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- Springett, Jane, 1952-, et al.
(författare)
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Närsjukvård : bakgrund, erfarenheter och pilotstudie
- 2005
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Närsjukvård är ett centralt begrepp i ett förändringsarbete som för genomförs i nordöstra Skåne för att utveckla hälso- och sjukvårdsväsendet. Det ingår därmed som en av de centrala delarna av Region Skånes vision om hälso- och sjukvård: Skånsk livskraft – vård och hälsa. Syftet med denna rapport är att ge en bakgrund till begreppet (Del A) och att presentera en del preliminära rön beträffande hur olika aktörer i nordöstra Skåne uppfattar begreppet (Del B). Del A ger en översikt kring ursprunget till begreppet Närsjukvård inom ramen för de förändringar i hälso- och sjukvården som sker i Sverige i stort. Den beskriver sedan vilka slags förändringar som har planerats på politisk nivå och som nu håller på att genomföras under detta paraplybegrepp, nationellt, regionalt och lokalt. För detta syfte används statliga dokument och publicerade utvärderingsstudier i stor utsträckning som källmaterial. Denna del ska därför inte ses som en heltäckande översikt. Del B inriktas på att belysa hur långt förverkligandet av idén om Närsjukvård har kommit inom regionen. Avsnittet är en kartläggning av olika aktörers förståelse av Närsjukvård i den nordöstra delen av Region Skåne. Forskningsfrågorna inriktades på hur folk pratade om Närsjukvård, det vill säga på hur de förstod och använde begreppet.
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| 3. |
- Abrahams, Harriët J. G., et al.
(författare)
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Moderators of the effect of psychosocial interventions on fatigue in women with breast cancer and men with prostate cancer : Individual patient data meta-analyses
- 2020
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 29:11, s. 1772-1785
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Forskningsöversikt (refereegranskat)abstract
- ObjectivePsychosocial interventions can reduce cancer‐related fatigue effectively. However, it is still unclear if intervention effects differ across subgroups of patients. These meta‐analyses aimed at evaluating moderator effects of (a) sociodemographic characteristics, (b) clinical characteristics, (c) baseline levels of fatigue and other symptoms, and (d) intervention‐related characteristics on the effect of psychosocial interventions on cancer‐related fatigue in patients with non‐metastatic breast and prostate cancer.MethodsData were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. Potential moderators were studied with meta‐analyses of pooled individual patient data from 14 randomized controlled trials through linear mixed‐effects models with interaction tests. The analyses were conducted separately in patients with breast (n = 1091) and prostate cancer (n = 1008).ResultsStatistically significant, small overall effects of psychosocial interventions on fatigue were found (breast cancer: β = −0.19 [95% confidence interval (95%CI) = −0.30; −0.08]; prostate cancer: β = −0.11 [95%CI = −0.21; −0.00]). In both patient groups, intervention effects did not differ significantly by sociodemographic or clinical characteristics, nor by baseline levels of fatigue or pain. For intervention‐related moderators (only tested among women with breast cancer), statistically significant larger effects were found for cognitive behavioral therapy as intervention strategy (β = −0.27 [95%CI = −0.40; −0.15]), fatigue‐specific interventions (β = −0.48 [95%CI = −0.79; −0.18]), and interventions that only targeted patients with clinically relevant fatigue (β = −0.85 [95%CI = −1.40; −0.30]).ConclusionsOur findings did not provide evidence that any selected demographic or clinical characteristic, or baseline levels of fatigue or pain, moderated effects of psychosocial interventions on fatigue. A specific focus on decreasing fatigue seems beneficial for patients with breast cancer with clinically relevant fatigue.
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| 4. |
- Arving, Cecilia, et al.
