Multiple Symptoms in COPD

Mål: Målet med studien var å undersøke sammenhengen mellom tung pust, depresjon, angst, trøtthet, søvnvansker og smerte hos personer med KOLS Bakgrunn: Forskning innen KOLS har primært fokusert på ett symptom av gangen, men det er lite kunnskap om mulige sammenhenger mellom flere symptomer. Teoretisk rammeverk som symptomhåndteringsmodellen kan gi innsikt i forståelsen av ulike sammenhenger mellom symptomer. Metode: Totalt deltok 154 personer med KOLS i tverrsnittstudien i perioden juni 2006-desember 2007. Alle gjennomførte lungefunksjonstest og fylte ut spørreskjema som inkluderte demografiske variable, Brief Pain Inventory, Hospital Anxiety and Depression Scale, Lee Fatigue Scale, General Sleep Disturbance Scale og Respiratory Quality of Life Questionnaire. Informasjon om sykdommer og medisiner ble hentet fra journal. Følgende analysemetoder ble benyttet: deskriptiv statistikk, bivariate korrelasjonsanalyse og multiregresjonsanalyser. Resultat: Alder viste signifikant sammenheng med tung pust, trøtthet, søvnvansker og smerte. Utdannelse viste signifikant sammenheng med depresjon og angst. Røyking viste signifikant sammenheng med angst, depresjon og smerte. Antall sykdommer viste signifikant sammenheng med tung pust. Bivariate korrelasjon viste at tung pust, depresjon, angst, trøtthet, søvnvansker og smerte var signifikant assosiert med hverandre. I multiregresjonsanalysen hadde lungefunksjon sammenheng med tung pust og søvnvansker. Tung pust viste størst signifikant sammenheng med de andre symptomene etter å ha kontrollert for demografiske og kliniske variable. Konklusjon: Tung pust er det mest fremtredende symptomet hos personer med KOLS og viser sammenheng mellom symptomer som depresjon, angst, trøtthet, søvnvansker og smerte. Resultatene fra studien tilsier at det kan være formålstjenlig å fokusere mer på multisymptomer i guidelines, behandling og forskning

Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review

Background: Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients’ homes, reduce hospital admissions, enhance patients’ feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. Objective: The aim of this review was to systematically map published studies on HCPs’ experiences and perspectives on the use of telehealth in HBPC. Methods: A scoping review was conducted using the methodology of Arksey and O’Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs’ experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. Results: This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. Conclusions: Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs’ point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC.publishedVersio

"A bit of everything": Health literacy interventions in chronic conditions- a systematic review

Objective: To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness. Method: We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers. Results: We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant hetero-geneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostlyassessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor. Conclusions: Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions’ complexity. Practice implications: A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions.publishedVersio

The Health Literacy Course for Caregivers of persons with non-communicable diseases – The HeaLCare study

Carers are increasingly taking on an important role in the care of a person with a non-communicable disease (NCDs). This is often in addition to their work, family and other commitments, leading to considerable pressure that can be detrimental to their own health. To take care of their own health and the one(s) they care for, caregivers need to be health literate (i.e., able to acquire, understand, assess, remember, and to use health information and services). 1-4 However, there is a need for increased knowledge about interventions to improve the health literacy (HL) of carers of people with NCDs, which the HeaLCare study will address. The HeaLcare study will co-design an intervention based on HL comprehensive needs assessment study and test its effectiveness to improve key outcomes (HL, coping, caregiver burden, quality of life (QOL), and health care costs) among caregivers of persons NCDs

Relevant associations between alexithymia and health-literacy in persons with psoriasis

Objective: To explore possible associations between alexithymia and health literacy (HL) in persons with psoriasis. Methods: We conducted a cross-sectional study, including 825 persons with moderate to severe psoriasis, using the Toronto Alexithymia Scale (TAS-20), and the Health Literacy Questionnaire (HLQ). Descriptive statistics compare HL means between alexithymic and not alexithymic participants. Associations between alexithymia and HL are analyzed using a linear multiple regression model. Results: 26 % of the participants were characterized as alexithymic, and 26.8% had borderline alexithymia. Higher alexithymia scores were associated with lower education, biological medicines, and more comorbidities, together with lower self-efficacy. The health literacy (HL) domains with the strongest associations with alexithymia were those focusing on managing and getting support for health, as well as the ability to find health information. Conclusion:. A more elevated alexithymia score is associated with lower health literacy. Further studies of these associations may contribute to a more comprehensive perspective of psoriasis. To know a patient's alexithymia level and HL needs may guide health care personnel’s understanding of possible associations between health status, clinical presentation, behaviour, and response to treatment.publishedVersio

Patients’ experiences with participating in a team-based person-centred intervention for patients at risk of or diagnosed with COPD in general practice

