ESMO 2012

Defining personalised medicine and patient empowerment

Professor Gabriella Pravettoni – University of Milan, Italy


Professoressa Gabriella Pravettoni, you are the Professor of Cognitive Psychology in the University of Milan. You’ve been working a long time on personalised medicine and patient empowerment and we work with ecancer with you in a couple of FP7 projects. I’ve seen lots of definitions of P medicine and there was a Nature paper on P4, P1, 2, 3, 4, to which you responded, “What about P5?” What is P5?

There were more than 140 definitions of personalised medicine and no-one was on person, patient person. So I just replied to Nature, it was a special issue on personalised medicine, that for sure we have to concentrate on patient and on person and not just on the genomics or the molecular biology or things that are, of course, precision and perfect things to work on and very important for science but not enough for patients. The idea, the research based on that, is that we concentrate very often on the promise of science, that is good, but it’s not the reality of the patient, that’s the problem we have. So I just tried to give an immediate answer to the patient, to the person, not to forget the person even if I recognise the range of science, the necessary great job of science, to work for the patient.

The patient can’t do much with a promise.

Yes, that’s the point.

That’s the bottom line. Now there’s lots of stuff at this ESMO meeting about patient empowerment, I don’t actually think that I would put any of what’s going on here on the term patient empowerment because it’s key to personalised medicine. But what is your definition of patient empowerment?

My definition of patient empowerment is that we have to empower, so to help, the patient, to help the person to have something better immediately. As we said before, we don’t live on something that will come or will happen but what we have now. So, for example, in one of the projects we are working together on, you know that we are trying to build a platform for the patient where the patient has some tools that he can immediately use and have a response, a follow-up; to help on one side the doctor to better understand the patient, to better communicate with the patient, and on the side of the patient to better explain what he has, what he or she is, even on the personality profile, to do the better choice and to realise together between the doctor and the patient what they can do.

So you’re saying that the patient should have something to do with the choice of treatment?

Yes, of course. I think that when we talk on personalised, we say devise treatment to the right patient. My view is devise treatment to the right person that has a specific profile of personality. So, for example to better, explain is that if I’m working with a patient that has a risky personality profile with a high risk, it means that I could easily involve in clinical trials. But if I am working with a person that has an anxiety trait of personality, a person that is depressed, I cannot involve them in an experimental clinical trial with a high risk because for that person the right answer is to work now with something that is recognised. Otherwise, when he or she talks with all the other patients and persons, or goes off for a second opinion, and the answer is different from the one the first doctor suggested, the problem is that he feels more anxious so it’s not right for him.

Now, cognitive psychology has unquestionably now come into its own and is recognised in mainstream medicine, no question. However, mainstream doctors like me don’t actually understand how you do it. So how do you do this kind of research, how do you physically find out about five kinds of personality and how do you give patients information that they can use in decision making?

The idea, basically, is the fact that we work using questionnaires, using fMRI if we are doing a neurocognitive psycho research but there are many ways. But even online, for example, we use some tools, as you know, or virtual reality for other patients. It depends, of course, on the scientific base of the research, but the idea is to help people to have the right mind-set, so concentrate on language, on culture of that patient, on memory, on attention, all the cognitive abilities that that patient has.

And you do that by questionnaire and by probing through, and you do that online, the patient can sit in the waiting room and answer the questions?

If we are talking about the personality questionnaire, yes, of course.

And then how do we get information to patients in a more intelligible, personalised way?

For example, we did a questionnaire that is called ALGA where we tried to identify the personality profile of a person, of a patient, to give the right suggestion, the right key words to the doctor to help in a better way that patient. What we can do is just ask the patient to answer on a iPad some questions and we have a result that are five types of personality and, of course, to the doctor what advice, just a few words, clear words, in which they could help in a better way the patient.

You talked about culture being important and you are doing some of this work in different languages?

Yes, for sure. For example, ALGA first started from Italy because we realised the questionnaire but then was immediately translated into English, French, German, Spanish and Latino American, that is different from Spanish. What we really understood… and in Japanese, for example. This is very important because we needed not only to translate but to understand that somewhere the culture is different and even the words are different so to better understand something that is very key to us. We can’t use the Spanish for the Venezuelans, for example, so we need to use the right words to reach the patient.

Gabriella, thank you, that was very clear and now I understand a little bit more about it.

Thank you.

I look forward to sharing the results with you in a year’s time.

OK, many thanks.