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The present thesis, entitled Chemotherapy-induced cognitive changes, is being submitted in the alternative format, by Oana Calina Lindner to The University of Manchester for the degree of Doctor of Philosophy in the Faculty of Medical and Human Sciences, School of Psychological Sciences. The thesis consists of five empirical studies, written in article formats and three connecting chapters. The General introduction in Chapter 1, places the thesis in the context of late effects research in cancer survivors. I describe the prevalence of physical and emotional late effects, before going into more details on cognitive late effects. Chapter 2 provides a meta-analytical summary of cognitive impairments following chemotherapy in adult patients. It has already been published in Neuropsychology in 2014. Chapter 3 describes the general objectives and hypotheses of the empirical studies, and Chapter 4 provides more details on the General methods utilized in all the studies. The studies focus on pre- and post-treatment young adult cancer patients who were compared to age-, sex-, and education-matched controls. The instruments include a comprehensive neuropsychological battery, a newly designed memory task, and a complex battery of self-assessment questionnaires. Chapter 5 is the first empirical study, which will be submitted to Journal of Clinical Oncology. It describes the pattern of neuropsychological status of young adult cancer patients following treatment for lymphoma, sarcoma, breast cancer, and germ cell tumour. The impairments were specific to executive functioning, verbal memory, and visuospatial abilities. Uniquely, the chapter depicts differences between cancer groups. Because chemotherapy may not be the primary factor triggering such effects, Chapter 6 details the neuropsychological profile of a group of young adult pre-treatment patients diagnosed with the same malignancies. This chapter will be submitted to Journal of Neuropsychology. Impairments were observed on tests of attention, executive functioning and visuospatial abilities. Both Chapters 5 and 6 emphasize the importance of matching on full scale IQ in cross-sectional studies and they provide evidence that patients' performance on tests of verbal memory and executive functioning may vary as a function of age. Chapter 7 will be submitted to Psycho-Oncology and it suggests the presence of acute memory deficits after the first treatment. Finally, Chapter 8, which will be submitted to Psychosomatic Medicine, provides an in-depth description of the psycho-emotional status of cancer survivors. It describes higher levels of anxiety, depression, fatigue, and cognitive complaints, which mediated the relationship between illness perceptions and quality of life. The complex interaction between these psycho-emotional factors is interpreted within the framework of cognitive-behavioural therapies, which may provide a method to decrease the emotional burden of survivorship in clinical practice. Finally, Chapter 9 summarizes all the empirical findings whilst connecting them to previous literature and specifying future research direction.

Background Loneliness, or the perceived discrepancy between the quantity and quality of ones’ actual social relationships and desired level of connectedness, is a potentially important psychosocial factor in lung cancer patients. The purpose of the current study was to investigate the relationship of loneliness to depressive symptoms, quality of life, and social-cognitive variables and to explore the role of loneliness in mediating relationships between social-cognitive variables and depressive symptoms and quality of life. Finally, the study examined whether loneliness predicted change over time in depressive symptoms and quality of life. Methods Lung cancer patients were recruited from the Moffitt Cancer Center Thoracic Oncology Clinic to complete two study questionnaires via hard copy or online. Participants completed measures of loneliness (UCLA V3), depressive symptoms, (CES-D) and quality of life (FACT-L) at baseline and 30 days later. Participants also completed measures of demographic characteristics and social-cognitive variables, including cancer-related stigma (CLCSS), cancer-related negative social expectations (CNSES), social constraint (SCS), avoidant coping (CRI – avoidant coping), and beliefs about one’s ability to cope with cancer (CBI-B) at baseline. Clinical characteristics were assessed via medical record review. Results Participants (n = 109) reported a low to moderate level of loneliness (M = 33.8), and 38% reported clinically significant (CES-D > 16) depressive symptoms. Quality of life in the current study (M = 98.1) was consistent with normative FACT-L data collected from a sample of lung cancer patients. Loneliness was positively correlated with depressive symptoms (r = .44) and negatively correlated with quality of life (r = -.59). In addition, loneliness was positively correlated with social-cognitive variables in the expected directions and social-cognitive variables were related to depressive symptoms and quality of life in the expected directions (p’s < .001). Mediation analyses yielded evidence for partial mediation, with loneliness mediating the relationships of social-cognitive variables with depressive symptoms and quality of life for nine of the ten models tested. The exception was findings showing that loneliness did not mediate the relationship between beliefs about one’s ability to cope with cancer and depressive symptoms. Loneliness at Time 1 predicted additional variance in depressive symptoms at Time 2 (Β = .38, Adj R2 = .31) after accounting for depressive symptoms at Time 1, but loneliness at Time 1 did not account for additional variance in quality of life at Time 2 after accounting for quality of life at Time 1. Conclusions Results suggest that consideration of loneliness is important in order to understand differences in depressive symptoms and quality of life in lung cancer patients. Beyond its direct impact on clinically relevant outcomes, the experience of loneliness may be the mechanism by which social-cognitive factors influence depressive symptoms and quality of life. Investigation of the relationship between stigma and loneliness in the context of lung cancer is particularly novel and warrants further exploration.

