| 1. |
- Ander, Malin, 1983-, et al.
(författare)
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A preliminary open trial of individualised cognitive behavioural therapy for young survivors of cancer during adolescence: initial findings and conceptualisation of distress
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: A subgroup of adolescent and young adult (AYA) survivors of cancer in adolescence report high levels of psychological distress. Empirically-supported treatments tailored to the concerns experienced by this population are lacking. The aims of this study were to (1) conduct a preliminary evaluation of an individualised cognitive behavioural therapy (CBT) intervention for adolescent and young adult (AYA) survivors of cancer during adolescence and (2) identify and conceptualise cancer-related psychological concerns using cognitive-behavioural theory.Methods: A single-arm trial in which ten AYA (17-25 years) survivors of cancer during adolescence were offered up to 15 sessions of individualised CBT guided by behavioural case formulations was undertaken. Clinical outcomes were assessed at baseline, post-treatment, and three months follow-up. Before commencing treatment, two individual qualitative interviews were conducted with each participant. Analysis of cancer-related concerns was guided by qualitative framework analysis and theoretical thematic analysis, and cognitive-behavioural theory was used to inform identification of themes.Results: Ten of 201 potential participants invited to participate were included resulting in an overall participation rate of 5%. Nine participants completed treatment and eight completed the follow-up assessment. The majority of concerns reported were cancer-related and conceptualised as social avoidance, fear and avoidance of emotions and bodily symptoms, low mood and unbalance in activity, and worry and rumination.Conclusions: Given significant difficulties with recruitment, further research is needed to examine barriers and the impact of mental health literacy and stigma on help seeking in the AYA cancer survivor population. Internet-administered CBT self-help tailored towards the main presenting concerns of AYA cancer survivors may be a promising solution.
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| 2. |
- Ander, Malin, 1983-
(författare)
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Cancer during adolescence : Psychological consequences and development of psychological treatment
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to examine long-term psychological distress following cancer during adolescence and to develop a tailored psychological intervention to reduce cancer-related distress experienced by young survivors of adolescent cancer that was feasible and acceptable.Study I adopted a longitudinal design, assessing health-related quality of life (HRQOL) and symptoms of anxiety and depression among adolescents diagnosed with cancer from shortly after diagnosis (n=61) up to 10 years after diagnosis (n=28). Findings suggest that development of HRQOL and anxiety and depression is not linear and whilst the majority adjust well, a subgroup report long-term elevated distress. In Study II, experiences of cancer-related psychological distress were explored using unstructured interviews. Participants described cancer treatment as a mental challenge, felt marked and hindered by the cancer experience, and struggled with feelings of inadequacy and insecurity, existential issues, and difficulties handling emotions. Study III was a preliminary investigation of individualised cognitive behavioural therapy (CBT), alongside the identification and conceptualisation of cancer-related concerns using cognitive-behavioural theory. Significant difficulties with recruitment were encountered. Participants reported cancer-related concerns conceptualised as social avoidance, fear and avoidance of emotions and bodily symptoms, imbalance in activity, and worry and rumination. In Study IV, the acceptability and feasibility of an internet-administered CBT based self-help intervention (ICBT) for young persons diagnosed with cancer during adolescence was examined using an uncontrolled design and embedded process evaluation. The study protocol for Study IV was included in this thesis along with preliminary findings demonstrating significant difficulties with recruitment.Overall, findings suggest that whilst the majority of survivors of adolescent cancer adjust well over time a subgroup report elevated levels of distress and a range of distressing cancer-related experiences. A number of cancer-related difficulties were identified in Study II and III, which may be used to inform the development of future psychological treatments for the population. Preliminary investigation of the psychological interventions examined within this thesis further highlights the need for future development work to enhance the feasibility and acceptability of psychological support for the population.
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| 3. |
- Ander, Malin, et al.