Abstract Background Symptoms and complications of chronic obstructive pulmonary disease (COPD) can affect daily activities and quality of life, and patients with COPD require long-term follow-up by their general practitioner. Providing patients with or at risk of COPD practical skills and motivation to improve their self-management is important. On this background, an interdisciplinary follow-up program was designed based on the Guided Self-Determination counselling method to facilitate problem-solving and mutual decision-making between healthcare professionals and patients. The aim of the study was to explore patients and healthcare professionals` experiences with the Guided Self-Determination-program to investigate feasibility issues. Methods A qualitative design was used to get insights in the experiences of receiving the Guided Self-Determination counselling program. In total, 13 patients with COPD (mean age 71.7 ± 7.7 years) 4 were current smokers, and 7 at risk of COPD (mean age 54.1 ± 9.9 years) all current smokers, received the Guided Self-Determination program. The researchers performed individual semi-structured telephone interviews after the 12 months Guided Self-Determination program with two patients at risk of COPD, four patients with COPD, three nurses, and five general practitioners. The intervention consisted of structured consultations with the nurse and patient in collaboration with the general practitioner at baseline and after 3, 6, and 12 months. The Guided Self-Determination method comprised facilitation of a mutual reflection process between the patient and the nurse to enhance self-management skills. Each consultation lasted for 60 min. The interviews were analysed using thematic analyses. Results Two themes were identified: (1) A structured follow-up is challenging but motivating. (2) A counselling method that opens for conversation, but it requires resources. Conclusions The findings indicated that patients with or at risk of COPD experienced enhanced self-management skills after participating in a structured and systematic team-based follow-up in general practice with use of the Guided Self-Determination method. The regularity of the follow-up seemed to be important to succeed to help the patients making lifestyle changes to increase health benefits. However, the Guided Self-Determination method was experienced as time consuming among the general practitioners and nurses, and there are currently no available financial rates for this type of treatment in Norway which may be a barrier to further implementation. Trial registration The trial is registered in ClinicalTrials.gov (ID: NCT04076384)

Lungerehabiliteringstilbud i norske kommuner for personer med kronisk obstruktiv lungesykdom - Kartleggingsstudie

Bakgrunn: Lungerehabilitering er en tverrfaglig, individuelt tilpasset behandling hvor hensikten er å bedre den fysiske og psykiske tilstanden til personer med kronisk obstruktiv lungesykdom (kols). Dette inkluderer, men er ikke begrenset til, fysisk trening, undervisning, pasientopplæring og råd om livsstil. Målet er å bedre etterlevelse av helsefremmende adferd. Nasjonale og internasjonale retningslinjer anbefaler lungerehabilitering som det viktigste behandlingstilbudet for pasienter med kols. Ved innføring av Samhandlingsreformen i 2012, ble det besluttet at rehabilitering skulle være en del av det kommunale helsetjenestetilbudet. Det er i dag uklart i hvilken grad norske kommuner har etablert tilbud om lungerehabilitering, hvor tilgjengelig dette er og hva tilbudet omfatter. Hensikt: Å undersøke tilbud og tilgjengelighet av lungerehabilitering i kommuner og frisklivssentraler i Norge. Metode: Nasjonalt kolsråd gjennomførte en kartleggingsstudie i perioden februar-april 2019. Et spørreskjema med spørsmål om innhold, organisering og tilgjengelighet til tverrfaglig lungerehabilitering ble sendt elektronisk til alle kommuner og frisklivssentraler. Resultat: Svarresponsen var 36 % og dekket for 45 % av den totale befolkningen i Norge. Behandlingsintervensjoner som inngår i et lungerehabiliteringsprogram for personer med kols ble rapportert som et tilbud i 21% av kommunene, mens 5% rapporterte at de har tverrfaglig lungerehabilitering over flere uker. Flere kommuner hadde tilbud om elementer som inngår i et lungerehabiliteringsprogram som mestringskurs (6 %) og bassengtrening (22 %) for pasienter med kols, mens treningsgrupper uavhengig av diagnose var rapportert hos 27 %, hverdagsrehabilitering hos 25 % og hjemmebehandling av fysioterapeut eller ergoterapeut hos 24 %. Konklusjon og implikasjon: Lungerehabilitering er den viktigste og mest kostnadseffektive behandling ved kols. Resultatene fra denne kartleggingsstudien viser at behandlingen kun er tilgjengelig i et fåtall av norske kommuner. Det er stort behov for å utarbeide nasjonale strategier som sikrer at pasienter med kols får tilgang til den beste og mest effektive behandlingen, lungerehabilitering, som bedrer og styrker fysisk og psykisk helse. Dette kan gi store samfunnsøkonomiske gevinster med redusert bruk av helsetjenester og færre sykehusinnleggelser

Definitions and measurement of health literacy in health and medicine research: A systematic review

Objectives The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments. Design Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019. Eligibility criteria We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years. Data extraction and synthesis Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam’s descriptions of the different health literacy levels. Results 120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1). Conclusion Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies

Definitions and measurement of health literacy in health and medicine research: A systematic review

Objectives: The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments. Design: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019. Eligibility criteria: We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years. Data extraction and synthesis: Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam’s descriptions of the different health literacy levels. Results: 120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1). Conclusion: Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies