attitudes (p > 0.05). Conclusion tant predictors of patient-centered attitudes among medical students. Further research should investigate the direct influence of faculty professionalism development programs on students’ patient centered-attitudes.

The neurobiological underpinnings of placebo and nocebo effects

The placebo effect, once considered only a nuisance in clinical research, is today a target of scientific inquiry that allows us understand how words, rituals and, more in general, the whole psychosocial context around the patient, affect the response to a treatment and the course of a disease. Today we are in a good position to study all these complex psychological factors by using a physiological and neuroscientific approach that uses modern neurobiological tools to probe different brain functions. Since a placebo is represented by the whole ritual of the therapeutic act, the main concept that has emerged today is that words and rituals may modulate the same biochemical pathways that are modulated by drugs. Most of our knowledge about these mechanisms comes from the field of pain, and represents a biomedical, psychological and philosophical enterprise that is changing the way we approach and interpret medicine, psychology and human biology. If on the one hand we know some of the mechanisms of drug action in the central nervous system, on the other we can now understand how the clinician-patient interaction may affect different physiological functions. In fact, the placebo effect and the therapist-patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica. This represents an epochal transition, in which the distinction between drugs and words is progressively getting thinner, and which helps us overcome the old dichotomy between psychology and biology.

Soldiering on: a survey on the lived experience of tinnitus in aged military veterans in the UK

Tinnitus has long been interrogated as a medical conundrum, with little discourse between medicine and other disciplines. It involves the perception of sound in the ears or head without any...

PET VISITATION AS NARRATIVE CARE FOR OLDER ADULTS IN THERAPEUTIC SETTINGS

A growing body of research highlights the physiological and psychosocial benefits of pet visitation programs in therapeutic settings. These programs utilize the profound connection between humans and animals to promote holistic healing, foster greater quality of life, and influence meaningful communication between patients and providers. For older adults in hospitals or long-term care, these benefits are often correlated with moments of pleasure, comfort, relaxation, and entertainment. The current study builds on this prior knowledge by examining pet visitation programs as a novel form of narrative care that can also help preserve biographical continuity and promote the sharing of lived stories. We worked with two volunteer pet visitation programs in Houston and one in Los Angeles. Our research included a variety of ethnographic methods, including participant observation; informal interviews with providers, patients (or residents, depending on the context), and their families; semi-structured interviews with volunteers; and discourse review of organizational materials. We employed a method of constant comparison to identify and thematically analyze recurrent patterns of behavior and overarching meanings across the data. Three primary themes emerged from the data: (a) compassion, (b) connection, and (c) response. Collectively, the presence of pets prompted stories and behaviors that foster healing relationships characterized by empathy and mutual understanding between patients (or residents), family members, and providers. Pet visitation programs facilitate storied conversations, increased autonomy, and alternative ways of knowing that promote greater understandings of the patient’s (or resident’s) psychosocial context and biographical history, leading to more personalized care and improved well-being.

Rationale and Design of the Hamburg City Health Study

The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study and a unique research platform and network to obtain substantial knowledge about several important risk and prognostic factors in major chronic diseases. A random sample of 45,000 participants between 45 and 74 years of age from the general population of Hamburg, Germany, are taking part in an extensive baseline assessment at one dedicated study center. Participants undergo 13 validated and 5 novel examinations primarily targeting major organ system function and structures including extensive imaging examinations. The protocol includes validate self-reports via questionnaires regarding lifestyle and environmental conditions, dietary habits, physical condition and activity, sexual dysfunction, professional life, psychosocial context and burden, quality of life, digital media use, occupational, medical and family history as well as healthcare utilization. The assessment is completed by genomic and proteomic characterization. Beyond the identification of classical risk factors for major chronic diseases and survivorship, the core intention is to gather valid prevalence and incidence, and to develop complex models predicting health outcomes based on a multitude of examination data, imaging, biomarker, psychosocial and behavioral assessments. Participants at risk for coronary artery disease, atrial fibrillation, heart failure, stroke and dementia are invited for a visit to conduct an additional MRI examination of either heart or brain. Endpoint assessment of the overall sample will be completed through repeated follow-up examinations and surveys as well as related individual routine data from involved health and pension insurances. The study is targeting the complex relationship between biologic and psychosocial risk and resilience factors, chronic disease, health care use, survivorship and health as well as favorable and bad prognosis within a unique, large-scale long-term assessment with the perspective of further examinations after 6 years in a representative European metropolitan population.

