| 1. |
- Andersson, Jenny, et al.
(författare)
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Is it possible to identify patient´s sex when reading blinded illness narratives? An experimental study about gender bias
- 2008
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 7:21, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: In many diseases men and women, for no apparent medical reason, are not offered the same investigations and treatment in health care. This may be due to staff's stereotypical preconceptions about men and women, i.e., gender bias. In the clinical situation it is difficult to know whether gender differences in management reflect physicians' gender bias or male and female patients' different needs or different ways of expressing their needs. To shed some light on these possibilities this study investigated to what extent it was possible to identify patients' sex when reading their blinded illness narratives, i.e., do male and female patients express themselves differently enough to be recognised as men and women without being categorised on beforehand?Methods: Eighty-one authentic letters about being diseased by cancer were blinded regarding sex and read by 130 students of medicine and psychology. For each letter the participants were asked to give the author's sex and to explain their choice. The success rates were analysed statistically. To illuminate the participants' reasoning the explanations of four letters were analysed qualitatively.Results: The patient's sex was correctly identified in 62% of the cases, with significantly higher rates in male narratives. There were no differences between male and female participants. In the qualitative analysis the choice of a male writer was explained by: a short letter; formal language; a focus on facts and a lack of emotions. In contrast the reasons for the choice of a woman were: a long letter; vivid language; mention of emotions and interpersonal relationships. Furthermore, the same expressions were interpreted differently depending on whether the participant believed the writer to be male or female.Conclusion: It was possible to detect gender differences in the blinded illness narratives. The students' explanations for their choice of sex agreed with common gender stereotypes implying that such stereotypes correspond, at least on a group level, to differences in male and female patients' illness descriptions. However, it was also obvious that preconceptions about gender obstructed and biased the interpretations, a finding with implications for the understanding of gender bias in clinical practice.
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| 2. |
- Andersson, Jenny, et al.
(författare)
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Using patients' narratives to reveal gender stereotypes among medical students
- 2013
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Ingår i: Academic Medicine. - 1040-2446 .- 1938-808X. ; 88:7, s. 1015-1021
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Gender bias exists in patient treatment, and, like most people, health care providers harbor gender stereotypes. In this study, the authors examined the gender stereotypes that medical students hold about patients. Method: In 2005, in Umeå, Sweden, the authors collected 81 narratives written by patients who had undergone cancer treatment; all information that might reveal the patients’ gender was removed from the texts. Eighty-seven medical students read 40 or 41 narratives each, guessed the patient’s gender, and explained their guess. The authors analyzed the students’ explanations qualitatively and quantitatively to reveal the students’ gender stereotypes and to determine whether those stereotypes had any predictive value for correctly guessing a patient’s gender. Results: The students’ explanations contained 21 categories of justifications, 12 of which were significantly associated with the students guessing one gender or the other. Only three categories successfully predicted a correct identification of gender; two categories were more often associated with incorrect guesses. Conclusions: Medical students enter their training program with culturally shared stereotypes about male and female patients that could cause bias during their future careers as physicians. To prevent this, medical curricula must address gender stereotypes and their possible consequences. The impact of implicit stereotypes must be included in discussions about gender bias in health care.
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| 3. |
- Blaschke, Sarah, et al.
(författare)
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Cancer patients' experiences with nature : Normalizing dichotomous realities
- 2017
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 172, s. 107-114
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore cancer patients' subjective experiences with nature in order to examine the relevance of nature-based care opportunities in cancer care contexts. The rationale was to describe the underlying mechanisms of this interaction and produce translatable knowledge. Methods: Qualitative research design informed by grounded theory. Sampling was initially convenience and then theoretical. Competent adults with any cancer diagnosis were eligible to participate in a semi structured interview exploring views about the role of nature in their lives. Audio-recorded and transcribed interviews were analyzed using inductive, cyclic, and constant comparative analysis. Results: Twenty cancer patients (9 female) reported detailed description about their experiences with nature from which a typology of five common nature interactions emerged. A theory model was generated constituting a core category and two inter-related themes explaining a normalization process in which patients negotiate their shifting realities (Core Category). Nature functioned as a support structure and nurtured patients' inner and outer capacities to respond and connect more effectively (Theme A). Once enabled and comforted, patients could engage survival and reconstructive maneuvers and explore the consequences of cancer (Theme B). A dynamic relationship was evident between moving away while, simultaneously, advancing towards the cancer reality in order to accept a shifting normality. From a place of comfort and safety, patients felt supported to deal differently and more creatively with the threat and demands of cancer diagnosis, treatment and outlook. Conclusions: New understanding about nature's role in cancer patients' lives calls attention to recognizing additional forms of psychosocial care that encourage patients' own coping and creative processes to deal with their strain and, in some cases, reconstruct everyday lives. Further research is required to determine how nature opportunities can be feasibly delivered in the cancer care setting.
