| 1. |
- Smith, Frida, 1973, et al.
(författare)
-
Exploring the meaning, role and experiences of a patient-led social innovation for people affected by cancer: a new collaborative care model complementing traditional cancer rehabilitation in Sweden
- 2021
-
Ingår i: BMJ open quality. - : BMJ. - 2399-6641. ; 10:4
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Kraftens Hus is the first support centre in Sweden designed by and for people affected by cancer, including patients, family, friends, staff members and local community representatives (collectively 'stakeholders'). The purpose of this study was to explore the meaning, role and experiences of Kraftens Hus stakeholders using a patient and public involved methodology. Methods To understand and map the experiences of visitors to Kraftens Hus, we applied concept mapping (CM), a mixed methods approach where data are collected and analysed in four structured steps designed to capture the diverse perspectives of multiple stakeholders. Qualitative interviews with relevant stakeholders supplemented the CM findings. Results The final concept map contained six clusters of ideas. Within the clusters, there was a recurring theme that cancer-affected people value accessible and long-term psychosocial support (PSS). The intended emotional, social and practical needs identified in a previous design process seem to have been addressed and appreciated by Kraftens Hus visitors. Conclusion Kraftens Hus is an example of a new patient-led social innovation based on a life-event perspective and integration of resources from different sectors in society. By focusing on life, not the disease, the care continuum expands, and long-term PSS is provided alongside cancer treatment. The evaluation confirms that PSS should focus on health and well-being in the broadest sense.
|
|
| 2. |
- Abel, Edvard, 1970, et al.
(författare)
-
Long-Term Aspects of Quality of Life in Head and Neck Cancer Patients Treated With Intensity Modulated Radiation Therapy: A 5-Year Longitudinal Follow-up and Comparison with a Normal Population Cohort
- 2020
-
Ingår i: Advances in Radiation Oncology. - : Elsevier BV. - 2452-1094. ; 5:1, s. 101-110
-
Tidskriftsartikel (refereegranskat)abstract
- © 2019 The Author(s) Purpose: Knowledge of long-term health-related quality of life (HRQOL) in patients with advanced head and neck cancer treated with intensity modulated radiation therapy is scarce. Methods and Materials: HRQOL in 126 patients with advanced head and neck cancer treated with intensity modulated radiation therapy was followed longitudinally from diagnosis to 5 years after treatment with the European Organization for Research and Treatment of Cancer's QLQ-C30, the European Organization for Research and Treatment of Cancer's Head and Neck Cancer Module, and the M.D. Anderson Dysphagia Inventory. The survivors' HRQOL was compared with an age- and sex-matched normal population cohort. Results: At 5 years, 73 of the 95 surviving patients had completed the study. Significant reductions in general pain (29 vs 12), head and neck (HN) pain (22 vs 14), and feeling ill (20 vs 10) were found, and emotional functioning (70 vs 83) and global quality of life (67 vs 74) improved, compared with baseline values. Conversely, dry mouth (19 vs 56), senses (8 vs 27), teeth problems (10 vs 22), opening mouth (19 vs 56), and sticky saliva (15 vs 40) were markedly worse, although significant improvements had occurred over time after treatment. Anderson Dysphagia Inventory scores >80 at 5 years indicated good swallowing function. In a subgroup analysis, dry mouth and senses were significantly better in patients treated with chemoradiotherapy. Comparison to a normal population cohort's HRQOL shows that the study group experienced a wide array of symptoms affecting their quality of life. Conclusions: The results of this large, long-term follow-up study show that a majority of patients report a reasonable quality of life 5 years after treatment and that there seems to be continuous improvement over time. Comparison with a normal population cohort, however, underlines the fact that classical side effects remain, even with improved radiation techniques. Additional emphasis on normal-tissue-sparing radiation therapy is warranted, with close attention devoted to HRQOL outcomes.
|
|
| 3. |
- Gram, D., et al.
(författare)
-
Residual positioning errors and uncertainties for pediatric craniospinal irradiation and the impact of image guidance
- 2020
-
Ingår i: Radiation Oncology. - : Springer Science and Business Media LLC. - 1748-717X. ; 15:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Optimal alignment is of utmost importance when treating pediatric patients with craniospinal irradiation (CSI), especially with regards to field junctions and multiple isocenters and techniques applying high dose gradients. Here, we investigated the setup errors and uncertainties for pediatric CSI using different setup verification protocols. Methods A total of 38 pediatric patients treated with CSI were identified for whom treatment records and setup images were available. The setup images were registered retrospectively to the reference image using an automated tool and matching on bony anatomy, subsequently, the impact of different correction protocols was simulated. Results For an action-level (AL)-protocol and a non-action level (NAL)-protocol, the translational residual setup error can be as large as 24 mm for an individual patient during a single fraction, and the rotational error as large as 6.1 degrees. With daily IGRT, the maximum setup errors were reduced to 1 mm translational and 5.4 degrees rotational versus 1 mm translational and 2.4 degrees rotational for 3- and 6- degrees of freedom (DoF) couch shifts, respectively. With a daily 6-DoF IGRT protocol for a wide field junction irradiation technique, the residual positioning uncertainty was below 1 mm and 1 degrees for translational and rotational directions, respectively. The largest rotational uncertainty was found for the patients' roll even though this was the least common type of rotational error, while the largest translational uncertainty was found in the patients' anterior-posterior-axis. Conclusions These results allow for informed margin calculation and robust optimization of treatments. Daily IGRT is the superior choice for setup of pediatric patients treated with CSI, although centers that do not have this option could use the results presented here to improve their margins and uncertainty estimates for a more accurate treatment alignment.
|
|
| 4. |
- Holmström, Paul, et al.