“We Are the Poles from Former Yugoslavia.” Transformation Processes Shifted in Time—The Biographical Perspective

This paper is based on the first analysis of the 25 narrative interviews collected from March to November 2018 in small local communities in the Lower Silesia Region. All narrators belong to the families that were transferred from the former Yugoslavia in 1946 to the western lands which were incorporated to Poland. The socio-cultural conditions are significant for local development, so I present some features of localism after 1989 when the state transformation processes started. Next, I discuss the narrators’ self-identity dilemmas and make an attempt to conceptualize “migrating biography” as one of the features of living in a postmodern world.
 The aim of the whole project, but not described in this article, is to reveal the intergenerational adult learning processes seen from the insider’s perspective, as well as to describe such lives in a psychosocial and cultural context.

Disentangling the Effects of Boys' Pubertal Timing: The Importance of Social Context.

Some prior studies have found that, for boys, earlier puberty is linked to higher crime and delinquency, while other studies have found that earlier puberty is associated with greater social competence and beneficial psychosocial development. The current study suggests that these seemingly contradictory results actually represent two divergent pathways by which earlier pubertal timing can affect adjustment. Which pathway boys take is highly dependent on psychosocial context. Using a sample of 310 African American boys and their primary caregivers tracked across three waves of data collection from ages 10.55-18.84 from the Family and Community Health Study (FACHS), the current study utilizes Latent Moderated Structural Equation Modeling (LMS) to analyze effects of interactions between pubertal timing and social contextual factors on criminal behavior and social competence. Results suggest that criminogenic effects of early puberty are contingent on deviant peer group, poor school experience, harsh parenting, and neighborhood disorganization, whereas the association between earlier puberty and social competence is attenuated by harsh parenting. Results suggest that modeling both positive and negative development outcomes together may give a clearer picture of the developmental consequences of pubertal timing for boys. In addition, this study shows the importance of social context in shaping the meaning and consequences of biological variables like pubertal timing.

Clear skies ahead: optimizing the learning environment for critical thinking from aqualitative analysis of interviews with expert teachers.

IntroductionThe learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners’ development of critical thinking.MethodsWe took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions.ResultsThree major themes emerged regarding participants’ descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1) Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2) Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3) Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning).DiscussionAn optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-00536-5) contains supplementary material, which is available to authorized users.

Pain Anticipation and Nocebo-Related Responses: A Descriptive Mini-Review of Functional Neuroimaging Studies in Normal Subjects and Precious Hints on Pain Processing in the Context of Neurodegenerative Disorders.

The exacerbation of a clinical condition or the occurrence of negative symptoms after an inert substance dispensation or a sham treatment is known as “nocebo effect.” Nocebo is the psychobiological effect due to the negative psychosocial context that accompanies a therapy, and it is a direct consequence of negative expectations by the patients and their own personal characteristics. Although the clinical relevance of the phenomenon is now recognized, a small number of studies have tried to ascertain its neural underpinnings (that it means nocebo responses). Moreover, there is no consensus on the brain networks involved in nocebo processes in humans. In particular, nocebo hyperalgesia has attracted almost no research attention. We conducted a mini-review on the few experimental pain functional magnetic resonance imaging (fMRI) studies of nocebo responses to discuss how negative expectancies and conditioning effects engage brain networks to modulate pain experiences. Moreover, we present possible clinical implications considering Alzheimer’s disease and behavioral frontotemporal dementia, in which the existence of a hypothetically disrupted neurocognitive anticipatory network—secondary to an endogenous pain modulatory system damage—may be responsible for pain processing alterations.

Fine Particle Air Pollution and Physiological Reactivity to Social Stress in Adolescence: The Moderating Role of Anxiety and Depression.

