Articoli Scientifici

The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia:A Quality Improvement Study

Paola Di Giulio, RN, MSc, Silvia Finetti, MSc, Fabrizio Giunco, MD, Ines Basso, RN, Debora Rosa, RN, MSc,Francesca Pettenati, MSc, Alessandro Bussotti, MD, Daniele Villani, MD, Simona Gentile, MD,Lorenzo Boncinelli, MD, Massimo Monti, MD, Sandro Spinsanti, PhD, Massimo Piazza, MD,Lorena Charrier, MD, and Franco Toscani, MD. Vol. - No.  2018 Journal of Pain and Symptom Management 1

Editorial- Expectation Conversations About the Very Predictable Events in Advanced Dementia

Cari Levy MD, PhD *Department of Medicine, University of Colorado Denver and the Division of Health Care Policy and Research, Denver Veterans Affairs Medical Center,Denver, CO; JAMDA 16 (2015) 724e727

Critical Decisions for Older People With Advanced Dementia: A Prospective Study in Long-Term Institutions and District Home Care

Toscani F, van der Steen JT, Finetti S, Giunco F, Pettenati F, Villani D, Monti M, Gentile S, Charrier L, Di Giulio P; End of Life Observatory-Prospective Study on DEmentia Patients Care (EoLO-PSODEC) Research Group.

J Am Med Dir Assoc. 2015 Apr 2. pii: S1525-8610(15)00173-5. doi: 10.1016/j.jamda.2015.02.012. [Epub ahead of print]


Choosing care homes as the least preferred place to die: a cross-national survey of public preferences in seven European countries.

Calanzani N, Moens K, Cohen J, Higginson IJ, Harding R, Deliens L, Toscani F, Ferreira PL, Bausewein C, Daveson BA, Gysels M, Ceulemans L, Gomes B; Project PRISMA.BMC Palliat Care. 2014 Oct 23;PMID: Free Article

Prescribing in palliative care A quest for appropriateness; Palliat Med 2013 27: 293; Franco Toscani

Priorities for treatment, care and information if faced with serious illness: A comparative population-based survey in seven European countries.Irene J Higginson, Barbara Gomes, Natalia Calanzani, Wei Gao, Claudia Bausewein, Barbara A Daveson, Luc Deliens, ,Pedro L Ferreira, Franco Toscani, Marjolein Gysels, Lucas Ceulemans, Steffen T Simon, Joachim Cohen, Richard Harding and on behalf of Project PRISMA published online 23 May 2013 Palliat Med  

Educating families about end-of-life care in advanced dementia: acceptability of a Canadian family booklet to nurses from Canada, France, and Japan. Marcel Arcand, Kevin Brazil, Miharu Nakanishi, Taeko Nakashima, Michel Alix, Jean-François Desson, Rémy Morello, Louise Belzile, Marie Beaulieu, Cees MPM Hertogh,Franco Toscani, Jenny T van der Steen.

International Journal of Palliative Nursing 2013, Vol 19, No 2

Treatments and Prescriptions in Advanced Dementia Patients Residing in Long-Term Care Institutions and at Home Franco Toscani, M.D.,1 Paola Di Giulio, R.N.,1 M.Sc.,2 Daniele Villani, M.D.,3 Fabrizio Giunco, M.D.,4Cinzia Brunelli, Sc.D.,1 Simona Gentile, M.D.,5 Silvia Finetti, M.Sc.,1 Lorena Charrier, M.D.,6Massimo Monti, M.D.,7 Jenny T. van der Steen, Ph.D.;8 on behalf of the End of LifeObservatory – Prospective Study on Dementia Patients Care (EoLO-PSODEC) Research G

JOURNAL OF PALLIATIVE MEDICINE Volume 16, Number 1, 2013 , Mary Ann Liebert, Inc.

Translation and cross-cultural adaptation of a family booklet on comfort care in dementia: sensitive topics revised before implementation -Jenny T van der Steen,1 Cees M P M Hertogh,1 Tjomme de Graas,1 Miharu Nakanishi,2 Franco Toscani,3 Marcel Arcand4

JME Online First, published on November 10, 2012 as 10.1136/medethics-2012

End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal.

Meñaca A, Evans N, Andrew EV, Toscani F, Finetti S, Gómez-Batiste X, Higginson IJ, Harding R, Pool R, Gysels M.

Crit Rev Oncol Hematol. 2012 Jun;82(3):387-401. Epub 2011 Jul 8.