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| 4. |
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| 5. |
- Fallbjörk, Ulrika, 1967-, et al.
(författare)
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Aspects of body image after mastectomy due to breast cancer : a two-year follow up study
- 2013
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 17:3, s. 340-345
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This 2-year follow-up study explores aspects of body image after mastectomy due to breast cancer.Materials and Methods: This population-based study included 76 women living in northern Sweden who, during November 2006 to October 2007, underwent mastectomy due to breast cancer. The women completed a questionnaire entitled “Life After Mastectomy (LAM)” 10 months after the mastectomy and again 2 years later. We used SPSS version 18.0 for data processing and analysis.Results:The findings indicate that few significant changes in body image had taken place during the 2-year interval between the first and second completion of the questionnaire. An exception was a significant decrease in feelings of sexual attractiveness and comfort during sexual intimacy. At follow-up, 21% of the women had undergone breast reconstruction (BR). They were significantly younger than the women who had not had BR (53 v. 63 years). Besides being younger, no other significant differences could be found between those women who had undergone BR and those who had not. The fact that the decrease in sexual attractiveness and feelings of comfort during sexual intimacy also applied to the subgroup of women who had had BR may therefore be surprising. A better understanding of issues related to breast cancer treatment and sexual function is vital.Conclusion: It is important for health care professionals to be aware of problems related to sexual intimacy and to be prepared not just to provide information about these, but also to reflect on expectations v. reality together with the women.
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| 6. |
- Fallbjörk, Ulrika, 1967-, et al.
(författare)
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Differences between women who have and have not undergone breast reconstruction after mastectomy due to breast cancer
- 2010
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 49:2, s. 174-179
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study compares potential differences between women with breast cancer who after mastectomy had undergone breast reconstruction with those who had not. Material and methods: All women (N=149) in the northern medical region of Sweden who had undergone mastectomy in 2003 received a self-reported questionnaire entitled “Life After Mastectomy (LAM)” that included standardized measures of sociodemographic, decision-making process, breast reconstruction (BR) yes or no, sexuality, and body image. SPSS was used for data processing. Results: In total 85% of the women returned the questionnaire and of these 25% had undergone BR. In accordance with previous studies, we found that the mean age of the women in the BR group was significantly lower (52 vs. 64 years), they had a higher education, and a higher proportion were employed, influenced by the physician's opinion regarding BR, sexually active, and rated a negative impact concerning the factors attractiveness and body disclosure. A multiple regression analysis, however, showed that the choice to undergo breast reconstruction or not was only independently associated with age, feeling of attractiveness and sexual interest. Discussion: Age explained most differences found between the two groups. When researchers try to identify what differentiates the groups of women who undergo reconstruction between those who do not undergo reconstruction after mastectomy, it is thus necessary to take into consideration that the meanings of mastectomy, body image, attractiveness and similar variables may vary due to the phase of a woman's life. In conclusion, considering the impact of age is of paramount importance in future studies for our understanding of women's experiences.
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| 7. |
- Fallbjörk, Ulrika, 1967-, et al.
(författare)
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From "no big deal" to "losing oneself" : different meanings of mastectomy
- 2012
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Ingår i: Cancer Nursing. - Philadelphia : Lippincott Williams & Wilkins. - 0162-220X .- 1538-9804. ; 35:5, s. E41-E48
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Tidskriftsartikel (refereegranskat)abstract
- Background: Because of early detection and advanced treatment options, more women with breast cancer survive after mastectomy and thus have to face the choice of living with or without a reconstructed breast for many years to come. Objective: This article investigates these women’s narratives about the impact of mastectomy on their lives, as well as their reflections on breast reconstruction.Methods: Fifteen women were strategically chosen from a previous population-based study on mastectomy. They were contacted for further exploration in thematic narrative-inspired interviews 4.5 years after mastectomy.Results: Three types of storylines were identified. In the first storyline, the mastectomy was described as ‘‘no big deal’’; losing a breast did not disturb the women’s view of themselves as women, and breast reconstruction was not even worth consideration. In the second storyline, the women described the mastectomy as shattering their identity. Losing a breast implied losing oneself as a sexual being, a woman, and a person. The third storyline fell in between the other two; the sense of femininity was wounded, but not to the extent that they felt lost as women.Conclusion: Our findings suggest that the experience of mastectomy due to breast cancer is very much individual and contextual. Losing a breast may be of minor or major importance.Implications for Practice: Healthcare practitioners should be attentive to how the women themselves experience the personal meaning of losing a breast and guard against vague preconceptions based on the breast-sexuality-femininity discourse and its connection to what the patient needs.
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| 8. |
- Henriksson, Roger, et al.
(författare)
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High-grade astrocytoma treated concomitantly with estramustine and radiotherapy.
- 2006
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Ingår i: Journal of neuro-oncology. - : Springer Science and Business Media LLC. - 0167-594X .- 1573-7373. ; 78:3, s. 321-6
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Tidskriftsartikel (refereegranskat)abstract
- Experimental and early clinical investigations have demonstrated encouraging results for estramustine in the treatment of malignant glioma. The present study is an open randomized clinical trial comparing estramustine phosphate (Estracyt) in addition to radiotherapy with radiotherapy alone as first line treatment of astrocytoma grade III and IV. The 140 patients included were in a good clinical condition with a median age of 55 years (range 22-87). Estramustine was given orally, 280 mg twice daily, as soon as the diagnosis was established, during and after the radiotherapy for a period of in total 3 months. Radiotherapy was delivered on weekdays 2 Gy daily up to 56 Gy. Eighteen patients were excluded due to misclassification, leaving 122 patients eligible for evaluation. Overall the treatment was well tolerated. Mild or moderate nausea was the most common side effect of estramustine. The minimum follow-up time was 5.2 years for the surviving patients. For astrocytoma grade III the median survival time was 10.6 (1.3-92.7) months for the radiotherapy only group and 17.3 (0.4-96.9+) months for the estramustine + radiotherapy group. In grade IV the corresponding median survival time was 12.3 (2.1-89.2) and 10.3 (0.3-91.7+) months, respectively. Median time to progress for radiotherapy only and radiotherapy and estramustin group in grade III tumours was 6.5 and 10.1 months, respectively. In grade IV tumours the corresponding figures were 5.1 and 3.3 months, respectively. Although there was a tendency for improved survival in grade III, no statistical significant differences were found between the treatment groups. No differences between the two treatment groups were evident with respect to quality of life according to the EORTC QLQ-protocol. In conclusion, this first randomized study did not demonstrate any significant improvement of using estramustine in addition to conventional radiotherapy, however, a trend for a positive response for the estramustine group was found in patients with grade III glioma.
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| 9. |
- Isaksson, Joakim, 1976-, et al.
(författare)
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Next of kin's motives for psychosocial consultation : Oncology social worker's perceptions of 54 next of kin cases
- 2019
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 28:1, s. 154-159
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Although oncology social workers (OSWs) have emerged as a core profession in the provision of psychosocial services, there is a lack of empirical studies that describe their daily clinical work with next of kin (NOK). The overall aim of this study was to explore NOK's motives for consulting an OSW. This can provide us with insights into what types of skills OSWs need to have in order to fulfil their duties.Methods: From a nationwide survey, we used data from 54 NOK cases that Swedish OSWs met face to face.Results: About half of the motives concerned help in dealing with personal grief connected to the patients' cancer and distressing symptoms, while the other half concerned needs for help in dealing with the position of being the NOK, relationship conflicts, and assistance with socio-economic issues.Conclusions: The motives show that NOK does not just ask for help to come to terms with distress related to the patients' situation. Based on the diversity of motives, we suggest that OSWs (at least in Sweden) need a broad education in counselling psychology. Furthermore, health care personnel need to be attentive to the NOK's own voice and not reduce it to the voice of the patient and the patient's needs in referrals.
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| 10. |
- Lilliehorn, Sara, 1976-, et al.
(författare)
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Admission into a helping plan : a watershed between positive and negative experiences in breast cancer
- 2010
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 19:8, s. 806-813
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Tidskriftsartikel (refereegranskat)abstract
- Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on predefined categories.Objective: The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs.Methods: Seventy-one patients treated with radition therapy were consecutively included and repeatedly interviewed about their experiences of health care. 'Critical incidents' where identified from the interviews and analysed due to the similarities-differences technique in grounded theory.Results: Four categories of needs where detected: 'access', 'information', 'treatment', and 'how approached'. These categories and their properties merged into a core category - 'admission into a helping plan'. These findings are well understood in terms of attachment theory. In times of immanent danger and stress people strive to fina a 'safe haven' to attach to. Cancer patients' 'safe haven' can be described as 'a helping plan'. It is not the result of a separate patient-caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health-care system as a whole.Conclusions: The presented model of patients needs as converging into 'admission into a helping plan' may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own 'hoope work'.
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| 11. |
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| 12. |
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| 13. |
- Lilliehorn, Sara, 1976-, et al.
(författare)
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Living at a residency away from home during radiotherapy as narrated by 52 patients with breast cancer : a cage of safety and discomfort
- 2018
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 40:4, s. 450-456
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: In the Nordic countries many patients with cancer conclude their treatment with 5–6 weeks of radiotherapy while staying at a residency far away from home. The experience of this stay, from a rehabilitation perspective, has not previously been studied.Method: Fifty-two women with breast cancer were followed with repeated thematic interviews from diagnosis up to 2 years.Results: The majority of women saw both pros and cons with their stay, and overall the stay could be described as “A cage of safety and discomfort”. Pros included “Safety”, “Closeness and learning”, and “Feeling like being on holiday”, while cons included “An intruding self-image”, “Isolation and increased vulnerability”, and “A loss of function”. Some patients supported their own rehabilitation by socializing with their “fellow sisters”, while others isolated themselves and mainly found it burdensome to be there.Conclusions: The residence becomes an interactional field with the potential to facilitate patients in resuming a new everyday life. The women who do not interact with others and/or who are stuck with feelings of anxiety should be offered the opportunity to take part in a group exclusively for “fellow sisters” in a similar situation.
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| 14. |
- Lilliehorn, Sara, 1976-, et al.
(författare)
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Meaning of work and the returning process after breast cancer : a longitudinal study of 56 women
- 2013
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Ingår i: Scandinavian Journal of Caring Sciences. - Hoboken : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 27:2, s. 267-274
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Tidskriftsartikel (refereegranskat)abstract
- Background: An increasing number of women survive breast cancer and a majority return to work. However, findings based on mean values may conceal individual processes that need to be better understood to discuss meaningful rehabilitation.Aim: The purpose of this paper is to describe the sick-leave pattern of a group of Swedish women with primary breast cancer but foremost to explore their ideas about what motivates and discourages their return to work.Method: Fifty-six women were repeatedly interviewed over a period of 18 to 24 months. Interview sections that clearly illustrated the women’s experiences and ideas about work were categorized using the comparative similarities-differences technique.Findings: The average length of sick leave was 410 days (range 0-942). Six months after the first day of sick leave, 29% worked at least their previous service grade. At 12 months, 55%, and at 18 months 57% did so. Those treated with chemotherapy had in average more than twice as large sick leave as those who did not. Three categories emerged. ‘Motives for not returning to work’ consists of four sub-categories: ‘I’m still too fragile to return to work’; ‘My workplace is a discouraging place’; ‘I took an opportunity to pause’ and ‘I’ve lost the taste for work’. ‘Motives for returning’ consists of two sub-categories: ‘Work generates and structures my everyday life’ and ‘I miss my workplace’. Finally, ‘Transition in work approach’ reflects a changed approach to work.Conclusion: The meaning of work varies over time, but first and foremost work was regarded as an important part of the healing process as it restores the disruption of everyday life. Guidelines cannot be reduced to a linear relationship with biomedical variables but the individual context of everyday life must be considered.
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| 15. |
- Lilliehorn, Sara, 1976-, et al.