Exposure to high levels of fine particle air pollution (PM2.5) is associated with adolescent pathophysiology. It is unclear, however, if PM2.5 is associated with physiology within psychosocial contexts, such as social stress, and whether some adolescents are particularly vulnerable to PM2.5-related adverse effects. This study examined the association between PM2.5 and autonomic reactivity to social stress in adolescents and tested whether symptoms of anxiety and depression moderated this association. Adolescents from Northern California (N = 144) participated in a modified Trier Social Stress Test while providing high-frequency heart rate variability and skin conductance level data. PM2.5 data were recorded from CalEnviroScreen. Adolescents reported on their own symptoms of anxiety and depression using the Youth Self-Report, which has been used in prior studies and has good psychometric properties (Cronbach's α in this sample was .86). Adolescents residing in neighborhoods characterized by higher concentrations of PM2.5 demonstrated greater autonomic reactivity (i.e., indexed by lower heart rate variability and higher skin conductance level) (β = .27; b = .44, p = .001, 95% CI = 0.19 to 0.68) in response to social stress; this association was not accounted for by socioeconomic factors. In addition, adolescents who reported more severe anxiety and depression symptoms showed the strongest association between PM2.5 and autonomic reactivity to social stress (β = .53; b = .86, p < .001, 95% CI = 0.48 to 1.23). Exposure to PM2.5 may heighten adolescent physiological reactivity to social stressors. Moreover, adolescents who experience anxiety and depression may be particularly vulnerable to the adverse effects of PM2.5 on stress reactivity.

A meta-ethnography of adult smokers' exploring the meanings of tobacco dependency medications adherence behaviours during smoking cessation.

To synthesize the experiences and adherence of adult smokers' with tobacco dependence medications. Meta-ethnography. Seven bibliographic databases were systematically searched until April 2016. A standardized appraisal tool evaluated the quality of the selected studies. Seven studies met the eligibility criteria. Three major themes described the experiences and adherence of adult smokers' with tobacco dependence medications; the psychosocial context, predilection for willpower and "natural" methods and a tendency to resist medications. The findings of this meta-ethnography are important to future clinical practice guideline development so health professionals contribute effectively to further reduction in smoking prevalence. Further research is needed to understand resistance to tobacco dependence medications and to inform the design of person-tailored interventions to improve tobacco dependence medication adherence that can be incorporated into smoking cessation interventions. Smoking causes more death and disability in the world than any other avoidable factor. Research on smoker perspectives on tobacco dependence medications is sparse. Tobacco dependency is a unique treatment context with specific adherence issues. Smokers are active decision-makers regarding tobacco dependence medications. Inconsistent adherence to tobacco dependency medication regimens was apparent. Implications for health professionals, healthcare policy and clinical practice guidelines regard the structure of consultations with smoking patients. It is critical for all health professionals to assess the person seeking to stop smoking and foresee the possible causes of non-adherence behaviour. Addressing non-adherence will to lead to more effective health communications and positively contribute to quality of smoking cessation care.

An Exploration of Psychosocial Factors Associated with Female Genital Self-Image

Negative genital self-perceptions or female genital self-image (FGSI) is a prevalent concern for women. This is a significant problem in and of itself but also because it is associated with a variety of negative outcomes including less frequent sexual behavior, more negative cognitive-affective sexual responses, and poorer decision-making about genital health. This study examined the extent to which various psychosocial factors are associated with more negative FGSI. Two hundred cisgender women with diverse ages and relationship statuses completed an online survey that included measures of sexual health education (quality of school-based sexual health education (SHE), female genital knowledge), pornography use, sexual experiences (positive and negative partner genital feedback, frequency of sexual activity), and cognitive-affect appraisals (body image, sexual comfort). Social desirability, cognitive-affective appraisals, sexual experiences, and SHE were associated with FGSI at the bivariate level. The results of a multiple regression analysis indicated that only sexual comfort, body image, and positive genital feedback contributed uniquely to the prediction of FGSI. The results are interpreted in terms of the importance of the psychosocial context for understanding women’s genital self-perceptions as well as their implications for prevention and intervention strategies aimed at addressing the problem.

