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- Friberg, Febe, 1950, et al.
(författare)
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Exploration of dynamics in a complex person-centred intervention process based on health professionals' perspectives
- 2018
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The assessment and evaluation of practical and sustainable development of health care has become a major focus of investigation in health services research. A key challenge for researchers as well as decision-makers in health care is to understand mechanisms influencing how complex interventions work and become embedded in practice, which is significant for both evaluation and later implementation. In this study, we explored nurses' and surgeons' perspectives on performing and participating in a complex multi-centre person-centred intervention process that aimed to support patients diagnosed with colorectal cancer to feel prepared for surgery, discharge and recovery. Method: Data consisted of retrospective interviews with 20 professionals after the intervention, supplemented with prospective conversational data and field notes from workshops and follow-up meetings (n = 51). The data were analysed to construct patterns in line with interpretive description. Results: Although the participants highly valued components of the intervention, the results reveal influencing mechanisms underlying the functioning of the intervention, including multiple objectives, unclear mandates and competing professional logics. The results also reveal variations in processing the intervention focused on differences in using and talking about intervention components. Conclusions: The study indicates there are significant areas of ambiguity in understanding how theory-based complex clinical interventions work and in how interventions are socially constructed and co-created by professionals' experiences, assumptions about own professional practice, contextual conditions and the researchers' intentions. This process evaluation reveals insights into reasons for success or failure and contextual aspects associated with variations in outcomes. Thus, there is a need for further interpretive inquiry, and not only descriptive studies, of the multifaceted characters of complex clinical interventions and how the intervention components are actually shaped in constantly shifting contexts.
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| 2. |
- Friberg, Febe, 1950, et al.
(författare)
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Qualitative Outcome analysis: a method for developing clinical interventions from qualitative results with examples of information processing in palliative cancer care
- 2010
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Ingår i: 6 th Nordic Interdisciplinary Conference on Qualiative Methods in the Service of Health, May 2-4, 2010.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Recent decades have witnessed the development of qualitative methods as well as intense debate concerning the significance of methodological rigour. Although qualitative research has become an established part of health care, questions have been raised concerning how results can inform practice. Qualitative Outcome Analysis (QOA) is a method derived from qualitative research that allows interventions to be evaluated and that bridges the theory-practice gap on the path from knowledge generation to knowledge implementation. Aim: The aim is to describe Qualitative Outcome Analysis (QOA) by means of examples from an ongoing project about information processing in palliative cancer care and on the basis of our results from phenomenological and conversational analysis studies of person centred information in palliative care for patients with recurrent gastroenterological cancer. The participatory dimensions identified in the project will be related to QOA procedures. Methods: Focus groups with the palliative care team at an oncology outpatient unit were held, and major results from previous studies in the project were used as a framework or guide in order to facilitate discussion and reflection on the team’s professional experiences. In this way patient-reported qualitative findings were merged with professionals’ experience. Group discussion data were analyzed concurrently. A preliminary clinical intervention model was developed and refined by means of small scale clinical tests conducted by the team as well as other focus groups made up of different palliative care teams. Results: The applicability of QOA will be presented. A particular dimension identified in the process is participatory aspects related to the shared commitment between the researchers´ goal with the model and the team’s goal of facilitating clinical development. Such participatory aspects will be elaborated upon and related to the Participatory Action Research tradition. Discussion: The significance of relating QOA to Participatory Action Research will be reflected upon.
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| 5. |
- Karlsson, Magdalena, et al.
(författare)
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Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: a life-world phenomenological study
- 2014
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Ingår i: Bmc Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many people around the world are getting cancer and living longer with the disease. Thanks to improved treatment options in healthcare, patients diagnosed with advanced gastrointestinal cancer can increasingly live for longer. Living with cancer creates existential uncertainty, but what does this situation mean for the individual? The purpose of the study is to interpret meanings of existential uncertainty and certainty for people diagnosed with advanced gastrointestinal cancer and receiving palliative treatment. Methods: This study is part of a larger project in which 7 men and 7 women aged between 49 and 79 participated in a study of information and communication for people with advanced gastrointestinal cancer. A total of 66 interviews were conducted with participants who were followed up over time. The narrative interviews were transcribed verbatim and the texts were analysed in three steps: naive reading, structural analysis and interpreted whole by utilizing a phenomenological life-world approach. Results: This study has identified different spheres in which people diagnosed with advanced gastrointestinal cancer vacillate between existential uncertainty and certainty: bodily changes, everyday situations, companionship with others, healthcare situations and the natural environment. Existing in the move between existential uncertainty and certainty appears to change people's lives in a decisive manner. The interview transcripts reveal aspects that both create existential certainty and counteract uncertainty. They also reveal that participants appear to start reflecting on how the new and uncertain aspects of their lives will manifest themselves - a new experience that lays the foundation for development of knowledge, personal learning and growth. Conclusions: People diagnosed with advanced gastrointestinal cancer and receiving palliative care expressed thoughts about personal learning initiated by the struggle of living with an uncertain future despite their efforts to live in the present. Their personal learning was experienced through a changed life for themselves and having to confront their own pending death and develop self-insight regarding finality of life. Healthcare professionals can try to support people receiving palliative treatment for cancer by diversifying avenues for their personal growth, thus helping them manage their existential uncertainty and gravitate towards greater existential certainty.
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| 6. |
- Pettersson, Monica, 1963, et al.
