| 1. |
- Broberger, Eva, et al.
(author)
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Spontaneous reports of most distressing concerns in patients with inoperable lung cancer : at present, in retrospect and in comparison with EORTC-QLQ-C30+LC13
- 2007
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In: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 16:10, s. 1635-1645
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Journal article (peer-reviewed)abstract
- Patients with lung cancer experience considerable distress. Therefore, accurate methods for assessing distress and quality of life over time may play a key role for managing and evaluating palliative care. Alternatives to commonly used standardized questionnaires are individual measures. This study prospectively and retrospectively explored the concerns that 46 patients with inoperable lung cancer spontaneously reported as causing most distress close to diagnosis and 6 months later. Changes in content individually generated through a structured inductive freelisting were compared with EORTC-QLQ-C30+LC13 ratings. The results showed that patients perceived a wide variety of concerns as most distressing and that their concerns changed over time. Between 56 and 62% of these concerns were assessed by items included in the EORTC-QLQ-C30+LC13 questionnaires. Furthermore, patients' reports of most distress from fatigue, pain and dyspnea were not always reflected in intensity ratings of comparable EORTC-QLQ-C30+LC13 items. These results indicate that items included in standardized measures are not always adequate to assess patients' concerns, priorities and changes over time. In addition to standardized questionnaires, individualized measures may be useful in the clinical palliative setting for providing detailed information about the individual's problems and prioritizations.
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| 2. |
- Larsen, Anne, et al.
(author)
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Complex caring needs without simple solutions : the experience of interprofessional collaboration among staff caring for older persons with multimorbidity at home care settings
- 2017
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In: Scandinavian Journal of Caring Sciences. - 0283-9318 .- 1471-6712. ; 31:2, s. 342-350
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Journal article (peer-reviewed)abstract
- Background: Older persons with multimorbidity being cared for at home often have complex needs which can´t be met by one player. Interprofessional collaboration is therefore considered necessary if care is to be organised according to the needs of the elderly. To achieve coherent healthcare, municipalities and regions need to develop this area.Aim: The aim of the study was to illustrate how various professionals belonging to homemaker services, home care services in municipality and Hospital-Based Home Care Services experience their collaboration in caring for older persons with multimorbidity.Method: Eleven informants took part in the study and individual interviewed. The material was analysed using a hermeneutic data analysis.Result: The result shows that collaboration between players contains various types of experiences which influence not only the staff who are involved in collaboration but also the result of the collaboration itself. The informants´ experience of collaboration was defined by trust and distrust and by security and insecurity. These influenced both the staff who were involved in collaboration and the result of collaboration itself.Conlusion: Complex situations could not be solved with simple models. Instead a flexible approach appears necessary with focus shifted from structures to interpersonal relations and interactions. Therefor the different professions have to work as a transprofessional team where close interactions, flexibility and improvisation is a key to success. Relevance to clinical practice: A transprofessional approach to teamwork collaboration can blur professional boundaries and take the competence of all staff into account when home health care to older people with multimorbidity is to be provided by multiple caregivers. This is suggested as an approach with potential to provide high quality and safe care to a vulnerable population.
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| 3. |
- Tishelman, Carol, et al.
(author)
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Symptoms in patients with lung carcinoma : distinguishing distress from intensity.