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

Marjolein Gysels1,2,4*, Natalie Evans1,5, Arantza Men˜ aca1, Erin Andrew1, Franco Toscani3, Sylvia Finetti3,H. Roeline Pasman5, Irene Higginson2, Richard Harding2, Robert Pool1,4, on behalf of Project PRISMA, Barcelona Centre for International Health Research, Universitat de Barcelona, Barcelona, Spain, 2 Department of Palliative Care, Policy and Rehabilitation, King’s College. PLOS one Published April 3, 2012

A Family Booklet about Comfort Care in Advanced Dementia: Three-Country A Family Booklet about Comfort Care

in Advanced Dementia: Three-Country Evaluation

Jenny T. van der Steen, PhD, Marcel Arcand, MD, MSc, Franco Toscani, MD, Tjomme de Graas, MD, Silvia Finetti, MA, Marie Beaulieu, PhD, Kevin Brazil, PhD, Miharu Nakanishi, PhD, Taeko Nakashima, PhD, Dirk L. Knol, PhD, and Cees M. P. M. Hertogh, MD, PhD


Physicians’ and Nurses’ Perceived Usefulness and Acceptability of a Family Information Booklet about Comfort Care in Advanced Dementia

Jenny T. van der Steen, Ph.D.,1–3 Franco Toscani, M.D.,4 Tjomme de Graas, M.D.,1,2 Silvia Finetti, M.A.,4 Miharu Nakanishi, Ph.D.,5 Taeko Nakashima, Ph.D.,5 Kevin Brazil, Ph.D.,6, Cees M. P. M. Hertogh, M.D., Ph.D.,1,2 and Marcel Arcand, M.D., M.Sc

Annals of Oncology Advance Access published February 16, 2012

Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders,Germany, Italy, the Netherlands, Portugal and Spain

B. Gomes1*, I. J. Higginson1, N. Calanzani1, J. Cohen2, L. Deliens3,2, B. A. Daveson1,D. Bechinger-English1, C. Bausewein4,1, P. L. Ferreira5, F. Toscani6, A. Men˜ aca7, M. Gysels7,L. Ceulemans8, S. T. Simon9,10, H. R. W. Pasman3, G. Albers3, S. Hall1, F.E.M. Murtagh1,D. F. Haugen11,12, J. Downing13, J. Koffman1, F. Pettenati6, S. Finetti6, B. Antunes5,1 &R. Harding1 on behalf of PRISM

Decisions Affecting Quality of Life or Survival for Severely Demented Persons

A Survey on Doctors and Nurses of Nursing Homes and Districts; Laura Simionato, MSc; Paolo Di Giulio, MSc ;Valerio Dimonte, MSc ;Daniele Villani, MD ;Simona Gentile, MD; Franco Toscani, MD; Fabrizio Giunco, MD

JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 6, November/December 2010


Intervista a Franco Toscani: "Alla fine". UNA CITTA' n°. 166 maggio 2010, mensile di interviste.

What "best practice" could be in Palliative Care: an analysis of statements on practice and ethics expressed by the main Health Organizations

Gaia Barazzetti1,5 email, Claudia Borreani2 email, Guido Miccinesi3 email and Franco Toscani4 email

BMC Palliative Care 2010, 9:1doi:10.1186/1472-684X-9-1

I Luoghi della Cura -Anno VII- N.4-2009

Decisioni critiche di fine vita nel paziente anziano con demenza grave ricoverato in RSA: studio pilota

Patrizia Massariello, Paola Di Giulio, Valerio Dimonte, Franco Toscani a nome del gruppo EOLO- Psodec

J Pain Symptom Management Volume 38, Issue 3, Pages 365-71 (September 2009)

Off- Label Prescriptions in Italian Hospices: A National Survey

F. Toscani, P. Di Giulio, R. Campi, I. Pellerin, A. De Luca and G. Casale on behalf of the End of Life Observatory Research Group

Una nuova intervista a Franco Toscani("Una nuova medicina") e a Paola Di Giulio sono  disponibili su alla pagina

Il n° 33 della rivista Janus (primavera 2009) ha pubblicato a pag. 27/31 l’articolo "Passato prossimo, futuro anteriore" di F. Toscani.

Treatments in patients dying with dementia: a cross-cultural perspective.

van der Steen JT, Toscani F, Di Giulio P, Werner P, Boogaard JA, Zysberg A, Volicer L.

J Am Geriatr Soc. 2008 Mar;56(3):565-7; author reply 567. No abstract available.

