| 1. |
- Baxter, Rebecca, 1989-, et al.
(författare)
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Core elements of serious illness conversations : an integrative systematic review
- 2023
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Ingår i: BMJ Supportive & Palliative Care. - : BMJ Publishing Group Ltd. - 2045-435X .- 2045-4368.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ariadne Labs' Serious Illness Care Program (SICP), inclusive of the Serious Illness Conversation Guide (SICG), has been adapted for use in a variety of settings and among diverse population groups. Explicating the core elements of serious illness conversations could support the inclusion or exclusion of certain components in future iterations of the programme and the guide.Aim: This integrative systematic review aimed to identify and describe core elements of serious illness conversations in relation to the SICP and/or SICG.Design: Literature published between 1 January 2014 and 20 March 2023 was searched in MEDLINE, PsycINFO, CINAHL and PubMed. All articles were evaluated using the Joanna Briggs Institute Critical Appraisal Guidelines. Data were analysed with thematic synthesis.Results: A total of 64 articles met the inclusion criteria. Three themes were revealed: (1) serious illness conversations serve different functions that are reflected in how they are conveyed; (2) serious illness conversations endeavour to discover what matters to patients and (3) serious illness conversations seek to align what patients want in their life and care.Conclusions: Core elements of serious illness conversations included explicating the intention, framing, expectations and directions for the conversation. This encompassed discussing current and possible trajectories with a view towards uncovering matters of importance to the patient as a person. Preferences and priorities could be used to inform future preparation and recommendations. Serious illness conversation elements could be adapted and altered depending on the intended purpose of the conversation.
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| 2. |
- Baxter, Rebecca, 1989-, et al.
(författare)
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Perils and payoffs for patients in serious illness conversations as described by physicians : a qualitative study
- 2024
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Ingår i: BMJ Open Quality. - : BMJ Publishing Group Ltd. - 2399-6641. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Serious Illness Care Programme was developed to promote more, better and earlier serious illness conversations. Conversations about goals and values are associated with improved experiences and outcomes for seriously ill patients. Clinicians’ attitudes and beliefs are thought to influence the uptake and performance of serious illness conversations, yet little is known about how clinicians perceive the impact of these conversations on patients. This study aimed to explore physicians’ perceptions regarding the impact of serious illness conversations for patients.Methods: The Serious Illness Care Programme was implemented as a quality improvement project in two hospitals in Southern Sweden. Focus group evaluation discussions were conducted with 14 physicians and inductive thematic analysis was undertaken.Results: The results revealed that physicians considered potential perils and optimised potential payoffs for patients when engaging in serious illness conversations. Potential perils encompassed inappropriate timing, damaging emotions and shattering hopes. Potential payoffs included reflection time, secure space, and united understandings.Conclusions: Physicians depicted a balance in evaluating the perils and payoffs of serious illness conversations for patients and recognised the interrelation of these possibilities through continual assessment and adjustment.
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| 3. |
- Gentile, Ambra, et al.
(författare)
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Developmental outcomes in Italian young cancer survivors : the effect of lack of social support in physical activity practice on quality of life and mental health
- 2024
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Ingår i: Journal of Community and Applied Social Phychology. - : John Wiley & Sons. - 1052-9284 .- 1099-1298. ; 34:2
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Tidskriftsartikel (refereegranskat)abstract
- Life expectancy among young cancer survivors has increased in the last decades. Unfortunately, young cancer survivors might still experience mental and physical issues due to cancer treatment. Moreover, although physical activity is a valid tool for increasing social support and reducing the risk of obesity, sedentary behaviour is very common among young cancer survivors.Therefore, the current pilot study aims to estimate lack of social support impact on physical activity practice on mental health and quality of life. A sample of 69 Italian young cancer survivors (60% females) were included in the study and physical activity, anxiety, depression and quality of life were assessed by self-reported questionnaires. The results showed that a lack of social support for exercising was connected to higher depressive symptoms, while no influence was detected on anxiety. Concerning quality of life, the analysis of variance model showed a significant effect of the lack of social support on physical mobility but not on self-care, usual activities, pain and discomfort and general health. In conclusion, integrating physical activity in young cancer survivors' life-style, considering cancer-related side effects, might enhance their mental health and quality of life by providing social support at the same time. Healthcare professionals shoulde valuate the feasibility and support adapted physical activity programmes for young cancer survivors, to reduce the risk of depression and obesity, among others.