Although young adult (YA) survivors of child cancer comprise a unique group from a developmental standpoint, in most treatment and research settings either child or general adult measures of quality of life (QL) are used to measure adjustment and functioning. Studies have relied heavily on survey methods, and though many hint at a variety of specific problems that a subset of YAs may experience, most identify YA survivors as relatively well adjusted. Interview studies with survivors and care-providers and interactions in survivor support venues paint a more complex and problematic picture of adjustment. To better understand the QL concerns unique to YAs this study employed grounded theory methodology to build a model of survivorship from participant perceptions. Four focus groups were conducted (N=15) with survivors between the ages of 18 and 30 years recruited from in-person and online support group settings. Themes emerged describing a larger extent of struggles than prior studies have identified. The grounded theory model detailed that having cancer can fundamentally change an individual, and these changes and resulting struggles do not end with remission. Survivors described constantly pursuing normalcy in the context of being fundamentally different, while balancing the dual roles of young adult and survivor. Survivors revealed difficulties in essentially every area of their lives (school, work, friendships, family, romance, self-esteem, outlook and attitudes, etc.), and though many could identify strategies for addressing these problems, maladaptive coping techniques dominated and survivors were left feeling overwhelmed, under-supported, and misunderstood. Results suggest that YAs could benefit from QL measures developed specifically with their unique concerns in mind. While progress has been made in developing YA-specific measures, such measures have not become widespread practice in clinical and research settings. Furthermore, this study suggests that collecting such information in a conversational, semi-structured interview format may elicit a fuller scope of survivors’ concerns than pencil and paper methods, though further research is recommended in this area.

Adolescents with cancer are surviving at improved rates with levels of psychopathology in line with their healthy peers. Thus, recent psycho-oncology research is focusing on finding significant predictors to their positive adjustment and psychosocial functioning. The author examined adolescent cancer survivors (n = 50; diagnosis age = 10 – 21; 2 – 10 years post-diagnosis) to test the mediation effects of positive emotionns (satisfaction with life, subjective happiness, and optimism) and time perspective on the outcome variables quality of life and benefit finding with demographic/medical variables (gender, number of treatments received for cancer, and previous psychotherapy) as independent variables. Results indicated that positive emotions fully mediated the relationship between the number of treatments received for cancer and quality of life and partially mediated the relationship between having engaged in psychotherapy and quality of life with adolescent cancer survivors. Importantly, results indicated that patients' with a relapse diagnosis scored significantly different than those with no relapse diagnosis on quality of life. Although positive emotions were significantly associated with scores on benefit finding in a positive direction, benefit finding did not fit two of the four criteria for mediation. Time perspective indices did not meet full criteria for significant mediation with the relationships between independent and outcome variables. Regarding time perspective indices, significant associations included: prior participating in psychotherapy was associated with higher scores on a Past-Negative time perspective, the more treatments received for cancer was associated with higher scores on a Present-Focused time perspective, and higher scores on the Past-Negative time perspective was associated with lower scores on benefit finding. Discussion centers on the use of evidence-based interventions that cultivate positive emotions with adolescent cancer survivors and the utility of implementing quality of life assessment in pediatric medical settings. Continued emphasis is placed on larger sample sizes via multi-center cooperation that may better illustrate adjustment difficulties within subgroups of this population (i.e. relapse diagnosis). Future research considerations are provided for the constructs of time perspective and benefit finding.