I Luoghi della Cura

Studio retrospettivo sulle modalità di morte nei pazienti con demenza

Manuela Galeazzi, Monica Fantinato, Franco Toscani, Paola Di Giulio, Valerio Dimonte, a nome del Gruppo EoLO.

ANNO VI- N.°4 - 2008

JAN Research Methodology

Validation of the italian version of Discomfort Scale- Dementia of Alzheimer Type

Carolina Dello Russo, Paola Di Giulio, Cinzia Brunelli, Valerio Dimonte, Daniele Villani, Giovanni Renga & Franco Toscani- 11 July 2008

Journal of Palliative Medicine

To cite this paper:
Paola Di Giulio, Franco Toscani, Daniele Villani, Cinzia Brunelli, Simona Gentile, Patrizia Spadin. Journal of Palliative Medicine. September 1, 2008, 11(7): 1023-1028. doi:10.1089/jpm.2008.0020.

Il n° 22 della rivista Janus (estate 2006), ha pubblicato a pag. 116/117 l'articolo "....fare una pessima morte" di F.Toscani. Editoriale ed indice del numero della rivista sono disponibili in formato Acrobat Reader sul sito dell’editore .

Il numero  154- 2006 di Salute e Territorio ha pubblicato l'articolo " Cure palliative ed eutanasia . Un conflitto insanabile? " di Franco Toscani.

Per leggere correttamente alcuni documenti presenti in questa sezione è necessario disporre del lettore Acrobat® Reader®. Per installare il programma sul proprio computer cliccare sull'immagine qui a destra.

American Journal of Bioethics
  Publisher:  Taylor & Francis
  Issue:  Volume 6, Number 1 / January-February 2006
  Pages:  W6 - W18
  URL:  Linking Options
  DOI:  10.1080/15265160500394994


Deception, Catholicism, and Hope: Understanding Problems in the Communication of Unfavorable Prognoses in Traditionally-Catholic Countries

Franco Toscani A1 and Calliope Farsides A2

A1 Fondazione Lino Maestroni—Instituto di Ricerca in Medicina Palliativa—Cremona
A2 King's College London

The doctor's use of deception in appropriate circumstances has commonly been considered a necessity of the medical art. Resistance to full and frank communication is typical of many traditionally Catholic countries, and particularly of Italy, a western country where Catholicism remains particularly influential. The Catholic teaching on truth and lies, and the problem of telling the truth to a severely ill patient is discussed. It is suggested that the contemporary Catholic model of gradually telling a terminal patient the truth, which looks reasonable and feasible in theory, is rarely followed in practice, as in the majority of cases the truth is not told tout court. Problems stem from the way in which medicine is currently practiced in Italy; from the synergism between Catholicism and the medical tradition's grounded paternalism; and from the ambiguity of the term ‘hope’. Catholic ethics in fact recommends that the truth must be told without destroying hope, but the Catholic meaning of ‘hope’ is very different from its meaning in current language.


Catholicism, communication to terminal patients, deception of prognosis, hope, medical deontology, truth-telling

The references of this article are secured to subscribers


 Il n° 20 della rivista Janus (inverno 2005) ha pubblicato a pag. 53 l'articolo "Alla guerra del dolore con le armi di una volta" di F.Toscani.Editoriale ed indice del numero della rivista sono disponibili in formato Acrobat Reader sul sito dell’editore ( ).

J Pain Symptom Management Volume 30, Issue 1, Pages 33-40 (July 2005)

How People Die in Hospital General Wards: A Descriptive Study

Franco Toscani MDCorresponding Author Contact Information, Paola Di Giulio RN, MSC, Cinzia Brunelli ScD, Guido Miccinesi MD, Dario Laquintana RN and on behalf of the End-of-Life Observatory Groupasterisk operator

Lino Maestroni Palliative Medicine Research Institute (F.T., C.B.), Cremona; Nursing Research Unit (P.D.G., D.L.), Mario Negri Institute, Milan; and Epidemiology Unit (G.M.), Center for the Study and Prevention of Cancer, Florence, Italy

Vol.30, No.1 July 2005.