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| 4. |
- Maric, Dora, et al.
(författare)
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Effects of resistance training on sleep quality and disorders among individuals diagnosed with cancer : a systematic review and meta‐analysis of randomized controlled trials
- 2024
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Ingår i: Cancer Medicine. - : John Wiley & Sons. - 2045-7634. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sleep disorders are often complained by cancer patients and can last years after the end of therapies, leading to different negative consequences. Non-pharmacological strategies such as exercise interventions may be considered to counteract this phenomenon. The literature supports the beneficial effects of aerobic training (AT), while evidence on resistance training (RT) is scarce. Accordingly, our systematic review aims to investigate the potential novel effect of RT on sleep outcomes in cancer survivors.Methods: The literature search was conducted on MEDLINE (Pubmed), Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases, including only randomized controlled trials (RCTs). The screening procedure was conducted using the web-based software COVIDENCE. Sleep outcomes assessed through self-reported questionnaires or objective sleep measurements were extracted from RCTs recruiting cancer survivors of any age and gender, on or off treatment. The risk of bias (RoB) for each study was assessed using the Cochrane RoB 2 tool for RCTs. Meta-analytic syntheses were performed on sleep quality and insomnia.Results: A total of 21 studies were included in the review. Considering the mean percentage differences of all studies combined, promising positive results were found after combined aerobic and resistance exercise program (COMB) for sleep quality (−19%) and sleep disturbance (−17.3%). The meta-analysis results showed significant improvement for both sleep quality and insomnia (d = 0.28, SE: 0.11, Z = 2.51, p < 0.01, 95% CI: 0.07–0.49 and d = 0.43, SE: 0.20, Z = 2.18, p = 0.029, 95% CI: 0.07–0.49, respectively).Conclusion: RT interventions of 60 minutes per session, performed 2–3 times a week for 12 weeks, with exercise intensity ranging from 60% to 80% of one-repetition maximum can be administered to cancer survivors, aiming to improve sleep outcomes.
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| 5. |
- Orre, Carl Johan, et al.
(författare)
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Implementation and involvement of a dynamic instrument as a practice support in rehabilitation processes of chronic diseases
- 2020
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Ingår i: Proceedings of the 6th International Conference on Design4Health. - Sheffield : Lab4Living, Sheffield Hallam University. - 9781838111700 ; , s. 28-35
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Konferensbidrag (refereegranskat)abstract
- In the rehabilitation of chronic and severe illnesses, it is common to use paper-based questionnaires to capture experiences of symptoms associated with illness or treatment. Managing such instruments consumes time, and offers care professionals a narrow space of possible actions toward the patients. The purpose of this paper was to report the initial concerns we encountered in the early phases involving a dynamic instrument in nursing practice. This project is based on the Self Management Assessment Scale (SMASc) with the purpose to provide digital support that enables personalized work methods with the patient. With SMASc, patients answer questions on a mobile phone, tablet or computer. The compiled result is provided instantly before the patient-nurse consultation. SMASc is here understood as an interactive artefact with dynamic affordances. A dynamic instrument manifests a theoretical foundation aligning to the use situation, is programmable and digitally distributed, and offers individually compiled datafied views that connect the person's situation and the theoretical apparatus - in this case, a person's need for self-management support. The data this report builds on was produced during two project meetings and throughout the design and development of the instrument prototype. Data analysis approach applied was an analysis focusing on emerging concerns surfacing from discussions that followed the introduction of the prototype. We found that the nurses cared for the development of their practice and strived to advance and steer it in a more nursing-oriented direction. They did not fully comply with the instrument's item formulations and how these should or could be used. Further work has to be done to involve more stakeholders in the future work so that everyone feels engaged and can put their views on the design of the instrument, and on the implementation work itself.
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| 6. |
- Pusa, Susanna, 1982-, et al.
(författare)
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Core competencies for serious illness conversations : an integrative systematic review
- 2024
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Ingår i: Journal of Palliative Care. - : Sage Publications. - 0825-8597.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The Serious Illness Care Program was developed to support goals and values discussions between seriously ill patients and their clinicians. The core competencies, that is, the essential clinical conversation skills that are described as requisite for effective serious illness conversations (SICs) in practice, have not yet been explicated. This integrative systematic review aimed to identify core competencies for SICs in the context of the Serious Illness Care Program. Methods: Articles published between January 2014 and March 2023 were identified in MEDLINE, PsycINFO, CINAHL, and PubMed databases. In total, 313 records underwent title and abstract screening, and 96 full-text articles were assessed for eligibility. The articles were critically appraised using the Joanna Briggs Institute Critical Appraisal Guidelines, and data were analyzed using thematic synthesis.Results: In total, 53 articles were included. Clinicians' core competencies for SICs were described in 3 themes: conversation resources, intrapersonal capabilities, and interpersonal capabilities. Conversation resources included using the conversation guide as a tool, together with applying appropriate communication skills to support better communication. Intrapersonal capabilities included calibrating one's own attitudes and mindset as well as confidence and self-assurance to engage in SICs. Interpersonal capabilities focused on the clinician's ability to interact with patients and family members to foster a mutually trusting relationship, including empathetic communication with attention and adherence to patient and family members views, goals, needs, and preferences.Conclusions: Clinicians need to efficiently combine conversation resources with intrapersonal and interpersonal skills to successfully conduct and interact in SICs.
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| 7. |
- Pusa, Susanna, 1982-, et al.
(författare)
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Evaluation of the Implementation Process of a Family Systems Nursing Approach in Home Health Care : A Mixed-Methods Study
- 2021
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Ingår i: Journal of Family Nursing. - : Sage Publications. - 1074-8407 .- 1552-549X. ; 27:3, s. 235-249
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Tidskriftsartikel (refereegranskat)abstract
- To support the incorporation of Family Systems Nursing (FSN) in clinical practice, more understanding is needed about the implementation of FSN in home health practice settings. Thus, the aim of this study was to evaluate nurses' perspectives about the implementation process of Family Systems Nursing Conversations (FSNCs) in home health care. A mixed-methods research design was used, integrating qualitative and quantitative data, and using triangulation as a methodological metaphor. The Quality Implementation Framework (QIF) was applied to guide the implementation process, and Proctor et al.'s taxonomy of implementation outcomes was used to evaluate the process. The findings demonstrated that FSN implementation was in progress. Overall, acceptability and appropriateness of FSNCs were evaluated as positive by home health nurses; however, some obstacles were found relating to feasibility, adoption, and fidelity. These results contribute to an increased understanding of the process and challenges of implementing FSNCs in home health care.
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| 8. |
- Pusa, Susanna, 1982-, et al.
(författare)
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Family systems nursing conversations : influences on families with stroke
- 2022
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Ingår i: BMC Nursing. - : BioMed Central. - 1472-6955. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Since a family member's stroke affects the entire family, family systems nursing conversations (FSNCs) may be an appropriate intervention to support the family as a whole. The purpose of our study was to illuminate family members' experiences within their family situations 6 months after participating in FSNCs when a family member under 65 years of age had suffered a stroke.METHODS: Fourteen semi-structured follow-up interviews were conducted with family members 6 months after they had completed a series of 3 FSNCs. The interview transcripts were subjected to qualitative content analysis.RESULTS: Family members experienced that the FSNCs had contributed to greater understanding of each other and greater closeness in the family. The FSNCs had also facilitated a mutual understanding of the family's situation, which they could better manage and move forward with together.CONCLUSIONS: FSNCs can support relational aspects and healthy transitions within families. However, long-term follow-up research is needed to generate sound evidence and inform education about FSNCs, as well as to facilitate their implementation. As a result, families may become better able to prevent the negative outcomes of illness in the family.