(författare)
-
Insights gained from a systematic reanalysis of a successful model-facilitated change process in health care
- 2021
-
Ingår i: Systems Research and Behavioral Science. - : Wiley. - 1092-7026 .- 1099-1743. ; 38:2, s. 204-214
-
Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Authors. Systems Research and Behavioral Science published by International Federation for Systems Research and John Wiley & Sons Ltd Health care is a complex system with multiprofessional staff and multiple patient care pathways. Time pressure and minimal margins for error make it challenging to implement new policies or procedures, no matter how desirable. Changes in health care also requires the participation of the staff. System dynamics (SD) simulations can lead to shared systems understanding and allows for the development and testing of new scenarios in silico before implementing solutions. However, research shows that the actual implementation rate of simulations is low. This paper presents a reanalysis of a successful change project in health care combining SD principles with basic action research (AR) premises. The analysis was done by a multidisciplinary research group using qualitative methodology and identifies that a fruitful combination of AR inquiry and SD modelling potentially can improve implementation rates.
|
|
| 5. |
- Johansson, Karin, et al.
(författare)
-
Compression Treatment of Breast Edema : A Randomized Controlled Pilot Study
- 2020
-
Ingår i: Lymphatic Research and Biology. - : Mary Ann Liebert Inc. - 1539-6851 .- 1557-8585. ; 18:2, s. 129-135
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Patients treated for breast cancer with breast conserving surgery and radiotherapy (RT) often complain about swelling, heaviness, and pain in the treated breast. This pilot study was undertaken to examine if compression therapy was effective as an early treatment to reduce breast edema and symptoms assessed by Visual Analogue Scale (VAS). Methods and Results: Fifty-six breast cancer-treated women with breast edema, diagnosed by the measurement of tissue water content by tissue dielectric constant (TDC) technique 3 months post-RT, were randomized to either an intervention group, wearing a sports bra of compression type, or a control group, wearing a standard bra daily for 9 months when tissue water content in breast, upper arm, and lateral thorax of the operated side, and symptoms assessed by VAS were evaluated. No differences were found between the groups at start or end of study concerning tissue water content or VAS. However, within both groups, a significant reduction in tissue water content and experience of heaviness was found. Conclusion: Breast edema as well as experience of heaviness in the affected breast found at 3 months post-RT decreased after 9 months independent of whether a sports bra of compression type or a standard bra was used.
|
|
| 6. |
- Langegård, Ulrica, 1969, et al.
(författare)
-
Health-related quality of life in patients with primary brain tumors during and three months after treatment with proton beam therapy
- 2021
-
Ingår i: Technical Innovations & Patient Support in Radiation Oncology. - : Elsevier BV. - 2405-6324. ; 17, s. 5-17
-
Tidskriftsartikel (refereegranskat)abstract
- Background Proton beam therapy (PBT) is increasingly administered to patients with primary brain tumors. Benefits of new treatments must be weighed against side effects and possible deterioration in health-related quality of life (HRQoL). The aim of this study was to describe and compare HRQoL, including acute symptom experiences and associated factors, in patients with malignant and benign brain tumors treated with PBT. Materials and Methods Adult PBT-treated patients with primary brain tumors (n=266) were studied. HRQoL was assessed with EORTC QLQ-C30, QLQ-BN20, HADS, ISI and MFI before, during and three months after treatment. Associations with demographic and medical factors were explored. Results Between baseline and three months post-treatment: HRQoL decreased significantly in the global health/QOL domains physical functioning, role functioning and cognitive functioning in the malignant group, global health/QOL and physical functioning decreased significantly in the benign group, more comorbidity was significantly associated with increased motor dysfunction, leg weakness, headache and future uncertainty. Fatigue and depression were the most frequent symptoms in both groups. Independent predictors of risk factor recognition were age, sex, chemotherapy, comorbidity and education level. Discussion Global health/QOL in patient with brain tumors is very complex and multidimensional. Symptoms are interrelated and related to patient, tumor and treatment factors. It is important to identify aspects of HRQoL that may be affected by treatment. These include both benefits, expected to improve HRQoL, and negative changes such as symptom experience and influencing factors. Evidence-based guidelines are needed for symptom management, and for high quality of care for patients experiencing low PBT-related HRQoL.
|
|
| 7. |
- Langegård, Ulrica, 1969, et al.