- 2005
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In: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 104:9, s. 2013-21
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Journal article (peer-reviewed)abstract
- BACKGROUND: The patient perspective on distress associated with lung carcinoma is important, yet understudied. Previous research on symptom experience generally had not differentiated the dimension symptom intensity/frequency from which symptoms are associated with most distress. The objective of the current study was to determine whether patterns of symptom intensity were similar to patterns of symptom distress, whether patterns were consistent at different time points, whether patterns varied by subgroups, and whether high symptom intensity was equivalent to distress.METHODS: Four hundred adults who were newly diagnosed with inoperable lung carcinoma completed a measure of symptom intensity/frequency and a new measure of distress associated with symptoms at six time points during the first year after diagnosis. These data were supplemented by field notes by research nurses and by less structured, qualitative interviews.RESULTS: The mean ranking of distress in the total group and in all subgroups remained constant at all time points, with breathing, pain, and fatigue associated with the most distress. In contrast, the pattern of mean rank order of symptom intensity showed little consistency; however, fatigue had the highest intensity scores at all time points.CONCLUSIONS: The current data challenged the uncritical use of summated scores of different symptom items in the context of lung carcinoma. Breathing and pain appeared to function as icons representing threats associated with lung carcinoma, with distress described as related to the past and the present and to expectations for the future. One of the most promising implications of these data was in fostering a preventive paradigm for symptom palliation.
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| 4. |
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| 5. |
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| 6. |
- Broberger, Eva
(author)
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Towards understanding patients’ and caregivers’ assessments of symptoms and quality of life in lung cancer
- 2007
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Doctoral thesis (other academic/artistic)abstract
- Lung cancer is associated with a wide range of symptoms arising from both disease progression and treatment side effects. Nurses caring for patients with lung cancer are thus challenged to help patients cope with a variety of problems. Individual perspectives, influences and experiences are of great importance to consider when interpreting patients and caregivers assessments of symptoms and quality of life. The overall aim of this thesis is to gain better understanding of different aspects influencing assessments of patients symptom experiences and quality of life by patients with inoperable lung cancer and their professional and family caregivers. The focus is on perspectives, symptom characteristics, changes in patients internal standards and prioritizations over time, and measurement approaches. The specific aims are to 1) explore whether there may be discrepancies between patients and their professional and family caregivers assessments of symptom occurrence and symptom distress, 2) examine changes in internal standards of measurement in patients regarding physical function, fatigue and overall quality of life, 3) examine changes over time and in retrospect in what patients spontaneously report as most distressing, 4) examine to what extent a standardized cancer-specific questionnaire assesses those concerns patients spontaneously reported as most distressing and 5) examine relationships between symptom occurrence, intensity and distress. The database for the four papers included in this thesis is comprised of prospective and retrospective symptom and quality of life assessments from sub-sets of patients participating in a longitudinal descriptive study of 400 patients diagnosed with inoperable lung cancer during the first year postdiagnosis. The relationship between symptom occurrence and symptom distress was studied in different ways, with all approaches confirming that they are separate components of patients symptom experiences. Patients and caregivers dyadic assessments of patient s symptom experience show that patients and caregivers were able to separate these two components although caregivers assigned most symptoms higher levels of intensity than patients themselves did. A symptom s association with distress was neither consistently related to its current occurrence, nor to whether high intensity levels were reported for that symptom. Patients spontaneous reports of a wide variety of concerns perceived as currently causing most distress changed over time and in retrospect. The cancer-specific questionnaire did not always adequately assess patients priorities, changes over time, or the content and intensity of concerns reported as most distressing, Decisive support to demonstrate that changes in patients internal standards of measurement influenced their assessments of symptom experience and quality of life during the first six months following diagnosis was not found. In summary, findings stress the importance of considering perspectives, symptom characteristics, patients priorities and adaptive processes, as well as measurement approaches when planning for symptom interventions to prevent or alleviate problems for the individual patient.
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| 7. |
- Carol, Tishelman, et al.