(författare)
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Development of health-related quality of life and symptoms of anxiety and depression among persons diagnosed with cancer during adolescence : a 10-year follow-up study
- 2016
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 25:5, s. 582-589
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The main aim was to investigate the development of health-related quality of life (HRQOL) and symptoms of anxiety and depression in a cohort diagnosed with cancer during adolescence from shortly after up to 10 years after diagnosis.Methods: Participants (n = 61) completed the SF-36 and the HADS shortly; six, 12, and 18 months; and two, three, four, and 10 years (n = 28) after diagnosis. Polynomial change trajectories were used to model development.Results: Polynomial change trajectories showed an initial increase which abated over time into a decrease which abated over time for the SF-36 subscales Mental Health and Vitality; an initial decline which abated over time into an increase for HADS anxiety; and an initial decline which abated over time into an increase which abated over time for HADS depression. The SF-36 mental component summary showed no change from two to 10 years after diagnosis whereas the SF-36 physical component summary showed an increase from two years after diagnosis which declined over time. Ten years after diagnosis 29% reported possible anxiety.Conclusions: Development of HRQOL and symptoms of anxiety and depression appears to be nonlinear among persons diagnosed with cancer during adolescence. Well into permanent survivorship an increase in symptoms of anxiety is shown and approximately a third of the participants report possible anxiety. The findings indicate the need for: studies designed to pinpoint the times of highest psychological risk, clinical follow-up focusing on psychological problems, and development of effective psychological interventions for survivors of adolescent cancer
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| 4. |
- Ander, Magnus, et al.
(författare)
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Elchockvapen som hjälpmedel vid polisiära ingripanden : En vetenskaplig utvärdering av Polismyndighetens försöksverksamhet med elchockvapen 2018-2019
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- BAKGRUND: Ur ett internationellt perspektiv har det, inom polisen, under de senaste åren skett en ökning i användandet av mindre dödliga vapen. Dessa vapen används för att ta kontroll över potentiellt farliga och icke samarbetsvilliga personer. Ett vanligt förekommande mindre dödligt vapen är elchockvapen (ECV). Elchockvapen har fram till 2018 inte använts i Sverige, men Polismyndigheten har under åren 2018–2019 genomfört en försöksverksamhet med ECV.SYFTE: Syftet med undersökningen var att utvärdera Polismyndighetens försöksverksamhet med ECV, samt att undersöka vilken legitimitet polisens användning av ECV har bland allmänheten.METOD: Både kvantitativa och kvalitativa data samlades in för att utvärdera försöket med ECV. Mätningar före, under, och i slutet av försöksverksamheten genomfördes med hjälp av en enkät. Enkäten besvarades av två grupper av poliser; en grupp som ingick i försöksverksamheten med ECV samt en kontrollgrupp poliser som inte ingick i försöksverksamheten. För att fördjupa förståelsen för enkätresultaten genomfördes djupintervjuer och fokusgruppsintervjuer med poliser som hade erfarenhet av ECV under försöksverksamheten. För att undersöka legitimitetsaspekter utifrån ett medborgarperspektiv genomfördes fokusgrupper med deltagare från allmänheten. Data från Polisens arbetsskadesystem LISA inhämtades för att undersöka ECV:s inverkan på skador hos poliserna.RESULTAT: Enkätresultaten visade inga skillnader mellan delaktiga och kontrollgrupp när det gäller upplevelse av stressfulla situationer. Upplevelsen av trygghet vid ingripanden med hög grad av motstånd eller när polisen blir fysisk angripen har dock ökat för de poliser som deltagit i ECVförsöket, jämfört med kontrollgruppen. Intervjuresultaten åskådliggör också att tillgången till ECV bidrar till att minska upplevelsen av stress i våldsamma situationer genom att ECV ökar tryggheten i sådana situationer. Intervjuresultaten påvisar även att tillgången till ECV gör att man slipper använda andra potentiellt skadligare våldshjälpmedel såsom fysiska metoder och skjutvapen. Enkätresultatet visar ingen skillnad mellan de som ingick i försöksverksamheten och kontrollgruppen när det gäller att utsättas för hot, våld eller motstånd, eller att polis eller motpart blir skadade. Resultaten från intervjuer och fokusgrupper synliggör att poliserna upplever att ECV fyller en viktig funktion. Poliserna ser enbart fördelar med ECV och vissa menar att det är det bästa verktyg som de har fått. ECV upplevs kunna rädda liv, minska skador på polis och motpart, samt förbättra arbetsmiljön för poliser. Intervjuer och fokusgrupper pekar på att deltagarna upplever att ECV har en deeskalerande inverkan, vilket både kan minska våldsanvändningen, och förebygga våld mot polisen. Enkät och intervjuresultaten indikerar att ECV bidrar till en minskad användning av andra hjälpmedel såsom batong och pepparspray, vilka ofta ger mer skador på både motpart och polis. Deltagarna från allmänheten har uppfattningen att ECV är ett effektivt och bra verktyg för polisen, men lyfter vikten av att det finns en lyhördhet gällande vilka situationer som den används i och mot vem.SLUTSATSER: Utifrån våra enkätresultat är det svårt att dra några säkra slutsatser kring hur användandet av ECV inverkar på skador hos poliser och motpart. Erfarenheterna bland de delaktiga är dock att risken för våld och skador minskar markant, vilket är en viktig indikator. Tillgången till ECV kan öka trygghet och minska stress i ingripandesituationer där kraftigt motstånd och våld förekommer. ECV kan även minska användandet av pepparspray och batong, och det finns indikationer på att ECV har använts istället för skjutvapen. ECV kan underlätta val av hjälpmedel vid ingripanden med hög grad av hot och våld och kan ha en deeskalerande inverkan. Polisens användande av våldshjälpmedel, inklusive ECV, upplevs berättigat av informanterna från allmänheten.
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| 5. |
- Ander, Malin, et al.
(författare)
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Exploration of psychological distress experienced by survivors of adolescent cancer reporting a need for psychological support
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:4
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Tidskriftsartikel (refereegranskat)abstract
- Objective In this qualitative study, we aimed to provide an in-depth exploration of cancer-related psychological distress experienced by young survivors of cancer during adolescence reporting a need for psychological support.MethodsTwo individual interviews were held with ten young survivors of cancer diagnosed in adolescence. The interviews were audio-recorded and transcribed verbatim. Analysis followed the guidelines for inductive qualitative manifest content analysis.ResultsThe survivors described distress experienced during and after the end of treatment. Five categories comprising 14 subcategories were generated. The categories included: A tough treatment, Marked and hindered, Not feeling good enough, Struggling with the fragility of life, and finally, An ongoing battle with emotions.Conclusion Young survivors of adolescent cancer reporting a need for psychological support described feeling physically, socially, and mentally marked by the cancer experience. They struggled with powerlessness, insecurity, social disconnection, loneliness, and feelings of being unimportant and a failure, and had difficulties understanding and managing their experiences. These concerns should be addressed in psychological treatments for the population irrespective of which approach or model is used to understand survivors’ difficulties. A transdiagnostic approach targeting processes that underpin different manifestations of distress may be effective.
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| 6. |
- Ander, Malin, et al.
(författare)
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Guided Internet-Administered Self-Help to Reduce Symptoms Of Anxiety and Depression Among Adolescents and Young Adults Diagnosed With Cancer During Adolescence (U-CARE: YoungCan) : study protocol for a feasibility trial
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction A subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored for this population are lacking. This protocol describes a feasibility study of a guided-internet-administered self-help programme (YoungCan) primarily targeting symptoms of anxiety and depression among young persons diagnosed with cancer during adolescence and of the planned study procedures for a future controlled trial. Methods/analysis The study is an uncontrolled feasibility trial with a pre-post and 3-month follow-up design. Potential participants aged 15-25years, diagnosed with cancer during adolescence, will be identified via the Swedish Childhood Cancer Registry. 30 participants will be included. Participants will receive YoungCan, a 12-week therapist-guided, internet-administered self-help programme consisting primarily of cognitive-behavioural therapy organised into individually assigned modules targeting depressive symptoms, worry and anxiety, body dissatisfaction and post-traumatic stress. Interactive peer support and psychoeducative functions are also available. Feasibility outcomes include: recruitment and eligibility criteria; data collection; attrition; resources needed to complete the study and programme; safety procedures; participants' and therapists' adherence to the programme; and participants' acceptability of the programme and study methodology. Additionally, mechanisms of impact will be explored and data regarding symptoms of anxiety, depression, post-traumatic stress, body dissatisfaction, reactions to social interactions, quality of life, axis I diagnoses according to the Mini International Neuropsychiatric Interview and healthcare service use will be collected. Exploratory analyses of changes in targeted outcomes will be conducted. Ethics/dissemination This feasibility protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref: 2016/210). Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences.
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