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| 9. |
- Pusa, Susanna, 1982-, et al.
(författare)
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Social processes in academic-community partnership in health care : A grounded theory study
- 2021
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: International and national guidelines state that palliative care should be offered to everyone who needs it. To promote the implementation of palliative care in nursing homes, a partnership collaboration was initiated with the goal of implementing high quality palliative care. The partnership consisted of three partner groups: a project group from a non-profit organisation providing health care, managers at the nursing homes and an academic partner. The aim was to explore the social processes within academic-community partnership in a collaboration project.METHODS: Digital focus group discussions were conducted with 16 participants, representing all three partner groups. One individual digital interview was also carried out. A constructivist perspective of a grounded theory approach was used for data analysis.RESULTS: The core category, partnership positioning, covers the social processes of the academic-community partnership in a collaboration project to implement and evaluate health-promoting interventions in clinical health care. The core category was found to have four categories: Pre-positioning, Co-positioning, Re-positioning and GoOn-positioning. The process of partnership positioning is conceptualised in a model.CONCLUSIONS: Our findings indicate that a new partnership in an implementation project needs holistic, systemic thinking. To enhance implementation in a collaborative project involving different professionals and actors a plan is required to facilitate positioning activities. The process, the roles and the components need to be clearly defined and documented, and the management of a system requires knowledge of the interrelationships between all the components within the system. The development of a conceptual model of Partnership Positioning contributes to knowledge concerning the social dynamic processes which can be applied to support future academic-community collaboration and/or implementation projects.TRIAL REGISTRATION: Not applicable. The present study has not been considered as a clinical trial.
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| 10. |
- Pusa, Susanna, 1982-
(författare)
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Vägen mot implementering av familjecentrerad omvårdnad
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: När människor är inkluderade i varandras liv påverkar en förändring av livssituationen hos en person även de övriga personerna som står den nära. Det innebär att när en person drabbas av ohälsa eller sjukdom påverkas även personens familj. Familjens upplevelse av den situation som uppstår i samband med ohälsa kan dessutom negativt påverka familjemedlemmarnas medvetenhet om familjens tillgängliga styrkor och resurser, vilket i sin tur kan påverka familjers kamp för att återfå och bibehålla hälsa. Traditionellt sett har vården fokuserat på att erbjuda stöd på personnivå, och främst då till patienter. De senaste decennierna har dock en tendens uppmärksammats till ökad förståelse för att hela familjen behöver inkluderas i omvårdnaden. Att anamma ett familjecentrerat förhållningssätt – det vill säga, att se och möta familjen som en enhet och som ett system – har visat sig ha flera fördelar utifrån såväl patient- och familje- som sjuksköterskeperspektiv. Detta har medfört en efterfrågan på forskning om hur familjecentrerad omvårdnad kan läras ut och implementeras i den kliniska hälso- och sjukvården.Syfte: Det övergripande syftet med avhandlingen är att belysa erfarenheter av stöd från distriktssköterskor/sjuksköterskor till familjer i ordinärt boende, samt att utvärdera implementering av familjecentrerade samtal.Metod: Avhandlingen inkluderar tre studier med kvalitativ design och en studie med mixad-metod design. I delstudie I samlades data in genom tio fokusgruppintervjuer med 36 distriktssköterskor och analyserades sedan med en fenomenologisk hermeneutisk metod. Datainsamlingen för delstudie II bestod av ljudinspelade familjecentrerade samtal med sju familjer, samt sju avslutande brev riktade till familjerna som distriktssköterskorna/sjuksköterskorna skrev efter samtalen med familjerna. Familjesamtalen