(författare)
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Two sides of the same coin – Oncology social workers' experiences of their working life and its pros and cons
- 2023
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Ingår i: Nordic Social Work Research. - : Routledge. - 2156-857X .- 2156-8588. ; 13:2, s. 267-279
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Tidskriftsartikel (refereegranskat)abstract
- From the litterature we learn that social workers in health care are exposed to different stressors connected to the risk for the development of burnout or traumatization. However, there is a lack of studies that focuses on the social workers' own narratives on the burdensome, but also the rewarding aspects, of social work in health care. This study focuses on social work in oncology. Thematically structured qualitative interviews were conducted in a narrative form with 20 oncology social workers, half of whom were less experienced and half of whom were more experienced and with additional training in psychotherapy. The interviews focused on 'pros and cons of practicing social work' and the results were categorized by means of the similarities-differences technique. The burdensome cons concerned 'Organizational and professional barriers' and 'Demanding cases', with the latter divided into 'Impasse because of hopelessness' and 'Impasse because of helpnessness'. The rewarding pros categories all concerned meaningfulness including 'Organizational meaningfulness', 'Meaningfulness from giving', 'Meaningfulness from receiving', and 'Meaningfulness from personal development'. Our findings indicate that the burdensome and rewarding aspects are two sides of the same coin. They are interconnected in the sense that the strain and challenge of being in situations of psychological despair also imply emotional satisfaction due to an experience of meaningfulness.
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| 16. |
- Lilliehorn, Sara, 1976-, et al.
(författare)
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What does an oncology social worker deal with in patient consultations? – An empirical study
- 2019
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Ingår i: Social work in health care. - : Informa UK Limited. - 0098-1389 .- 1541-034X. ; 58:5, s. 494-508
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Tidskriftsartikel (refereegranskat)abstract
- The oncology social worker is a core profession in the psychosocial care on cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker's (OSW's) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the 'carrying on as before' or finding a 'new normal'. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a 'working alliance' with their patients.
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| 17. |
- Salander, Pär, 1948-, et al.
(författare)
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A Balint-inspired reflective forum in oncology for medical residents : Main themes during seven years
- 2014
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 97:1, s. 47-51
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Reflection groups for clinicians, often called Balint groups, are a way of refining professional competence in health care. This study presents a model for reflective practice in a group setting and describes the kinds of troublesome cases that medical residents are concerned about.Methods: From 2005 to 2012 a Balint-inspired reflective forum has been a part of the academic seminar program for physicians in training in a Department of Oncology at a Swedish university. The present study is focused on all 63 cases presented in the forum.Results: The cases were categorized into three kinds of challenges: Communication challenges in the patient-physician relationship, Communication challenges in organizational matters, and Communication challenges with close relatives of the patient.Conclusion: The study tells us something about the vulnerability of being a medical resident and the identified challenges have bearings on medical education curricula as well as on how the training of junior physicians is organized. Practice implications: The cases are contextual and multifaceted, and a forum of this kind might therefore be regarded as a potential way to develop professional competence and to refine communication in clinical practice. A structured evaluation of the forum would be valuable.
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| 18. |
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| 19. |
- Salander, Pär, 1948-
(författare)
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Attributions of lung cancer : my own illness is hardly caused by smoking
- 2007
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 16:6, s. 587-592
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Tidskriftsartikel (refereegranskat)abstract
- People experiencing unexpected negative events tend to make sense of the situation through causal attributions. It seems that having some sort of answer to “why-me” makes the event less shattering and the world more controllable. We know for instance that the great majority of women with breast cancer tend to have clear ideas about its causes. Lung cancer, in contrast to breast cancer, has a well-known significant cause, as smoking explains about 80% of the incidence. This paper deals with the attribution process in lung cancer. It examines how lung cancer patients attribute the cause to their disease and how this relates to an understanding of how people deal with strain. Twenty-three patients with advanced non-small-cell lung cancer were consecutively followed by means of repeated interviews throughout the course of the disease. It emerged that among the smokers the most common attribution was “don’t know” – smoking was not seen as the prime cause to their cancer. This finding is discussed in relation to the few earlier somewhat contradictory studies that exist and it is argued that the finding is according well with the concept of ‘disavowal’ being the central process concerned in dealing with strain.
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| 20. |
- Salander, Pär, 1948-
(författare)
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Cancer : primära hjärntumörer
- 2011. - 1
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Ingår i: Kognitiv medicin. - Stockholm : Norstedts. - 9789113023229 ; , s. 302-308
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 29. |
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| 30. |
- Salander, Pär, 1948-, et al.
(författare)
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Gender differences in patient´s written narratives when being diagnosed with cancer
- 2005
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Ingår i: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 14:8, s. 685-695
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Tidskriftsartikel (refereegranskat)abstract
- The medical field has shown a growing interest in gender and gender differences. In psychosocial oncology, for example, some studies suggest that men and women cope differently with cancer; e.g. women express their emotions more readily than men do, and men rely more on their healthy spouse.Using a qualitative perspective, this study examines 83 narratives written by male and female cancer patients who were asked to write down how they experienced receiving their cancer diagnosis. The narratives were analyzed both as to structure and content.The women wrote longer, more personally, and more emotionally than the men, and to a greater extent they included family members and other relatives in their stories. When the men mentioned relatives, they mainly referred to their spouse. Men and women commented differently as to their experiences of ‘reception’; i.e. how their psychological needs were addressed and ‘connection’; i.e. whether they felt in sufficient contact with medical staff. Although the women described good reception, they complained a lot about bad connection. Among the men, it was just as common to report about positive as negative experiences in both categories.There are reasons to be cautious when evaluating these findings. The found differences may be due to different ways of reacting to similar situations or different willingness and ways of commenting on similar situations, but also to different reception and connection for men and women. Further research should focus on the basic question: Are men and women without medical reasons being treated differently during their oncological treatment?
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| 31. |
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| 38. |
- Salander, Pär, 1948-, et al.
(författare)
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Kuratorsfunktionen i svensk cancersjukvård : en nationell genomlysning
- 2018
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Ingår i: Omsorg. - : Fagbokforlaget. - 0800-7489. ; :3, s. 62-65
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Socialarbetaren (kuratorn) är den profession som i svensk cancersjukvård specifikt står för det psykosociala perspektivet. Föreliggande studie analyserar kuratorns verksamhet med utgångspunkt i patienters motiv till att söka upp kurator. Utfallet ger vid handen att motiven inte i första hand är socioekonomiska eller juridiska, utan i stället psykologiska, och förtrogenhet med det councelling-orienterade samtalet är därför efterfrågat och centralt. Detta bör beaktas när man planerar för legitimation av kuratorer i hälso- och sjukvård.
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| 39. |
- Salander, Pär, 1948-
(författare)
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Motives that cancer patients in oncological care have for consulting a psychologist : an empirical study
- 2010
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 19:3, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Most people with cancer are able to deal with the mental turmoil with support from ordinary health care, family and friends. However, by themselves or by attentive health-care workers some patients are referred to specialists within the psychosocial field, foremost social workers and psychologists. This paper deals with patients’ motives for seeing a psychologist. Methods: The case books for all patients who had met with the psychologist at a department of oncology in Sweden during a 10-year period were read through and categorised according to what the patients wanted to talk about. Results: The most commonly found motives were in sliding order: coping with anxiety and worries caused by the disease; dealing with relational problems in life outside the disease; dealing with relational problems actualised by the disease; living with a malignant diseasedespair in a new life situation; and finally dealing with a particular problem. Conclusion: Patients seeing a psychologist in oncology do not just ask for help to come to terms with anxiety and worries. More than a third of the patients wanted to talk about distressing relationships, which were not connected to, or only remotely connected to the cancer disease. Patients have different needs and competence in different psychological treatment perspectives is therefore important. The found diversity of motives bears impact on the external validity of screening instruments for distress and randomised controlled intervention studies.
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| 40. |
- Salander, Pär, 1948-, et al.
(författare)
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Motives that head and neck cancer patients have for contacting a specialist nurse : an empirical study
- 2016
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 25:21-22, s. 3160-3166
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The purpose of this study is to systematically explore the motives for patients with head and neck cancer to contact a speciaist nurse during two years postdiagnosis.Background: Research focusing on the role of specialist nurses in cancer care almost exclusively concern cancers other than head and neck cancerDesign: Qualitative, descriptive study based on the contacts between patients with head and neck cancer and a specialist nurse.Methods: Patients were invited to contact a specialist nurse by telephone. The specialist nurse took systematic field notes, that is, she registered who contacted her, the nature of the call and the outcome. Sixty patients were included.Results: In descending order, the motives for contact were questions about practical and uncomplicated matters, consultations about medical troubles/worries, presenting a report of the patient's situation, requests for additional information about the treatment plan and requests for medical information. The pattern of the patients' motivations for calling was not related to medical or social factors, suggesting that the initiative to make a contact is very much a question of the complexity of individual life circumstances. Very few referrals were sent from the specialist nurse to other professionals.Conclusions: The specialist nurse turned out to be more than just a coordinator of health-care resources. The findings bring up questions about the potential of the nurse's function as a coordinator, but also as a potential attachment figure, and questions about the nurse's relationships to other professionals.Relevance to clinical practice: When implementing a specialist nurse function, it is important to decide whether the function should be inspired by a broader relational perspectice. In addition to the indispensible competence and experience in the clinical field of head and neck cancer, training in counselling and acquaintance with object-relational psychology will then be desirable.
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| 43. |
- Salander, Pär, 1948-
(författare)
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Qualities in the short life : psychological studies relevant to patient and spouse in malignant glioma
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis deals with psychological issues concerning patients with malignant gliomas, and their spouses. There is no known medical cure, and the patients have a limited survival expectancy. Therefore studies evaluating new treatment modes, an overall supportive atmosphere, and attempts to avoid imposing unnessesary strain are necessary.Thirty consecutive patients with astrocytomas, grade III-IV, were included in a clinical trial with estramustine phosphate in addition to conventional treatment with surgery and radiotherapy. Both the patients and their spouses participated in the present study which aimed at a deeper understanding of the psychological processes relevant to their situation. By means of repeated thematically structured interviews, patients and spouses were followed separately during the entire course of the disease process. In addition to these interviews, all patients were assessed with a mini-mental examination, and five-month survivors were tested with a comprehensive neuropsychological battery. Questionnaires on reaction to the diagnosis and assessing psychosocial well-being were also administered to the patients.The interviews were analysed with grounded theory methodology and the findings were juxtaposed to concepts in psychoanalysis and coping theory. The main finding was that the patients, despite or owing to their severe medical situations, showed a marked capacity to create protection and hope. By means of biased perception they created an 'illusion' that palliated their strain. This finding is related to object-relational psychoanalysis with obvious implications for the crucial discussion on telling bad news. Another finding was that the spouses displayed different crisis trajectories depending on the overall status of their partners. Different senses of the relationship were related to different modes of coping. Especially spouses to patients with personality changes were put under severe strain and ought to be acknowledged by medical staff. Patients with no obvious deficits five months after termination of primary treatment nevertheless evidenced, at neuropsychological testing, a pronounced deficiancy in long-term memory, but no clear impairment in global intellectual capacities. Estramustine phosphate was found to have a negative impact on sexuality and might be one causative agent behind the decline in long-term memory, but these adversive effects did not seem to affect psychosocial well-being. The selective reminding technique proved to be sensitive in detecting deficits and is recommended in future clinical trials affecting the CNS.
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| 46. |
- Salander, Pär, 1948-, et al.
(författare)
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Severely diseased lung cancer patients narrate the importance of being included in a helping relationship
- 2005
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Ingår i: Lung Cancer. - Amsterdam : Elsevier. - 0169-5002 .- 1872-8332. ; 50:2, s. 155-162
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Tidskriftsartikel (refereegranskat)abstract
- Because patients with advanced lung cancer have a poor prognosis, healthcare staff should treat and support them with sensitivity without placing them under necessary strain. A common way of revealing patients’ psychological needs is to rely on questionnaires where predefined potential problem areas are examined. Another and less common way of detecting their needs is to focus on the patients’ concrete everyday-experiences in their contacts with health care. In this study, 23 consecutive patients with advanced non-small cell lung cancer were asked to describe their experiences in dealing with their healthcare providers. Data were analysed qualitatively by categorising the incidents according to content. It emerged that ‘being connected to health care’ and being ‘acknowledged as a person’ were by far the most prominent dimensions. Very few incidents were directly related to ‘information’. The results suggest that in oncology it is important to call attention to the fact that the patient-physician relationship cannot be reduced to the communication of information. Other dimensions are worth considering.
