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  • 1. Alvariza, Anette
    et al.
    Holm, Maja
    Sophiahemmet University.
    Benkel, Inger
    Norinder, Maria
    Ewing, Gail
    Grande, Gunn
    Håkanson, Cecilia
    Sophiahemmet University.
    Öhlen, Joakim
    Årestedt, Kristofer
    A person-centred approach in nursing: Validity and reliability of the Carer Support Needs Assessment Tool2018In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 35, p. 1-8, article id S1462-3889(18)30058-9Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The Carer Support Needs Assessment Tool (CSNAT) was developed for use among family caregivers in palliative care for assessment of their support needs. The purpose of this study was to translate and evaluate the validity and reliability of the CSNAT in a sample of Swedish family caregivers and nurses in a palliative care context.

    METHODS: Data for this validation study was collected during 2016 in the context of palliative home care in two larger Swedish cities. The study was conducted in three stages to reach conceptual, semantic, operational and measurement equivalence between the original UK version and the Swedish version. Stage I consisted of translation to Swedish. In Stage II, cognitive interviews were performed with 8 family caregivers and 10 nurses. Data were analyzed based on relevance, clarity and sensitivity. In Stage III, the CSNAT and related self-rating measures (caregiver burden, preparedness for caregiving and quality of life) were completed by 118 family caregivers. Data quality, construct validity and test-retest reliability were evaluated.

    RESULTS: The CSNAT items were considered relevant and useful to identify areas of support needs. The Swedish CSNAT showed sound psychometric properties with satisfactory data quality and few problems with missing data across items (1.8%-6.1%). All items except one correlated as expected (rho>0.3) with caregiver burden, supporting construct validity. All items had satisfactory test-retest reliability (κw=0.45-0.75).

    CONCLUSIONS: This study further adds to the validity of the CSNAT and shows in addition that it is reliable and stable for use among family caregivers in palliative care.

  • 2.
    Bergkvist, Karin
    et al.
    Sophiahemmet University.
    Larsen, Joacim
    Johansson, Unn-Britt
    Sophiahemmet University.
    Mattsson, Jonas
    Svahn, Britt-Marie
    Hospital care or home care after allogeneic hematopoietic stem cell transplantation: patients' experiences of care and support2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 4, p. 389-395Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    Treatment at home during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation (HSCT) has been an option for patients at our center since 1998. Earlier studies have shown that home care is safe and has medical advantages. In this study, we present patients' experiences of care and support while being treated in hospital or at home during the acute post-transplantation phase.

    METHOD:

    Patients (n = 41, 22 in hospital care and 19 in home care) answered the SAUC questionnaire at discharge (when home, or from hospital). Both statistical analysis and deductive content analysis were used.

    RESULTS:

    The patients were highly satisfied with the care and support during the acute post-transplantation phase. Patients in home care were found to be more satisfied with care in general than patients in hospital care. The importance of safety, empathy, and encouragement from healthcare staff were expressed regardless of where care was given. Patients also felt that receipt of continuous, updated information during treatment was important and they had a strong belief in HSCT but were uncertain of the future regarding recovery.

    CONCLUSIONS:

    The main findings of this study were that in comparison to hospital care, home care does not appear to have a significant negative effect on patients' experiences of care and support during the acute post-transplantation phase. In addition patients in home care felt safe, seen as a person and encouragement seem to empower the patients at home. Thus, this study may encourage other transplantation centers to provide home care if the patients want it.

  • 3. Bränström, Richard
    et al.
    Petersson, Lena-Marie
    Saboonchi, Fredrik
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Alexanderson, Kristina
    Physical activity following a breast cancer diagnosis: Implications for self-rated health and cancer-related symptoms2015In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 19, no 6, p. 680-5Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Studies have consistently shown an association between physical activity and increased health and well-being after a cancer diagnosis. Nevertheless, large proportions of breast cancer survivors do not meet recommended levels of physical activity. The aim of this study was to describe physical activity levels during the first two years after being diagnosed with breast cancer, and to explore the predictive ability of physical inactivity on longer-term self-rated health, physical symptoms, and psychological distress.

    METHOD: Study participants were women recently having had a first breast cancer surgery at one of the three main hospitals in Stockholm between 2007 and 2009. A total of 726 women were included and responded to six questionnaire assessments during the 24 months following diagnosis.

    RESULTS: Less than one third of the participants were sufficiently physically active at baseline. Physical activity decreased after surgery, increased at 8 month follow-up, and subsequently decreased slightly during the subsequent follow-up period. Physical inactivity was related to reduced health, increased symptoms such as pain, depression, and anxiety.

    CONCLUSION: This study provides additional support for the beneficial consequences of being physically active after a breast cancer diagnosis and highlights a potential target for intervention. This study provides additional support showing that being physically active even at a very low level seems to result in health benefits. Physical activity should be encouraged among patients treated for breast cancer.

  • 4.
    Holm, Maja
    et al.
    Sophiahemmet University.
    Alvariza, Anette
    Fürst, Carl-Johan
    Wengström, Yvonne
    Årestedt, Kristofer
    Öhlen, Joakim
    Goliath, Ida
    Recruiting participants to a randomized controlled trial testing an intervention in palliative cancer care - The perspectives of health care professionals2017In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 31, p. 6-11, article id S1462-3889(17)30205-3Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The recruitment of participants to randomized controlled trials (RCTs) in palliative cancer care by health care professionals is often unsuccessful, which could result in failure to achieve study power. The purpose of this paper is to describe how health care professionals experienced recruiting patients and family caregivers to an RCT in palliative cancer care.

    METHODS: The study had a qualitative explorative design. Ten palliative home care settings were involved in the RCT and data were generated through focus group discussions and interviews with health care professionals who were responsible for the recruitment. The transcripts were analyzed with interpretive descriptive principles.

    RESULTS: The experiences of the health care professionals reveal that communicating the RCT-design to patients and family caregivers was a challenging part of the recruitment but was considered a process of learning over time. The delicate situation that participants were living under added to the challenge and health care professionals believed that the randomized design was contrary to their normal approach to always offer the best possible support.

    CONCLUSIONS: The results contribute valuable knowledge for future trials in palliative cancer care. To promote successful recruitment, health care professionals may be in need of more training to improve their communication skills and it may be necessary to consider other research designs than the RCT.

  • 5. Saboonchi, Fredrik
    et al.
    Petersson, Lena-Marie
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Alexanderson, Kristina
    Brännström, Richard
    Vaez, Marjan
    Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: patterns of transiency and severity of the distress response2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 598-604Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress.

    AIM: To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery.

    METHODS: Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemar's test, and logistic regression.

    RESULTS: There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness.

    DISCUSSION: The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.

  • 6.
    Siouta, Eleni
    et al.
    Sophiahemmet University.
    Farrell, Carole
    Chan, E. Angela
    Walshe, Catherine
    Molassiotis, Alex
    Communicative constructions of person-centred and non-person-centred caring in nurse-led consultations2019In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 40, p. 10-21Article in journal (Refereed)
    Abstract [en]

    Abstract

    Purpose

    Nursing is theorised to be a component of person-centred care. Communicative constructions of person-centred caring are a topic that needs to be studied in consultations. The study aimed to explore how person-centred caring and non-person- centred caring are verbally constructed in consultations between patients and nurse.

    Method

    This study was qualitative using audio-recorded observations from consultations with advanced nurse practitioners in nurse-led chemotherapy clinics from four hospitals in the UK through purposive sampling. Discourse analysis was used to identify communicative patterns in 45 non-participant observations of nurse consultations.

    Results

    The dominant discourse was a non-person-centred oriented discourse framed by the biomedical model. It was also possible to identify fragments of an alternative discourse—a person-oriented discourse localising health problems within the patient's personal and sociocultural context.

    Conclusions

    The prominent use of a non-person-oriented discourse focusing on the medical/technical aspects of a patient's assessment/evaluation in consultations may make it difficult for patients to raise questions and concerns from their daily lives during consultations. However, fragments of a person-oriented discourse show that it is possible for nurses to allow a person-centred approach to the consultation. The pedagogical implications have to do with raising nurses' awareness of the role of evaluative language in enhancing person-centred communication with patients in clinical interactions.

