| 1. |
- Broström, Anders, et al.
(författare)
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Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation
- 2019
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 28:5
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub-populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.
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| 2. |
- Fritzell, K., et al.
(författare)
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Making the BEST decision : The BESTa project development, implementation and evaluation of a digital Decision Aid in Swedish cancer screening programmes-a description of a research project
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:12 December
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has a long tradition of organized national population-based screening programmes. Participation rates differ between programmes and regions, being relatively high in some groups, but lower in others. To ensure an equity perspective on screening, it is desirable that individuals make an informed decision based on knowledge rather than ignorance, misconceptions, or fear. Decision Aids (DAs) are set to deliver information about different healthcare options and help individuals to visualize the values associated with each available option. DAs are not intended to guide individuals to choose one option over another. The advantage of an individual Decision Aid (iDA) is that individuals gain knowledge about cancer and screening by accessing one webpage with the possibility to communicate with health professionals and thereafter make their decision regarding participation. The objective is therefore to develop, implement and evaluate a digital iDA for individuals invited to cancer screening in Sweden. Methods This study encompasses a process-, implementation-, and outcome evaluation. Multiple methods will be applied including focus group discussions, individual interviews and the usage of the think aloud technique and self-reported questionnaire data. The project is based on The International Patient Decision Aid Standards (IPDAS) framework and the proposed model development process for DAs. Individuals aged 23 74, including women (the cervical-, breast-and CRC screening module) and men (the CRC screening module), will be included in the developmental process. Efforts will be made to recruit participants with selfreported physical and mental limitations, individuals without a permanent residence and ethnic minorities. Discussion To the best of our knowledge, the present study is the first attempt aimed at developing an iDA for use in the Swedish context. The iDA is intended to facilitate shared decision making about participation in screening. Furthermore, the iDA is expected to increase knowledge and raise awareness about cancer and cancer screening.
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| 3. |
- Hedberg, Berith, 1951-
(författare)
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Communicative approaches in the decision making process
- 2009
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Ingår i: 7th Interdisciplinary Conference on Communication, Medicine Ethics (COMET).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Communication in health care is sometimes problematic because of the participants' asymmetrical positions when negotiating the patients' future care. When decisions are made about stroke survivors' care treatment they should be involved despite communicative disabilities. Method: In a total of five hours recorded talk, data from care-planning meetings with elderly persons surviving stroke, has been transcribed and analyzed. To identify how the actors agreed upon decisions about care efforts after discharge, an inductive analyzing approach was used through the procedure of coding and categorization. By looking for patterns the two approaches emerged. Findings: Two distinctive approaches appeared in the communicative process, the open-minded and the aimdriven. The open-minded was characterized by questioning, merging information discussing alternative solutions leading to a goal step by step. The other communicative approach appeared to be aim-driven and was characterized by alliances between some of the participants. When the participants were involved in communicative alliances, they seemed to share a predetermined common goal for the patient's further care after discharge. The most significant alliance involved the patient together with relatives. The most noteworthy finding is that of the patient's need for communicative alliances with other participants when negotiating their needs and desires of further care. It was shown the stroke survivors are able to express their life world perspective when they are in alliances with relatives or healthcare professionals.
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| 4. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:5, s. 446-455
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.AIM: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.METHODS: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale-Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.RESULTS: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.CONCLUSION: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.
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| 5. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Factors associated with involvement in risk communication and confidence in shared decision making among patients with atrial fibrillation.
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S74-S75
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.
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| 6. |
- Hedberg, Berith, 1951-
(författare)
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Flerpartssamtalet före utskrivning
- 2008
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Ingår i: Stroke i fokus. - Lund : Studentlitteratur. - 9789144019710
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 7. |
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| 8. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Shared decision-making and person-centred care in Sweden : Exploring coproduction of health and social care services
- 2022
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Ingår i: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. - : Elsevier. - 1865-9217 .- 2212-0289. ; 171, s. 129-134
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden the health system is nationally regulated and locally provided by 21 regions and 290 municipalities. To meet the shifting paradigm, where the person is viewed as a co-producer of health and care, Sweden has laws, regulations and policies which support the patient as an active partner in the communication with professionals in the system. Coproduction, person-centred care and shared decision making contribute jointly to the paradigm shift. Principles of human dignity and equity must be supported nationally and enacted in the decentralized, regional provision of care. Infrastructures exist or are under development which can support and strengthen care that is co-produced and based in a person-centred philosophy and approach, where shared decision making becomes a reality in practice. A Knowledge management system together with National Quality registries have the potential to form a co-produced, person-centred learning health system, where patients, and next of kin and professionals are included as partners. The joint integration of Shared decision making, Person-centre care and Coproduction into the Swedish healthcare system now looks like a possible way to realize the emerging paradigm.
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| 9. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Utvärdering av Samverkan i Vårdkedjan
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet var att utvärdera samverkan i vårdkedjan genom att belysa om Esther får vård i eller nära hemmet, får lika vård på hela Höglandet, upplever vården och omsorgen som en vårdgivare, har en individuell vårdplan och vet vart hon/han ska vända sig. Kvantitativ data avseende åldersfördelning, vårdnivå, vårdtillfällen, medelvårdtid, väntetid på akutmottagningen, medicinklinikens rådgivande koordinatorsfunktion och ”Medicin direkt” samt avvikelserapportering har insamlats från befintlig statistik från Höglandets sjukvårdsvårdsområde. Kvalitativ data har insamlats genom fokusgruppsintervjuer med 29 äldre personer > 65 år och 21 vård- och omsorgspersonal inom Höglandets sjukvårdsområde. Statistiken visar att antalet inskrivna individer i hemsjukvården har ökat, primärvårdsbesöken likaså och antalet läkarbesök i patientens bostad/motsvarande har i det närmaste fördubblats. På motsvarande sätt visar statistiken att antalet inläggningar, medelvårdtid samt återinläggningar har minskat. För åldersgruppen 80 år och äldre har antal besök på kirurgisk mottagning ökat medan besöken på medicinsk mottagning har minskat. I samma åldersgrupp visar statistiken att medelväntetiden på kirurgkliniken respektive medicinkliniken har ökat med 52 respektive 53 minuter. Rådgivningar via medicinklinikens koordinator har ökat samtidigt som överföringen av patienten till akutmottagningen vid Höglandsjukhuset också har ökat. Resultatet från den kvalitativa analysen visar att Esther känner sig trygg när hon/han behöver hjälp och stöd av vårdgivaren. För ”Esther som individ” innebär samverkan i vårdkedjan tillgänglighet, kontinuitet och aktivitet men också delaktighet, integritet och trygghet. Sitt beroende av andra hanterar Esther genom att använda strategier som eget ansvar, anpassning, acceptans och passivisering. För personalen utgör ramar och villkor som omger deras arbete i relation till Esthers behov av vård och omsorg, faktorer som påverkar samverkan i vårdkedjan. Slutsatsen är att grundtanken i Esther nätverk finns förankrad i vårdkedjan. Personalens gemensamma synsätt avspeglas i att Esther i hög grad är nöjd med den vård och omsorg hon får och att hon känner sig trygg med den. Trygghet är grundläggande för Esther och innebär kontinuitet, tillgänglighet och att få en individ- och behovsanpassad vård och omsorg genom hela vårdkedjan. Inom ramen för samverkan är detta områden som skulle kunna förbättras ytterligare.
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