Sabemos que o câncer é considerado um problema de saúde pública, muitas são as pessoas acometidas por esta enfermidade e a tendência é que aumente cada vez mais. Paralelo às enormes proporções de incidência do câncer está o aumento no número de pessoas que alcançam sucesso no tratamento oncológico, surgindo um novo grupo: os sobreviventes de câncer. Neste trabalho, entendemos como sobrevivente de câncer o paciente que está há no mínimo cinco anos fora de tratamento, sem apresentar evidência da doença. Sendo assim, define-se como objetivo geral desta pesquisa: discutir os aspectos emocionais de pacientes que terminaram o tratamento oncológico há no mínimo cinco anos. A amostra é constituída por dez participantes que tiveram câncer adulto e terminaram o tratamento oncológico há no mínimo cinco anos em um hospital público da cidade de Aracaju. Para a coleta de dados desta pesquisa foi elaborado um roteiro de entrevista semi-estruturada. Os dados foram analisados de forma qualitativa, utilizando a técnica de análise de conteúdo. Assim, este trabalho mostra que, sobreviver ao câncer é uma experiência complexa, ligada ao modo de enfrentamento e adaptação de cada um. Constitui-se um desafio para os sobreviventes apropriar-se da condição de curado, uma vez que a possibilidade de volta da doença é algo a se considerar, sendo necessário que o sobrevivente consiga elaborar a experiência passada e conviva com a incerteza do futuro. O presente estudo reflete ainda sobre a importância de que não se trata apenas de curar o paciente, mas de oferecer meios para que possa retomar sua vida, integrar-se ao seu meio social. Nesse contexto, a equipe de saúde deve incluir em seus planos terapêuticos ações além dos aspectos clínicos da doença, preocupando-se também com o apoio emocional e social, promovendo o aprimoramento de habilidades de enfrentamento para lidar com a nova condição de saúde e libertar-se do passado, auxiliando os sobreviventes a conviver com esta dualidade que é inerente a vida / Cancer is considered a public health problem. Many people are affected by this illness and there is a tendency for its increasing. However, parallel to the large proportions of cancer incidence, there is the increasing number of people who reach success on cancer treatment. This causes the emergence of a new group: the cancer survivors. We understand a cancer survivor as the patient that hasnt been treated for five years and has no evidence of the disease. The general objective of this research is to discuss the emotional aspects of this group of patients. The sample is constituted by cancer survivors from a public hospital in the city of Aracaju. The data was organized through a semi-structured interview guide that had been previously elaborated. The data was analyzed on a qualitative way, using the content analysis technique. Thus, this research shows that surviving cancer is a complex experience, and it is connected to the way each patient confronts and get adapted to the cure process. Appropriated cure conditions constitute a challenge to survivors once the possibility of the disease return has to be analyzed. The survivor needs to succeed on elaborating the past experience and live with the uncertainty of the future. This study also emphasizes that it is not just a matter of getting the patient cured, but also providing means of resuming to his/her life, and reintegrating him/her into the social environment. In this context, the health care team should include in their treatment plans, actions that goes beyond the clinical aspects of the disease, offering emotional and social support, promoting the improvement of coping skills to deal with their new condition and to get rid of the past, helping survivors to live with the duality inherent in life

O trabalho tem como proposta entrar em contato com o câncer infantil e suas conseqüências do ponto de vista da própria criança com câncer, investigando o que significa para ela estar doente e buscando conhecer o sentido de sua vivência neste momento particular de sua vida. O trabalho fundamenta-se no método de pesquisa qualitativa de inspiração fenomenológica em Psicologia. Partindo de uma questão orientadora - Como é para a criança com câncer conviver com sua doença e seu tratamento? - a fonte de investigação utilizada foram as vivências de crianças com câncer no grupo de apoio psicológico, atividade que faz parte da rotina do Serviço de Psicologia do GACC-Grupo de Apoio à Criança com Câncer. O grupo reuniu-se semanalmente durante 01 hora, em local e horário fixos, no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Foram utilizados materiais gráfico e lúdicos. As crianças participantes, em média 05 em cada sessão, tinham diferentes diagnósticos de câncer e encontravam-se em diferentes fases de seus tratamentos. Suas idades variaram de 03 a 16 anos. A construção dos