(författare)
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Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study
- 2014
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 23:3, s. 251-258
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Tidskriftsartikel (refereegranskat)abstract
- Background The Distress Thermometer (DT) has been used in psycho-oncology research across the globe and has been recommended as a clinical tool to be used routinely in cancer settings to detect clinically significant distress. We sought to characterize the translation and validation of the DT in cancer patients in different countries and cultures and summarize how the translated versions function to detect clinically significant distress. Methods An electronic mail survey was sent to the members of the International Psychosocial Oncology Society Federation of Psycho-Oncology Societies and electronic searches of English language databases were conducted to identify translations of the DT and studies designed to validate these translations. Results Our efforts yielded a total of 21 non-English translations of the DT; 18 of these were validated in studies designed for that purpose. A variety of instruments were used in receiver operating characteristic curve analysis to derive an optimal cut-off score indicative of clinically significant distress. Cut-off scores varied by language, country, and clinical setting and to sample characteristics. In the majority of studies, a score of 4 maximized sensitivity and specificity relative to an established criterion. Conclusions These findings provide a broad, international perspective on the current state of psychosocial screening using the DT. Findings also demonstrate widespread awareness of the need for psychological and social support of persons diagnosed with and treated for cancer.
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| 6. |
- Bäckman, Malin, et al.
(författare)
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A randomized pilot study with daily walking during adjuvant chemotherapy for patients with breast and colorectal cancer
- 2014
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 53:4, s. 510-520
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Tidskriftsartikel (refereegranskat)abstract
- Background. Physical activity during chemotherapy has been shown in several studies to reduce fatigue, improve symptoms and impact positively on health-related quality of life (HRQoL). Challenges associated with intervention studies on physical activity during cancer treatment relate to consistent adherence. The primary objective was to study feasibility and adherence of physical activity intervention among patients with cancer during adjuvant chemotherapy treatment. The secondary objective was to investigate the effects of physical activity on health aspects, including HRQoL, symptoms and surrogate markers for cardiovascular disease. Material and methods. This randomized controlled trial included patients with breast cancer (BRCA) and colorectal cancer (CRC) during adjuvant chemotherapy. The intervention continued for 10 weeks and included daily walks of 10 000 steps and a weekly supervised group walk. Adherence was assessed by a pedometer and the number of participants who reported step counts every week and percentage of participants who achieved the target steps every week. Results. Adherence average reached 91% during the intervention period; in total 74% completed the exercise intervention. The majority of the participants achieved an average of 83% of the target of 10 000 steps per day for 10 weeks. There was a significant increase in daily physical activity (p = 0.016) in the intervention group. Significant differences were also found for some breast cancer-specific symptoms [swelling, mobility and pain (p = 0.045)]. The study showed a relatively small weight gain an average of 0.9 kg in the intervention group and 1.3 kg in the control group. Conclusion. Physical activity in the form of walking is feasible during adjuvant chemotherapy treatment despite increasing symptoms. The physical activity increased in the intervention group during the study time and had a positive impact on breast symptoms and the weight gain was lower in comparison to previous studies.
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| 7. |
- Edén, Lena, 1940-, et al.
(författare)
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Characteristics of disability pensioners returning to work : an interview study among individuals with musculoskeletal disorders
- 2007
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Ingår i: Disability and Rehabilitation. - 0963-8288 .- 1464-5165. - 0963-8288 ; 29:22, s. 1720-1726
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on 'resting disability pension'. Method. Qualitative analyses of interviews with 17 individuals going back to work. Results. Three adaptation patterns were identified: The Go- getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality. Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/ her life.
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| 9. |
- Henriksson, Anna
(författare)
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Physical activity and exercise during curative oncological treatment : exploring the effects of exercise intensity and behaviour change support, safety, and patients’ and exercise professionals’ experiences
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: This thesis aimed to explore the effects of exercise intensity and behaviour change support (BCS), the safety of exercise, and experiences of exercise for both patients and exercise professionals during oncological treatment (e.g. neo/adjuvant chemotherapy, endocrine treatment, radiotherapy). This thesis is based on data from the Phys-Can (Physical training and Cancer) multicentre research program, consisting of a feasibility study, an observation study, and a randomised controlled trial (RCT). Methods: Paper I and II were quantitative studies. Paper I was a RCT with a 2x2 factorial design. Patients newly diagnosed with breast, prostate, or colorectal cancer about to start oncological treatment were randomised to six months of high intensity (HI) or low-moderate intensity (LMI) supervised group based resistance- and home-based endurance training, with or without additional BCS. The primary outcome, cancer related fatigue (CRF), was assessed by the Multidimensional Fatigue Inventory. Multiple linear regression and additional responder analysis for primary outcomes were performed. Paper II was a descriptive and comparative study based on secondary data from the observation study and RCT. Data were presented descriptively, and related factors to adverse events (AEs) were analysed with logistic regressions. Paper III and IV were qualitative studies. Participants were patients with breast, prostate, or colorectal cancer undergoing oncological treatment (Paper III) or coaches supervising exercise for participants in the RCT (Paper IV). Data were collected through semi-structured individual- (Paper III and IV) and focus group interviews (Paper III) and analysed with qualitative content analysis (Paper III) and thematic analysis (Paper IV). Main results and conclusions: The results from this thesis indicate that exercise at HI may not improve CRF in comparison with exercise at LMI in patients undergoing treatment, thus patients can be advised to exercise at either preferred intensity. Also, additional BCS did not improve CRF in relatively motivated patients receiving supervised exercise (Paper I). Furthermore, exercise-related AEs in persons undergoing oncological treatment are minor, of musculoskeletal origin, and with a similar incidence as in healthy populations. However, a higher risk of minor exercise-related AEs was reported in HI groups than in LMI groups. More serious AEs were rare, thus it seems safe to exercise even at HI for these patient groups (Paper II). The results also indicated that patients could experience side effects and concerns regarding the safety of exercising during oncological treatment as barriers to engage in physical activity. Therefore, engaging in physical activity before the onset of side effects from treatment and providing information regarding physical activity to patients could be beneficial (Paper III). Professionals supervising exercise for patients may find it highly rewarding, which is promising for implementation in cancer rehabilitation. However, patients may still receive contradictory information regarding the safety of exercise from health care staff, which can be difficult for exercise professionals to counteract (Paper IV).
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| 10. |
- Johansson, Yvonne, 1959-
(författare)
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Tensions in the field of health care : knowledge networks and evidence-based practice: an action research approach
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Empirically, this thesis has focused on nine research and development (R&D) networks set up to promote a professional approach to care and strengthen the collaboration between health care sectors in a Swedish health care setting. The research project was embedded in an action research approach intended to encourage network development by means of a dialogical process. The specific research question was: What are the actors‟ perceptions of knowledge networks and how might we account for the networks‟ evolution, role and ways of working? Bourdieu‟s concepts reproduction and symbolic violence were used as analytical tools and were chosen as a way of answering and explaining the empirical story line. Data was collected by use of a multi-method approach consisting of 39 interviews, observations, document review and reflexive notes. The intention was to elicit data that supported both network development and the theoretical explanation to come. It appeared that the networks concerned had several advantages, such as being a forum for internal dialogue and exchange of experiences. In addition, two main patterns emerged: Firstly, most of the participants within the networks were advocates of a linear top-down model of implementation of evidence-based knowledge into practice. Secondly, they experienced inertia in the transfer process. From the collaborative process undertaken it emerged that their linear top-down model of knowledge transfer seemed to be firmly rooted. Theoretically, the thesis contributes to an understanding of why the process of knowledge transfer was considered by the participants within the networks to be a sluggish process. The thesis also contributes to an explanation of why they adhered to the macro-discourse of evidence-based medicine at the expense of involving practitioners outside the networks in horizontal patterns of exchange. It is argued that the networks had a symbolic value and were also a product of and reproduced the evidence-based discourse and the prevailing structures within their field. This contrasted with the role of networks as arenas for generation of local knowledge in the network literature. A major challenge facing health care sectors is that of how to support practitioners in the incorporation of new practices resulting in actual changes.
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