(författare)
-
The Art of Living With Symptoms : A Qualitative Study Among Patients With Primary Brain Tumors Receiving Proton Beam Therapy
- 2020
-
Ingår i: Cancer Nursing. - Philadelphia : LIPPINCOTT WILLIAMS & WILKINS. - 0162-220X .- 1538-9804. ; 43:2, s. E79-E86
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Symptom management in conjunction with proton beam therapy (PBT) from patient's perspective has not been explored. Such knowledge is essential to optimize the care in this relatively new treatment modality.Objective: The aim of this study was to explore the process of symptom management in patients with brain tumor receiving PBT.Methods: Participants were 22 patients with primary brain tumor who received PBT, recruited in collaboration with a national center for proton therapy and 2 oncology clinics at 2 university hospitals in Sweden. Interviews using open-ended questions were conducted before, during, and/or after treatment. Verbatim interview transcripts were analyzed using classic Grounded Theory.Results: "The art of living with symptoms" emerged as the core concept. This encompassed 3 interconnected symptom management concepts: "Adapting to limited ability," "Learning about oneself," and "Creating new routines." These concepts were summarized in a substantive theoretical model of symptom management. Despite the struggle to manage symptoms, participants lived a satisfactory life.Conclusions: Symptom management in conjunction with PBT comprises a process of action, thoughts, and emotions. The concepts that emerged indicated patients' symptom management strategies were based on their own resources.Implications for Practice: It is important that PBT facilities develop an approach that facilitates the symptom management process based on patients' experiences of symptoms, as well as their actions and available resources.
|
|
| 8. |
|
|
| 9. |
- Lindberg, Jesper, 1983, et al.
(författare)
-
A national perspective about the current work situation at modern radiotherapy departments
- 2020
-
Ingår i: Clinical and Translational Radiation Oncology. - : Elsevier BV. - 2405-6308. ; 24, s. 127-134
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The radiotherapy (RT) community faces great challenges to meet the growing cancer incidence, especially regarding workload and recruitment of personnel. Workflow-related issues affect involved professions differently since they have specific expertise and various roles in the workflow. To obtain an objective understanding of the current working situation and identify workflow bottle necks in RT, we conducted a national survey on this topic in 2018. Materials and Methods: All 17 (photon-based) RT departments in Sweden were invited to participate in the study, which targeted both managers and employees in RT. Descriptive statistics were calculated for each profession and for small, medium and large departments (2/3–4/≥5 linacs). Results: Altogether, 364 filled-in questionnaires were returned (32/332 managers/employees; 94% response rate). Managers reported a general need for more staff (all professions). Small departments reported no problems with waiting times (0/3); whereas 2/3 of medium and large departments did (medium: 5/8, large: 2/3). All professions had a positive attitude towards working in RT (mean = 86%, 0/100%=negative/positive attitude). Organizational issues were ranked highest among reoccurring events that were most frustrating/had most negative effect on the work environment. The most severe workflow-related problems were reported to originate at contouring. Conclusion: Future efforts to improve the modern RT workflow need to focus on how to make positive mechanisms at small departments useful in larger settings. Our data also reveal that strong leadership and improved routines at contouring are warranted by all RT professions to reduce frustration related to organizational issues and to increase work effectivity.
|
|
| 10. |
- Lindberg, Jesper, 1983, et al.
(författare)
-
An analytical approach to aggregate patient inflows to a simulation model over the radiotherapy process.
- 2021
-
Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21
-
Tidskriftsartikel (refereegranskat)abstract
- In meeting input data requirements for a system dynamics (SD) model simulating theradiotherapy (RT) process, the number of patient care pathways (RT workflows) needs to be kept low to simplify the model without affecting the overall performance. A large RT department can have more than 100 workflows, which results in a complex model structure if each is to be handled separately. Here we investigated effects on model performance by reducing the number of workflows for a model of the preparatory steps of the RT process.We created a SD model sub-structure capturing the preparatory RT process. Real data for patients treated in 2015-2016 at a modern RT department in Sweden were used. RT workflow similarity was quantified by averaged pairwise utilization rate differences (%) and the size of corresponding correlation coefficients (r). Grouping of RT workflows was determined using two accepted strategies (80/20 Pareto rule; merging all data into one group) and a customized algorithm with r≥0.75:0.05:0.95 as criteria for group inclusion by two strategies (A1 and A2). Number of waiting patients for each grouping strategy were compared to the reference of all workflows handled separately.There were 128 RT workflows for 3209 patients during the studied period. The 80/20 Pareto rule resulted in 14/8/21 groups for curative/palliative/disregarding treatment intent. Correspondingly, A1 and A2 resulted in 7-40/≤4-36/7-82 groups depending on r cutoff. Results for the Pareto rule and A2 at r≥85 were comparable to the reference.The performance of a simulation model over the RT process will depend on the grouping strategy of patient input data. Either the Pareto rule or the grouping of patients by resource use can be expected to better reflect overall departmental effects to various changes than when merging all data into one group. Our proposed approach to identify groups based on similarity in resource use can potentially be used in any setting with variable incoming flows of objects which go through a multi-step process comparable to RT where the aim is to reduce the complexity of associated model structures without compromising with overall performance.
|
|