The 3i Conceptual Framework for Recognizing Patient Perspectives of Type 1 Diabetes During Emerging Adulthood

Early emerging adulthood, the developmental life stage roughly spanning between the ages of 18 and 24 years, can be a challenging time for individuals living with type 1 diabetes, being associated with an increased risk of acute complications, loss to follow-up, and the emergence of long-term diabetes complications. Few evidence-based interventions exist, and practice guidelines instead emphasize the importance of delivering individualized, developmentally appropriate care. To inform the provision of tailored care and education by illuminating the individual lived experiences of emerging adults with type 1 diabetes. This qualitative study used in-depth interviews conducted with 33 emerging adults living with type 1 diabetes between October 14, 2016, and May 16, 2017. Participants were recruited from 2 urban Young Adult Diabetes Clinics in the city of Toronto, Ontario, Canada, using a convenience sampling approach. Narrative analysis of participants' accounts was conducted inductively to define story typology. Participant accounts of type 1 diabetes during childhood, adolescence, and emerging adulthood. Interviews were conducted with 33 participants aged 18 to 24 years (mean [SD] age at interview, 20.6 [1.7] years); 17 (51%) were women. Duration of diabetes ranged from 3 to 20 years (mean [SD] duration, 12.0 [4.8] years). Narrative analysis identified 3 distinct story types, or lenses, termed ingrained (n = 14), intrusive (n = 12), and inconspicuous (n = 7). Ingrained narratives portrayed an active integration of diabetes self-management into daily life. Intrusive narratives were characterized by stories of struggles for acceptance and striving for control. Inconspicuous narratives were differentiated by descriptions of a willingness to ignore diabetes and its attendant daily tasks with the goals of preserving normalcy and limiting distress. Mean levels of hemoglobin A1c were higher in participants conveying an intrusive lens narrative (mean [SD], 9.3% [1.6%]) than those conveying an ingrained lens (mean [SD], 7.4% [0.7%]) (difference between intrusive and ingrained, 1.9%; 95% CI, 0.8%-2.9%; P = .007) or an inconspicuous lens (mean [SD], 8.6% [1.5%]). Although every person is unique, there are commonalities in how emerging adults perceive and depict their experiences living with type 1 diabetes. Among the emerging adults interviewed in the present study, the 3i conceptual framework of ingrained, intrusive, and inconspicuous lenses encapsulated these commonalities. Recognition of the different psychosocial contexts surrounding type 1 diabetes during emerging adulthood may help health care professionals individualize their care accordingly.

824-P: Ecological Momentary Assessment of Diabetes Self-Management: A Systematic Review of Methods and Procedures

Ecological momentary assessment (EMA) is a mHealth method of real-time data collection in which people report on behavior and the context of the behavior at multiple time points in their natural environment. It is an innovative counterpart to traditional research methods that have relied on retrospective measures. The aim of this systematic review is to describe EMA methodology that has been used in studies of diabetes self-management. PubMed, CINAHL, PsycINFO, and EMBASE were searched for studies published between January 2000 and December 2018. We identified six studies that met the inclusion criteria. We evaluated the following areas of EMA methodology: 1) sampling and study design, 2) primary measures, 3) delivery technology, 4) EMA schedule and prompting strategy, and 5) EMA compliances. Five out of six studies were conducted in the U.S. with adolescents with type 1 diabetes. One study was conducted in Japan with adults with type 2 diabetes. Four studies used a prospective observational study design with a monitoring period ranging from 3 to 14 days (a total 1,000 to 2,128 observations:). Two studies were integrated with ecological momentary interventions (30 days and 6 months) with real-time biobehavioral feedbacks. All studies assessed diabetes self-management behaviors via EMA surveys. Most studies (78%) reported the relationship among psychosocial contexts, mood, affect, eating, and glucose monitoring. Three studies used handheld computers; two used automated telephone response systems; and one used a smartphone app. The prompt frequency ranged from twice a day to 1-2 times per hour using interval-contingent prompting strategy. Most studies failed to report EMA compliance rates. For those who reported, compliance rates ranged 59-96%. There has been limited research using EMA methodology to assess diabetes self-management and contextual factors. More research with standardized EMA reporting may help to develop personalized diabetes intervention. Disclosure S. Nam: None. R. Whittemore: None. D. Vlahov: None. G. Dunton: None.