(författare)
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Prepared for surgery : Communication in nurses preoperative consultations with patients undergoing surgery for colorectal cancer after a person-centred intervention
- 2018
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Ingår i: Journal of Clinical Nursing. - : Blackwell Publishing. - 0962-1067 .- 1365-2702. ; 27:13-14, s. 2904-2916
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectivesTo describe preoperative communication after a person‐centred intervention in nurses' consultations with patients undergoing surgery for colorectal cancer.BackgroundPatients all over the world scheduled for surgery are referred to preoperative consultations with healthcare professionals. The goal is to assess the risk of perioperative complications, improving quality of care and enabling patients to be prepared for surgery and recovery. A person‐centred intervention was developed, which consisted of an interactive written patient education material and person‐centred communication.DesignAn explorative quantitative and qualitative study based on 18 audio‐taped transcriptions.MethodsEighteen patients preoperative nursing consultations at three Swedish hospitals were analysed quantitatively regarding structure: words, time, phases, questions, discursive space, and qualitatively: topics and how the person‐centred communication appeared in the consultations.ResultsThe median time for consultations was 27 min (range 13–64 min). The nurses used two‐thirds of the discursive space in the consultations with the patients. The patient education material was used as a support to structure the consultation and discuss sensitive and difficult issues. Seven topics were discussed during the consultation. Two different approaches to communication were identified: Talking with the patient versus Talking to the patient. Talking with the patient (seen as person‐centred communication) was defined as: listening to the narrative and confirming each other, raising difficult topics, seeing each other as persons, building on strengths and resources, preparing for surgery and asking open questions.ConclusionWays of communicating influence how the preoperative consultation develops. Talking with the patient could be seen as person‐centred communication in the preoperative care, and when using this approach, the intervention purpose of person‐centred communication was met.Relevance to clinical practiceEducation in person‐centred communication is important for nurses to improve their skills in performing preoperative consultations.
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| 7. |
- Smith, Frida, et al.
(författare)
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Participatory design in education materials in a health care context
- 2017
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Ingår i: Action Research. - : SAGE Publications. - 1476-7503 .- 1741-2617. ; 15:3, s. 310-336
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Tidskriftsartikel (refereegranskat)abstract
- Written patient education material, for example, discharge-information is commonly used in hospital settings. Despite following guidelines on how to best present text and using patients as consultants, improvements can still be made from a patient’s perspective. Here, we describe the process of developing patient education material using a participatory design methodology, with patients, clinicians, researchers and designers working as co-designers following a structured process map. The method emphasises coping with conflicting interests and using this as a source of development. The philosophies behind action research and person-centred care were combined in a practical setting, enhancing both perspectives and generating actionable knowledge to be further used in patient involvement projects. The results reveal that predominant areas of tensions focused on power, organization, content and clinical usability. This study is one of the first to involve patients as co-designers of education materials in the health care context, and not only as consultants. Working as co-designers was found to be productive and in line with person-centred care philosophy, with focus on partnership and equality. The results of this study can therefore benefit both patients and other relevant stakeholders in the healthcare system in developing written patient education materials.
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| 9. |
- Wallengren Gustafsson, Catarina, et al.
(författare)
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Challenges When Translating and Culturally Adapting a Measurement Instrument: The Suitability and Comprehensibility of Materials (SAM+CAM)
- 2018
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Ingår i: Global Qualitative Nursing Research. - : SAGE Publications. - 2333-3936. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- There is evidence that low suitability and comprehensibility of printed education materials (PEMs) affects patients' and relatives' ability to read and comprehend information. However, few instruments measure the suitability of written information, and none exist in the Swedish language. The aim was to describe the translation and adaptation of the Suitability and Comprehensibility of Materials (SAM+CAM) instrument into the Swedish language and health care context and to explore challenges related to this process. The SAM+CAM instrument was translated and culturally adapted in five steps: forward translation, synthesis, back translation, expert review, and pretests. Differences were found when translating and culturally adapting the SAM+CAM instrument in the areas of semantic, idiomatic, and experiences. Participants revealed several clarity inconsistencies between items. They also identified linguistic differences and unfamiliar wording; they found that the instrument was perplexing to use and lacked knowledge regarding the specific health care areas in the examined PEMs. The cultural perspective is a significant factor that influences the usability of PEMs. Therefore, expert groups of participants are useful when adapting instruments to different cultures. The Swedish SAM+CAM instrument requires experienced and highly qualified raters.
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| 10. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Making Sense of Receiving Palliative Treatment: Its Significance to Palliative Cancer Care Communication and Information Provision.
- 2013
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Ingår i: Cancer nursing. - : Wolters Kluwer. - 1538-9804 .- 0162-220X. ; 36:4, s. 265-273
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: By receiving palliative treatment over time, a growing number of people with advanced gastrointestinal cancer are living longer. An image of palliative care, often existing in the public, as being exclusively for the dying could thus be particularly challenging in relation to patients' making sense of receiving palliative treatment over time. OBJECTIVE:: The aim was to interpret how patients diagnosed with advanced gastrointestinal cancer make sense of receiving palliative treatment. METHODS:: A phenomenological life-world approach was chosen. Seven men and 7 women with advanced gastrointestinal cancer receiving palliative treatment were followed up using repeated narrative interviews, which took place at a Swedish oncology clinic. In total, 66 interviews were conducted. The analysis followed hermeneutic principles and was interpreted stepwise. RESULTS:: Making sense was revealed as a phenomenon constructed narratively, through patients' searching for knowledge and understanding, approached by a dialectic pattern of living in wait and in the present, and finally, as a process of human learning through being and becoming, which transforms the experience and results in a changed personal experience. CONCLUSION:: Making sense of receiving palliative treatment is a process of human learning at the end of life, characterized by an ongoing search for knowledge and understanding. To enhance patients' sense making in this context, professionals need to go beyond "providing information." IMPLICATIONS FOR PRACTICE:: The attention of health professionals must be directed at recognizing and enhancing patients' ways of seeking knowledge to help them make sense of receiving palliative treatment. Person-centered activities need to be developed.
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