och breven analyserades med hjälp av kvalitativ innehållsanalys. I delstudie III analyserades individuella intervjuer med 21 distriktssköterskor/sjuksköterskor med kvalitativ innehållsanalys. Mixad metod användes i delstudie IV, där kvantitativa data från instrumentet Families’ Importance in Nursing Care – Nurses’ Attitudes (FINC-NA) integrerades med kvalitativa data från individuella intervjuer med 14 distriktssköterskor/sjuksköterskor.Resultat: Resultatet visar att distriktssköterskor/sjuksköterskor strävar efter att stödja familjer (I, IV) och att familjecentrerad omvårdnad i form av familjecentrerade samtal kan vara ett sätt att stöda familjer att dela med sig av sina upplevelser och känslor både inom familjen och med distriktssköterskan/ sjuksköterskan (II, IV). Det upplevda stödet från såväl familjen som distriktssköterskan/sjuksköterskan ansågs värdefullt för att bättre hantera situationen och framtiden (II). Distriktssköterskorna/sjuksköterskorna uppfattade den webbaserade utbildningen i familjecentrerad omvårdnad inklusive familjecentrerade samtal som överlag funktionell och välanpassad (III). Utbildningen med den påföljande implementeringen beskrevs bidra till ett förändrat förhållningssätt hos dem, där de tänkte och arbetade mer inkluderande och stödjande gentemot familjer, även när de inte utförde familjecentrerade samtal enligt den tänkta strukturen (III, IV). Utvärderingen av implementeringen av de familjecentrerade samtalen visade att införandet av familjecentrerade samtal fortgick även om de inte hade implementerats fullt ut som avsett. Acceptans och lämplighet utvärderades överlag positivt, dock framkom personliga, sociala och organisatoriska hinder, vilka påverkade genomförandet, användningen och metodtroheten (IV).Konklusion: Stöd från distriktssköterskor/sjuksköterskor till familjer är en omvårdnadshandling som förutsätter medveten omsorg i ett aktivt möte med familjen, där varje enskild person, men även familjen som enhet, behöver beaktas. Detta stöd för familjers hälsa kan ske genom familjecentrerad omvårdnad. En webbaserad utbildning för distriktssköterskor/sjuksköterskor i familjecentrerad omvårdnad och familjecentrerade samtal utgör ett adekvat steg i processen att implementera detta arbetssätt i den kliniska verksamheten. Sammanfattningsvis bidrar avhandlingen till kunskap om hur stödjande familjecentrerade samtal kan implementeras i klinisk verksamhet och vilka aspekter som kan påverka detta.
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| 11. |
- Vasilopoulou, M., et al.
(författare)
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Interventions about physical activity and diet and their impact on adolescent and young adult cancer survivors : a Prisma systematic review
- 2024
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Ingår i: Supportive Care in Cancer. - : Springer Nature. - 0941-4355 .- 1433-7339. ; 32:6
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Forskningsöversikt (refereegranskat)abstract
- Purpose Over the past few decades, the incidence of cancer among adolescents and young adults (AYA) has been increasing. The impact of behaviors, such as physical activity (PA) and nutrition, on disease progression, prognosis, and overall health and quality of life for AYA cancer survivors is of significant importance. This systematic review aims to evaluate the effectiveness of PA and diet interventions for AYA cancer survivors and to critically evaluate existing literature, gaps, and limitations.Methods A search of literature was conducted in PubMed, Science Direct, Scopus, and Google Scholar following the PRISMA guidelines. Twenty-two studies were included from online databases from 2012 to 2022, 13 of which were randomized controlled trials.Results Most interventions were related to PA, with only four studies including nutrition or Diet interventions. The interventions were generally feasible and acceptable to AYA cancer survivors, and digitally based PA interventions were commonly used. PA interventions mainly comprised aerobic and resistance training and were individualized. Overall, this review found various PA and diet interventions for AYA cancer survivors that were feasible and well-accepted, but gaps in knowledge and design still exist.Conclusions This systematic review underscores the importance of conducting more research on diet interventions for YCS.
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