According to the patient engagement model by Graffigna et al. [16,
17], patient engagement is a process featuring four sequential phases.
In the phase of ‘‘blackout’’, patients fall in an initial state of
emotional, behavioral and cognitive blackout determined by the
critical event, which is described as unexpected and out of their
control. In the subsequent phase of ‘‘arousal’’, patients are hyper
attentive to every symptom produced by their body. Symptoms during
this phase are perceived as an ‘‘alarm bell’’ that worries the patient
and may instigate dysregulated emotional responses. The ‘‘adhesion’’
phase arrives when patients have acquired sufficient knowledge and
behavioral skills to effectively adhere to medical prescriptions and
feel sufficiently confident in their own emotional strength to cope
with their condition. Finally, in the ‘‘eudaimonic project’’ phase,
patients have fully accepted their condition and that the patient self is
only one of their possible selves. They are also able to recognize
internal resources that are useful for projecting satisfactory life
trajectories for their future.