  • 7. Toft, Teolinda
    et al.
    Alfonsson, Sven
    Hovén, Emma
    Carlsson, Tommy
    Sophiahemmet University.
    Feeling excluded and not having anyone to talk to: Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling2019In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 42, p. 76-81, article id S1462-3889(19)30108-5Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore experiences related to interpersonal relationships following a cancer diagnosis in a sibling.

    METHODS: Respondents (n = 7 females) were recruited by means of convenience sampling during a camp for children affected by childhood cancer and their siblings. Data from children and adolescents with a sibling diagnosed with cancer was collected through individual face-to-face interviews and analyzed using systematic text condensation.

    RESULTS: Two categories portrayed the experiences related to interpersonal relationships following a cancer diagnosis in a sibling. Feeling excluded while wanting to maintain a relationship with their ill sibling and be involved in the care portrayed that trying to be involved in the care of their ill sibling was a stressful and difficult experience, since they were simultaneously expected to also manage household chores and attend school. Feeling stigmatized and exposed in social contexts while needing an allowing space to talk about their experiences portrayed the emotional difficulties evoked by social situations and behaviors of others, which left respondents feeling exposed and mistreated. Having the possibility to talk about their experiences and receiving social support was described as essential in order to cope with the situation.

    CONCLUSIONS: Health professionals need to take into consideration the emotional difficulties and vulnerable situation that children and adolescents who have a sibling diagnosed with cancer are at risk of experiencing. Stigmatization and social exposure present a risk of psychological distress. Having an allowing space to communicate feelings and experiences is desired. Interventions may be necessary to help these individuals psychologically cope.

  • 8.
    Wennman-Larsen, Agneta
    et al.
    Sophiahemmet University.
    Nilsson, Marie
    Saboonchi, Fredrik
    Olsson, Mariann
    Alexanderson, Kristina
    Fornander, Tommy
    Sandelin, Kerstin
    Petersson, Lena-Marie
    Can breast cancer register data on recommended adjuvant treatment be used as a proxy for actually given treatment?2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 22, p. 1-7Article in journal (Refereed)
  • 9.
    Wennman-Larsen, Agneta
    et al.
    Div. of Insurance Medicine, Dpt of Clinical Neuroscience, Karolinska Institutet.
    Olsson, Mariann
    Alexanderson, Kristina
    Nilsson, Marie I
    Petersson, Lena-Marie
    Arm morbidity and sick leave among working women shortly after breast cancer surgery2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 1, p. 101-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is limited knowledge about the impact of arm morbidity on sick leave in the immediate period after breast cancer surgery.

    PURPOSE: To determine if arm morbidity was associated with sick leave shortly after breast cancer surgery and to investigate the association between arm morbidity and sick leave, adjusted for treatment, work characteristics, co-morbidity, time since surgery, and sociodemographic factors.

    SAMPLE AND METHODS: Included were 511 women who within 12 weeks had had breast cancer surgery, were aged 20-63 years, had no distant metastasis, pre-surgical chemotherapy, or previous breast cancer, and worked ≥75% before breast cancer diagnosis. Percentages and odds ratios (OR) for being on sick leave were calculated, using multivariable analyses.

    RESULTS: Of the women, 10% reported arm morbidity, 43% had had a total axillary clearance, and 60% were on sick leave. In multivariable analysis, those with planned chemotherapy had the highest OR (4.69; 95% CI 2.97-7.41) for being on sick leave. Nevertheless, those reporting arm morbidity had the second highest OR (2.71; 1.23-5.97) which was higher than if having strenuous work postures (2.49; 1.50-4.15) or having had an axillary clearance (1.64; 1.04-2.60).

    CONCLUSION: Arm morbidity is an important factor for whether being on sick leave or not shortly after breast cancer surgery, even more important than type of axillary surgery or work situation. However, planned chemotherapy had the greatest impact for being on sick leave already shortly after breast cancer surgery.

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