(author)
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Are the most distressing concerns among patients with lung cancer adequately assessed? : A mixed-methods study
- 2010
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In: Journal of Clinical Oncology. - Baltimore : American Society of Clinical Oncology. - 0732-183X .- 1527-7755. ; 28:11, s. 1942-1949
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Journal article (peer-reviewed)abstract
- Purpose. Standardized questionnaires for patient-reported outcomes are generally composed of specified predetermined items, although other areas may also cause patients distress. We therefore studied reports of what was most distressing for 343 patients with inoperable lung cancer (LC) at six time points during the first year postdiagnosis and how these concerns were assessed by three quality-of-life and symptom questionnaires.Patients and Methods. Qualitative analysis of patients' responses to the question “What do you find most distressing at present?” generated 20 categories, with 17 under the dimensions of “bodily distress,” “life situation with LC,” and “iatrogenic distress.” Descriptive and inferential statistical analyses were conducted.Results. The majority of statements reported as most distressing related to somatic and psychosocial problems, with 26% of patients reporting an overarching form of distress instead of specific problems at some time point. Twenty-seven percent reported some facet of their contact with the health care system as causing them most distress. While 55% to 59% of concerns reported as most distressing were clearly assessed by the European Organisation for Research and Treatment for Cancer Quality of Life Questionnaire Core-30 and Lung Cancer Module instruments, the Memorial Symptom Assessment Scale, and the modified Distress Screening Tool, iatrogenic distress is not specifically targeted by any of the three instruments examined.Conclusion. Using this approach, several distressing issues were found to be commonly reported by this patient group but were not assessed by standardized questionnaires. This highlights the need to carefully consider choice of instrument in relation to study objectives and characteristics of the sample investigated and to consider complementary means of assessment in clinical practice.
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| 8. |
- Edelbring, Samuel, PhD, Docent, 1969-, et al.
(author)
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Flexible interprofessional student encounters based on virtual patients : a contribution to an interprofessional strategy
- 2022
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In: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 36:2, s. 310-317
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Journal article (peer-reviewed)abstract
- It is challenging to organize interprofessional activities in terms of coordinating students' various schedules. These challenges can be overcome by providing flexible online opportunities based on virtual patients (VPs). This study set out to study feasibility of using a blended approach based on virtual patients and a flexible interprofessional student encounter. The encounter was arranged in pairs or triads between nursing and medical students from two separate courses. Data were gathered through a questionnaire and followed up with group interviews. Reflective texts from the interprofessional encounters were analyzed in relation to descriptions of interprofessional competence. The great majority (86%) chose to meet online due to its flexibility. The participants gained an understanding of the other profession's roles and competences and a holistic patient awareness. Given its flexible and scalable opportunities, the blended online virtual patient approach provides a valuable contribution to an interprofessional programme.
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| 9. |
- Larsen, Anne, et al.
(author)
-
Complex caring needs without simple solutions : the experience of interprofessional collaboration among staff caring for older persons with multimorbidity at home care settings
- 2017
-
In: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Ltd. - 0283-9318 .- 1471-6712. ; 31:2, s. 342-350
-
Journal article (peer-reviewed)abstract
- Background: Older persons with multimorbidity being cared for at home often have complex needs which can´t be met by one player. Interprofessional collaboration is therefore considered necessary if care is to be organised according to the needs of the elderly. To achieve coherent healthcare, municipalities and regions need to develop this area. Aim: The aim of the study was to illustrate how various professionals belonging to homemaker services, home care services in municipality and Hospital-Based Home Care Services experience their collaboration in caring for older persons with multimorbidity. Method: Eleven informants took part in the study and individual interviewed. The material was analysed using a hermeneutic data analysis. Result: The result shows that collaboration between players contains various types of experiences which influence not only the staff who are involved in collaboration but also the result of the collaboration itself. The informants´ experience of collaboration was defined by trustand distrust and by security and insecurity. These influenced both the staff who were involved in collaboration and the result of collaboration itself. Conlusion: Complex situations could not be solved with simple models. Instead a flexible approach appears necessary with focus shifted from structures to interpersonal relations and interactions. Therefor the different professions have to work as a transprofessional team where close interactions, flexibility and improvisation is a key to success. Relevance to clinical practice: A transprofessional approach to teamwork collaboration can blur professional boundaries and take the competence of all staff into account when home health care to older people with multimorbidity is to be provided by multiple caregivers. This is suggested as an approach with potential to provide high quality and safe care to a vulnerable population.
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| 10. |
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