To describe how patients die in hospital, 370 patients (age >18 years; in hospital for > 24 hours) who died on the general wards of 40 Italian hospitals were assessed. Differences between patients whose death was expected and patients whose death was unexpected were evaluated. Data on treatments and care in proximity of death were collected after interviewing the nurse responsible for the patient within 72 hours of the patient's death, and from clinical and nursing records. For 58% of patients, death was highly expected. Symptom control was inadequate for the most severely ill patients: 75% experienced at least one “severe” symptom (42% pain and 45% dyspnea). Nurses tended to judge patients' global care as “good” or “very good” (76%), in spite of the persistence of symptoms and the scant use of analgesics. Despite some encouraging signs of sensitivity to end-of-life problems, acute inpatient institutions in Italy still deal inadequately with the needs of dying persons.

Key Words: Hospital death; terminal patients; end-of-life; symptom control; palliative care

 Palliative Medicine 2005; 19: 220- 227 

Predicting survival in terminal cancer patients: clinical observations or quality-of-life evaluations?

Franco Toscani and Cinzia Brunelli Istituto di Ricerca in Medicina Palliativa “Lino Maestroni”, Cremona, Guido Miccinesi, CSPO, Istituto Scientifico della Regione Toscana, Firenze, Massimo Costantini Servizio di Epidemiologia Clinica e Sperimentazioni Controllate, Istituto nazionale per la Ricerca sul Cancro, Genova, Michele Gallucci Unità di Cure Palliative  e Terapia del Dolore, Desio, Marcello Tamburini Servizio di Psicologia, Istituto Nazionale Tumori, Milano, Eugenio Paci CSPO, Istituto Scientifico della Regione Toscana Firenze, Paola Di Giulio Dip. Sanità Pubblica e Microbiologia, Facolta di Medicina e Chirurgia, Università degli Studi di Torino, Torino, Carlo Peruselli Unità Operativa di Cure Palliative , Ospedale di Biella.

 Il n° 17 della rivista Janus (primavera 2005) ha pubblicato a pag. 135 l’articolo Il vero miracolo del professor Di Bella di F. Toscani. Editoriale ed indice del numero della rivista sono disponibili in formato Acrobat Reader sul sito dell’editore .

 Il n° 14 della rivista Janus (estate 2004) ha pubblicato a pag. 108 l’articolo Living will o living wish? Di F. Toscani. Editoriale ed indice del numero della rivista sono disponibili in formato Acrobat Reader sul sito dell’editore

 Il n° 12 della rivista Janus (inverno 2003) ha pubblicato a pag. 51 l’articolo L’incertezza dell’ultima cena di F. Toscani. Editoriale ed indice del numero della rivista sono disponibili in formato Acrobat Reader sul sito dell’editore.

Il n° 11 della rivista Janus (autunno 2003) ha pubblicato a pagina 127 l’articolo Hospice: origine e destino di un termine medico di F. Toscani e G. Barazzetti. Editoriale ed indice del numero della rivista sono disponibili in formato Acrobat Reader sul sito dell’editore ( ).

Health and Quality of Life Outcomes

Research Open Access

Life at the end of life: beliefs about individual life after death and"good death" models - a qualitative study

Franco Toscani*1, Claudia Borreani2, Paolo Boeri2 and Guido Miccinesi3

Published: 07 November 2003

Health and Quality of Life Outcomes 2003, 1:65

 J Pain Symptom Manage 2001 Mar;21(3):179-88

Click here to read 

Quality of life assessment and outcome of palliative care.

Paci E, Miccinesi G, Toscani F, Tamburini M, Brunelli C, Constantini M, Peruselli C, Di Giulio P, Gallucci M, Addington-Hall J, Higginson IJ.

Palliat Med 1999 May;13(3):233-41

Click here to read 

Home palliative care for terminal cancer patients: a survey on the final week of life.

Peruselli C, Di Giulio P, Toscani F, Gallucci M, Brunelli C, Costantini M, Tamburini M, Paci E, Miccinesi G, Addington-Hall JM, Higginson IJ.


J Pain Symptom Manage 1999 Oct;18(4):243-52

Click here to read 

Terminal cancer patients and timing of referral to palliative care: a multicenter prospective cohort study. Italian Cooperative Research Group on Palliative Medicine.

Costantini M, Toscani F, Gallucci M, Brunelli C, Miccinesi G, Tamburini M, Paci E, Di Giulio P, Peruselli C, Higginson I, Addington-Hall J.

Support Care Cancer 1996 Jan;4(1):56-60

Classification and staging of terminal cancer patients: rationale and objectives of a multicentre cohort prospective study and methods used. The Italian Co-operative Research Group on Palliative Medicine.

Toscani F.

Sezione di Terapia del Dolore e Cure Palliative. Azienda Ospedaliera Cremonese, Cremona, Italy.











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