resultados compreendeu duas etapas. Na primeira etapa, foram analisadas 30 sessões do grupo de apoio psicológico realizadas no período de abril a dezembro de 1999. Nesta etapa, o objetivo do grupo era propiciar e facilitar a livre expressão de preocupações, dúvidas e sentimentos das crianças participantes, além de proporcionar um momento no qual pudessem compartilhar suas experiências. Desta primeira etapa emergiram três dimensões de análise: os temas das sessões, o próprio grupo enquanto intervenção psicoterapêutica e a gestação da idéia de elaborar o livro das crianças. Na segunda etapa, foram analisadas 15 sessões do grupo de apoio psicológico, realizadas no período de janeiro a junho de 2000. Nesta etapa, o objetivo do grupo era a criação do livro das criança, material informativo sobre o câncer infantil elaborado coletivamente. Desta segunda etapa emergiram os temas das sessões, organizados posteriormente sob a forma do livro das crianças. Após estas duas etapas de análise, foi realizada uma síntese compreensiva da construção dos resultados sob a luz da Psicologia Fenomenológica. Nas considerações finais, foram discutidos os desdobramentos práticos dos aspectos estudados, assim como o papel da Psicologia nestes contextos assistenciais. (FAPESP) / This paper proposes to come into contact with childhood cancer and its consequences from the cancer-stricken child’s own viewpoint, and investigate what it means for the child to be ill, seeking to find out the meaning of its experience at this particular juncture of its life. This paper is based on the qualitative research method of phenomenological inspiration in Psychology. With a leading question as the starting point – What is it like for a child who has cancer to live with this illness and its treatment? – the source used for investigation were the experiences of children suffering from cancer in a psychological support group, a routine activity that is a part of the Psychology Service of the GACC – Support Group for Children with Cancer. This group met weekly for one hour, at a fixed time and place, at the Children’s Hospital of the Ribeirão Preto Medical School of the University of São Paulo (USP). Graphic and playtime materials were used. The participating children, five per session on the average, had different cancer diagnoses, and were at different stages of their treatment. Their ages ranged from 3 to16 years. Construction of results comprised two stages. In the first stage, 30 psychological support group sessions held during the period from April through December 1999 were analyzed. In this stage, the group’s objective was fostering and facilitating the free expression of concerns, doubts and feelings by the participating children, in addition to providing a time for them to share their experiences. In the second stage, 15 psychological support group sessions held during the period from January to June 2000 were analyzed. In this stage, the group’s objective was creating the Children’s Book – collectively prepared informative material on childhood cancer. Subsequently, a synthesis comprising both stages of such construction of results was carried out under the light of Phenomenological Psychology. Practical developments of the aspects studied, as well as the role of Psychology in such care contexts, were discussed in closing remarks.

O câncer corresponde a um grupo de doenças que têm em comum o poder de proliferar células anormais de natureza embrionária primitiva em qualquer parte do organismo. A despeito dos avanços científicos e tecnológicos que permitem um aumento nas possibilidades de cura, o câncer desencadeia repercussões psicológicas em pacientes e familiares. Neste cenário de adoecimento torna-se essencial que esses indivíduos possam ser assistidos por profissionais de saúde que os orientem e os acolham em suas necessidades específicas. Porém, a atuação permeada pelo contato com profissionais de diferentes áreas, por jornadas prolongadas de trabalho e pelo convívio frequente com imprevisibilidade, vulnerabilidade, sofrimento e perda de pacientes, pode gerar sofrimento aos profissionais, dificultando uma assistência de qualidade aos pacientes. Esse estudo teve como objetivo compreender como profissionais de saúde, de diferentes especialidades, atuantes em um serviço especializado em tratamento oncológico pediátrico, vinculado a um hospital-escola do interior do estado de São Paulo, significam suas vivências neste contexto de trabalho. Foram entrevistados oito profissionais e, mediante autorização prévia dos mesmos, as entrevistas foram gravadas e transcritas na íntegra. A compreensão dos relatos foi realizada segundo o referencial fenomenológico, que se justifica pela necessidade de chegar à experiência tal como é vivida e de aproximar dos sentidos atribuídos pelos participantes. As entrevistas foram analisadas qualitativamente