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| 47. |
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| 48. |
- Salander, Pär, 1948-
(författare)
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"Spirituality" hardly facilitates our understanding of existential distress - but "everyday life" might
- 2018
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Ingår i: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 27:11, s. 2654-2656
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Tidskriftsartikel (refereegranskat)abstract
- The existential predicament of being human might come to the fore when we are stricken by cancer, perhaps primarily because we are removed from the shelter inherent in our routines of everyday life. These routines might help us to deal with the ultimate concerns of life, ie, isolation, freedom, meaninglessness, and death.1 We recognise these conceptualisations from European existential philosophy. However, instead of discussing the existential challenge in these terms, it has become far more popular in the scientific literature to instead make use of “spirituality” as a frame of reference. Broadly speaking, there has been a roughly 26‐fold increase in the number of papers focused on “spirituality” from the 1980s to the 2000s,2 and nearly all studies on “spiritual care” have emanated from the United States and the United Kingdom.3In this paper, I will briefly scrutinise the concept of “spirituality” first by critically reflecting on how the concept is constructed, defined, and made use of; in other words, what are “spirituality” researchers talking about? Second, I will question its validity, and third I will question the legitimacy of the cherished research concluding that “spirituality” alleviates distress and promotes well‐being. Finally, I will briefly, as roughly outlined above, suggest that “everyday life,” a bottom‐up perspective grounded in the patients' way of living their lives, might be a more fruitful conceptualisation that we should pay attention to in order to widen our scope when it comes to understanding how patients deal with distress.
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| 49. |
- Salander, Pär, 1948-, et al.
(författare)
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The creation of hope in patients with lung cancer
- 2014
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Ingår i: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 53:9, s. 1205-1211
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Lung cancer is associated with biomedical and psychological symptoms as well as a generally poor prognosis. When healthcare staff communicate with lung cancer patients it is essential that they consider the patients' own views of the situation to avoid putting unnecessary strain upon the patients' shoulders. The purpose of the present study is to better understand how a group of patients with lung cancer reflects upon their new life situation after diagnosis and primary treatment. METHOD: Fifteen patients with non-small cell lung cancer were consecutively included and, where possible, repeatedly interviewed during the course of the disease process. The 29 interviews were conducted in a thematically structured narrative form that facilitated a dialog between the interviewer and the patient. The interviews covered experiences with health care, living an everyday life, and thoughts about the future. FINDINGS AND REFLECTIONS: By focusing on how the patients more or less preconsciously elaborated mentally with their vulnerable situation, it was possible to detect different mental manoeuvres that they used as a way of creating hope. The patients distanced themselves from their disease, relied on a feeling of a sound body, idealised treatment possibilities, relied on healthy behaviour, focused on a concrete project, found that they were better off than others, and took solace in the fact that there were patients who had successfully managed the disease. DISCUSSION: The patients were not passive victims in the face of their diagnosis, but were actively trying to find ways of looking at their despairing situation in a positive light. A creative process for psychological survival had thus been initiated by the patients. We suggest that acknowledging this process should be the starting point from which physicians can engage in hope work with their patients.
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| 50. |
- Salander, Pär, 1948-
(författare)
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The Emperor's new clothes: Spirituality : a concept based on questionable ontology and circular findings
- 2012
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Ingår i: Archive for the Psychology of Religion/ Archiv für Religionspsychologie. - : Brill Academic Publishers. - 0084-6724 .- 1573-6121. ; 34:1, s. 17-32
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Tidskriftsartikel (refereegranskat)abstract
- ‘Spirituality’ is an old word which throughout history has been given different meanings. Overthe last two decades, it has successively become an increasingly frequent concept in scientificstudies, none the least in psychosocial oncology. Advocates of ‘spirituality’ regard it as a humandimension and state that since all humans have ‘spiritual needs’ it is urgent to develop ‘spiritualcare’. With the focus on recent publications, this article critically scrutinizes aspects of scientificsoundness in this growing research tradition, foremost problems of the lack of conceptual clarityand reliance on interconnected instruments that imply circular findings. It is concluded that theconcept adds more confusion than clarity if it is not put into a meaningful theoretical and culturalcontext, and subsequently it is important to guard against preconceptions and vague meaningsin this research field.
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