1250-P: Developing an “Appropriateness of Glucose-Lowering Therapy” Measure: Qualitative Analysis of Delphi Panel Deliberations

Despite the increasing focus on individualized diabetes care, current diabetes quality measures are still based on meeting generic HbA1c targets. We proposed an alternative measure to assess the appropriateness (vs. over- or under-treatment) of glucose-lowering therapy that accounts for patient complexity and treatment burden. We worked with OptumLabs® to convene a 12-member modified Delphi panel, selected from among its partner institutions and the NQF Measure Incubator® network, to refine the measure. Members included clinicians (endocrinology, primary care, geriatrics), pharmacists, nurses, researchers, and representatives of public and private health plans. In this study, we examined the factors the panel valued in an ideal appropriateness measure. Two researchers independently coded panelists’ written responses to a range of questions about the appropriateness measure. Conducting an inductive analysis, codes and overarching themes emerged by consensus. Participants conveyed that an ideal measure must promote individualized care (evidence-based treatments that are consistent with patient psychosocial and biological context, their values and preferences), allow for clinical decision making, and have optimal accountability properties (be easy to implement with reasonable accuracy and reliability, without unintended effects on utilization). Panelists prioritized protecting patient and clinician autonomy, reducing patient treatment burden and clinician punitive potential, and allowing for reasonable clinical exceptions. Our analysis identified factors that stakeholders value in formulating an appropriateness measure for glucose-lowering therapy. Addressing these factors, and those identified by people with diabetes in subsequent research, may produce a quality measure that strikes a patient-centered balance between glucose control targets and the everyday complexities of being, and treating, people with diabetes. Disclosure C.M. LaVecchia: None. V.M. Montori: None. N. Shah: None. R.G. McCoy: None. Funding American Association of Retired Persons; OptumLabs; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

Developing an adolescent and young adult (AYA) cancer program in an Italian adult high-volume cancer center.

e18034 Background: Given the lack of survival improvement and the several unmet clinical/psychosocial issues, programs for AYA (15 to 39 yo) are underway, involving local resources and organizations. Conventionally the healthcare system address inadequately the needs of AYAs. Humanitas Research Hospital is a high volume Cancer Center for adult patients with long lasting expertise in rare cancers based on a multidisciplinary approach. Methods: We conducted a retrospective evaluation of the number of patients followed in our Institute from 2010 to 2017 to assess our potential as an AYA referral center. In February 2017 we started a dedicated program, focused on medical and psychosocial issues of AYA and supported by an interdisciplinary team including medical oncologists, psychologists, surgeons, radiation oncologists, fertility experts, cardiologists, genetic consultants, endocrinologist, palliative care providers, social workers, and liason nurses . Results: From 2010 to 2017 more than 6600 AYA pts were seen in Humanitas. The epidemiology reflects the published data. Since the beginning of the program (February 2017), more than 2000 new AYA pts were referred to our dedicated clinic. Based on a patient-focused model of care, the aims of the first access are the comprehension of the complex pathways to diagnosis often delayed, the access to optimal care including clinical trial, the recognition of the unique psychosocial context, the counselling on key issues for AYA (fertility, cardiology, nutrition, smoking, financial). We created a dedicated physical space where pts, families and caregivers can spend time together, reducing the feeling of isolation. They meet also specialists trained to deal with their needs, to reduce the adverse impact of the diagnosis and to improve the adherence to treatment. Daily activities, such as cooking and photography class, professional writing and acting, are also offered. Conclusions: Humanitas AYA project modified the hospital environment making it more comfortable for our pts and improved the awareness of the healthcare providers to AYA unmet needs. Outcome and research program improvement are long-term endpoints to bridge the clinical gap of AYA pts.