conforme o método de análise da estrutura do fenômeno situado, proposto por Martins e Bicudo (1989), Giorgi (1985) e Valle (1997) e, posteriormente, foi realizada uma reflexão sobre os resultados à luz da Psicologia Fenomenológica proposta por Forghieri (2009). Os resultados mostraram que os participantes vivenciam sua atuação de forma ambivalente, marcada por satisfações e dificuldades. A satisfação aparece associada ao vínculo construído e às lições aprendidas com pacientes e familiares, ao reconhecimento recebido pelo trabalho prestado e à oportunidade de servir ao próximo. As dificuldades estão relacionadas ao contato com o sofrimento e com a morte de pacientes, ao convívio com profissionais de diferentes especialidades e à dificuldade de comunicação entre eles, essas últimas representando obstáculos a uma atuação integrada. Apesar das dificuldades, eles revelam disponibilidade e desejo de cuidar de seus pacientes, o que faz com que continuem escolhendo esse trabalho. Com intuito de lidar melhor com esse cenário, mobilizam diferentes recursos de enfrentamento, porém, ainda assim, em vários momentos, sentem-se desamparados tanto pelos colegas como pela instituição hospitalar e pela formação acadêmica. Frente aos desafios da prática, esse estudo ressalta a importância de repensar a formação em saúde, bem como a necessidade de oferta de assistência psicológica aos profissionais, como uma estratégia de cuidado ao cuidador. Destinar atenção à saúde mental dos profissionais de saúde é essencial para que eles tenham condições para adotar condutas mais humanizadas, proporcionando uma melhor qualidade da assistência aos pacientes. / Cancer corresponds to a group of diseases that have in commom the power to proliferate abnormal cells of a primitive embrio origin in any part of the organism. Despite the scientific advances which allow a raise in the chances of cure, cancer triggers psychological repercussions in patients and their families. In this scenario of illness it is tantamount that these individuals may be assisted by health professionals who guide them and cater for their specific needs. However, the acting permeated by the contact with professionals from various areas, by long working hours and by the constant idea of unpredictability, vulnerability, suffering and loss of patients might generate anguish to these professionals, making it difficult to have high quality assistance towards these patients. This study aimed at understanding how health professionals, of different areas of expertise, actively working in a job which is specific to the pediatrics oncologic treatment, linked to a university hospital in the inner area of the state of São Paulo, see the experiences they have within the scope of their work. Eight professionals were interviewed and, having the subjects previously authorized, the interviews were recorded and transcribed word by word. The comprehension of the reports was performed according to the phenomenological reference, which is justified by the need to reach the experience exactly the same way it is lived and to get closer to the senses assigned by the participants. The interviews were qualitatively analysed in accordance with the method of situated phenomenon structure analysis, proposed by Martins and Bicudo (1989), Giorgi (1985) and Valle (1997) and, later, a reflexion upon the results was carried out in light of the Phenomenological Psychology proposed by Forghieri (2009). The results showed that the participants live their acting in an ambivalent way, marked by pleasures and difficulties. The pleasures are associated with the bonding built and with the lessons learned with patients and their families, with the recognition awarded by the done service and the opportunity of helping a peer. The difficulties are related to the contact with suffering and to the death of the patients, to the living with professionals of different specialities and to the difficult communication among them, the latest representing obstacles to an integrated acting. In spite of the difficulties, they reveal availability and good will to handle the patients, which makes them keep choosing this line of work. Aiming at dealing better with this scenario, they mobilize different resources of confrontation, yet, still in numerous moments, they feel unassisted both by their co-workers and the hospital institution, as well as by the academic course. Facing the practice challenges, this paper highlights the importance of rethinking the graduation in the area of health, and also the need of offering psychological aid to the professionals as a strategy of care towards the caretaker. Paying attention to the mental health of the health professionals is essential so that they are in good shape to adopt more humanistic approaches, offering assistance of a higher quality towards these patients.

