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- Carlsson, Eva, 1959, et al.
(författare)
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Structure and content in consultations with patients undergoing surgery for colorectal cancer
- 2013
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 17:6, s. 820-826
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore the structure and content of pre-planned consultations as part of the care and treatment of patients undergoing surgery for colorectal cancer. Methods: The study was based on 50 transcripts of audio-recorded pre-planned consultations between seven patients and 36 healthcare professionals from the time of diagnosis, pre-operative consultation, discharge consultation and pathology report in a colorectal unit. Results: The spread of consultation time between professions was considerable. Total mean consultation time for patients during the care process (7 consultations/patient) was 111 mm (range 83-191). The mean consultation time for surgeons was 18 min (7-40), anaesthesiologists 12 min (5-18) and nurses 14 min (5-49). Patients took up 40% of the word space, healthcare professionals used 59% and significant others 1%. Word space changed in such a way that the patient became more active towards the final consultation. Neither during the diagnosis consultation nor during the pre-operative consultation did the patients meet the operating surgeon. Six major subjects emerged: general health, diagnosis, surgical procedure, pre-operative preparations, recovery and treatment and follow-up. Conclusions: There is a need for clearer structure in the consultations. Most consultations lacked a clear introduction to the subject of the conversation. The study makes it possible to develop methods and structure for supporting conversations in which the patient is given space to help with the difficult issues present after undergoing surgery for colorectal cancer. The study also contributes to providing knowledge of how to organise surgical consultations in order to optimise person-centeredness, teamwork and clinical efficiency. (C) 2013 Elsevier Ltd. All rights reserved.
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- Lidén, Eva, 1955, et al.
(författare)
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Ways of talking about illness and prognosis in palliative cancer care consultations-two interactional frames
- 2010
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Ingår i: SUPPORTIVE CARE IN CANCER. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 18:4, s. 399-408
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to describe how interaction about changes in illness and prognosis was shaped by participants in outpatient palliative cancer care consultations. The data collection involved six video-recorded consultations at an outpatient oncology unit at a university hospital in Sweden. The interactions were studied by means of discourse analysis. Inclusion criteria for the patients were gastro-intestinal cancer and receiving palliative care. The sample included three men and three women, aged 54-70, with various metastasised gastro-intestinal tumours. Significant others (SOs) were included where patients brought one to the consultation. Three male consultants aged 55-59 participated. In palliative care consultations, the person-to-person and the patient-professional conversation frames were found to be in use as patients, SOs and physicians talked about the patients illness and prognosis. Within the patient-professional frame, three interactional patterns were found: the patient emphasising emotional experiences of illness or well-being and the physicians responding by toning down strategies, patients asking direct questions and getting straight answers and finally interaction marked by cautiousness and avoidances. Within the person-person frame, the interactions were described as: playful talk, collegial talk and existential talk. When patients shared their personal interpretations of illness and prognosis, their narrative was more enhanced by the person-to-person frame than the patient-professional frame. Finding out if and how patients and SOs want to express their worries and finding a balance between the interactional patterns that occur are ethical challenges which health professionals must face. Since patients and SOs may restrain their emotional experiences, investigating grounded ways of overcoming these difficulties is imperative.
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- 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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- Pettersson, Monica, 1963, et al.
(författare)
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Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery
- 2017
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:4, s. 674-686
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse.AIM: The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer.METHOD: The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis RESULTS: The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns.CONCLUSION: There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing surgery.
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- Öhlén, Joakim, 1958, et al.
(författare)
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Exploration of communicative patterns of consultations in palliative cancer care.
- 2008
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Ingår i: European journal of oncology nursing : the official journal of European Oncology Nursing Society. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 12:1, s. 44-52
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Tidskriftsartikel (refereegranskat)abstract
- Building on the research conducted on institutional communication, and the analysis of actual communication taking place in clinical settings, this study describes and highlights features of palliative care consultations and focuses on the distribution of discursive space (i.e., share of words, lengths of turns), occurring topics and conversational frames. Six consultations between physicians, patients and significant others were videotaped and all participants took part in audio-taped interviews. The recordings were transcribed and analysed in regard to expectations of, the discursive space of, and topics addressed in the consultations. The distribution of the discursive space was unequal; the physicians had the greatest share of words and length of turns in all six consultations, and they mostly initiated discussion of medical issues connected to examinations and treatment, while only patients initiated the topic of the patient's future. During the consultations, institutional framing tended to dominate over client framing. There was found to be room for further study of the structure and content of palliative care consultations with emphasis on how the voice of the patient can manifest itself within the framework of the medical agenda of the consultation and its significance for palliative cancer team work.
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