Os objetivos do estudo são compreender como pacientes com câncer vivenciam o fenômeno da religiosidade e da fé, e como profissionais de saúde significam a religiosidade e a fé dos pacientes em tratamento de câncer e como vivenciam esse fenômeno. O tema religiosidade é considerado atual e importante para a época onde ainda falta uma atenção a esse aspecto aos pacientes com doenças graves. Trata-se de uma pesquisa qualitativa-descritiva, sob o referencial de análise fenomenológica em Stein (1999b) e Ales Bello (2006a), um modo de compreender e analisar o ser humano na sua totalidade - física, psíquica e espiritual, que possibilita um aprofundamento e uma correlação entre sua interioridade e exterioridade que se mostram nos desdobramentos das análises desenvolvidas. É no sentido das falas dos colaboradores onde se apóia a análise fenomenológica, enquanto descrição que quer conhecer intuitiva e imediatamente o que há \"por trás\" dessas falas. No presente estudo revelou que os pacientes com câncer mostram pertencer a uma diversidade de religiões: a maioria é de Evangélicos e Espíritas, a minoria são de Católicos. Os pacientes significam a religião como um meio de suporte e sustento fundamental nos momentos de dor e sofrimento causados pelo câncer e por seu tratamento. Eles percebem a comunidade religiosa como um apoio espiritual, com a qual eles podem compartilhar os seus sentimentos, os seus conflitos, as suas dores e serem acolhidos, como são, na sua finitude. Alguns mostram que puderam viver na vida transformações de valores que ainda não tinham sido vividos e nem experimentados, e passam a agir através destes. Nesse estudo, apresento também a experiência tal como vivida pelos profissionais de saúde a partir de seus relatos a maioria deles não freqüenta nenhuma igreja. Dois dizem Católicos praticantes e um Católico não praticante. A maioria dos profissionais diz Espiritualista, um médico se diz Budista e uma Espírita. Esses acreditam que a religião é inerente a todo ser humano. Eles confiam nos valores humanos e experienciam uma \"religião pessoal\". Eles expressam nas religiões os valores positivos que recebem os seus fiéis e estes procuram aprender vivê-los. A religião pode se viver individualmente (sozinho), ou seja, ser autônomo nos seus atos, sem influência do pastor, do padre que seja para orientar a seguir a estrada da vida. Os que são convictos de suas religiões (menos da metade) dos profissionais acreditam na proteção divina. Têm na Palavra de Deus e em Nossa Senhora o sustento para suas ações, tem uma disposição e motivação diferente para tratar com os doentes. A religião é vivenciada por elas de um modo humano e verdadeiro. Elas mostram vivê-lo com amor, ao se aproximar e se \"jogar\" por inteiro na relação com os pacientes e com os outros profissionais da equipe. No geral, os profissionais significam a importância da religiosidade para o paciente e sua família, mas estas devem vir como sustento e proteção para enfrentar a situação; eles esperam que esses enfermos vivam a sua fé com prudência e sempre aderindo à realidade. / This study aims to understand how cancer patients experience the phenomenon of religiosity and faith, as well as how health professionals signify the religiosity and faith of patients receiving cancer treatment and how they themselves experience this phenomenon. Religiosity is considered a current and important theme for a time in which attention to this aspect is still lacking for patients with severe diseases. This is a qualitative-descriptive research, using the reference framework of phenomenological analysis according to Stein (1999b) and Ales Bello (2006a), a way of understanding and analyzing human beings in their physical, mental and spiritual wholeness, permitting a more in-depth correlation between their interiority and exteriority that appear in the unfolding of the analyses. Phenomenological analysis is based on the collaborators\' discourse, as a description that intuitively and immediately wants to get to know what lies \"behind\" these statements. In the present study, cancer patients belonged to a range of religions: most of them were evangelics and spiritists, and a minority catholics. Patients signify religion as a means of support and fundamental sustenance in moments of pain and suffering caused by cancer and its treatment. They perceive the religious community as spiritual support, through which they can share their feelings, conflicts, pains and be welcomed as they are, in their finiteness. Some show that, in life, they could experience transformations in values they had neither lived nor experienced, and start to act through these. In this study, we also present the experience as health professionals live it, based on their reports, as most of them do not attend any church. Two say they are practicing catholics and one nonpracticing. Most professionals say they are spiritualists, one physician mentions he is a buddhist and one spiritist. They believe that religion is inherent in all human beings. They trust in human values and experience a \"personal religion\". In religions, they express the positive values their believers receive and the latter attempt to learn how to live accordingly. Religion can be lived individually (alone), that is, being autonomous in one\'s acts, without influence from the minister or priest to guide them in order to follow the route of life. Professionals convicted of their religion (less than half) believe in divine protection. The word of God and the Holy Virgin sustains their actions, giving them a different willingness and motivation to treat the ill. They experience religion in a humane and truthful way. They demonstrate that they experience this with love, by getting closer and \"casting\" themselves entirely into the relationship with patients and with other team professionals. In general, professionals signify the importance of religiosity for patients and their families, but it should serve as support and protection to face the situation; they expect patients to live their faith prudently, always adhering to reality.