Patients' experiences with a welfare technology application for remote home care: A longitudinal study

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home-based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self-governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness-management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals.publishedVersio

Distinct pain profiles in patients with chronic obstructive pulmonary disease

Background: Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients. Objectives: The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL). Patients and methods: A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity. Results: Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the “high probability of pain” group, while 29% were in the “moderate probability of pain” group. For the worst pain severity, 37% were in the “moderate pain” and 39% were in the “mild pain” groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale. Conclusion: Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.publishedVersio

Kvinners erfaringer med preoperativ informasjon før hjerteoperasjon - En retrospektiv studie

UNIVERSITETET I OSLO DET MEDISINSKE FAKULTETET Institutt for sykepleievitenskap og helsefag Boks 1153 Blindern, 0318 Oslo Navn: Vivi Lycke Christensen Dato: 29. 08. 2008 Tittel og undertittel: KVINNERS ERFARINGER MED PREOPERATIV INFORMASJON FØR HJERTEOPERASJON – En retrospektiv studie Sammendrag: Formål: Denne masteroppgaven har to formål: 1) Gjennomføre en studie om kvinners erfaringer med preoperativ informasjon etter hjerteoperasjon 2) Drøfte ulike sider ved datakvalitet i studier med retrospektivt design Funnene fra studien er presenteret i artikkelform. Drøfting av datakvalitet i studier med retrospektivt design er presentert i en refleksjonsoppgave. Det gis eksempler fra egen studie i drøftingen. Teoretisk forankring: Refleksjonsoppgaven bygger på forskningslitteratur knyttet til datakvalitet i kvalitativ forskning og retrospektivt design med spesielt fokus på recall bias. Metode: Studien har retrospektivt design og bygger på syv intervjuer med kvinner fra 59-80 år, som har gjennomgått hjerteoperasjon. Intervjuene omhandlet kvinnenes erfaringer med den preoperative informasjonen de fikk i forkant av hjerteoperasjonen. Basert på erfaringer med intervjustudien, er refleksjonsoppgavens tema vurdering av datakvalitet i retrospektive studier. Resultater: I forhold til egen studie ble forutsigbarhet vektlagt som en viktig komponent for at kvinnene skulle føle seg trygge i forkant av operasjonen. Flere av respondentene opplevde endringer i hukommelsen etter operasjonen, noe som utgjør en begrensning i studien. Retrospektive studier innhenter data fra en tidligere periode i respondentenes liv, og respondentens evne til å huske er derfor av betydning. Ut fra egen studie kan det være en nevrokognitiv svikt som følge av hjerteoperasjonen, som påvirker endringene i respondentenes hukommelse. Endringer i hukommelsen kan føre til at datamaterialet i en studie bør vurderes som mindre gyldig. Troverdighet, overførbarhet, pålitelighet og bekreftbarhet er kvalitetskriterier som må vurderes i forhold til kvalitative studier. Konklusjon: For å sikre datakvalitet i retrospektive studier er det nødvendig å vurdere alle kvalitetskriteriene. I en retrospektiv studie vil faren for å huske feil være til stede hos respondentene i større eller mindre grad. Studiens gyldighet kan allikevel ikke bare vurderes på grunnlag av respondentenes erfaringer med å oppleve endringer i hukommelsen. Vurdering av gyldigheten til en studie må heller vurderes ut fra forskerens fremstilling av data og om studiens metode svarer til studiens hensikt og problemstilling. Nøkkelord: Retrospektivt design, kvalitativ metode, troverdighet, overførbarhet, pålitelighet, bekreftbarhe

Målrettet ultralyd av vena cava inferior for vurdering av volumstatus utført av sykepleiere med en avansert funksjon – en systematisk litteraturstudie

Bakgrunn: Ultralydmåling av respirasjonsavhengige endringer i diameter av vena cava inferior kan hjelpe klinikeres vurderinger ved væskeresuscitering av hemodynamisk ustabile pasienter. Det er enkelt å gjennomføre, non-invasivt og krever lite opplæring. Studier har konkludert med at dersom sykepleiere med en avansert funksjon utfører målrettet ultralyd av vena cava inferior, kan det gi verdifull tilleggsinformasjon til kliniske vurderinger av volumstatus. Det er ikke funnet systematiske litteraturstudier som oppsummerer primærstudier der ultralyd av vena cava inferior for vurdering av volumstatus undersøkes. Hensikt: Undersøke om sykepleiere med en avansert funksjon kan utføre målrettet ultralyd av vena cava inferior for vurdering av volumstatus hos voksne pasienter. Metode: Studiens design er en systematisk litteraturstudie, med systematiske søk i databasene Cinahl, Medline, SweMed+, Cochrane Trials og Embase. Studiene ble kvalitetsvurdert ved hjelp av sjekkliste for Diagnostic Test Accuracy-studier fra Joanna Briggs Institute. Innhenting av korrekte ultralydbilder og pålitelig vurdering av volumstatus utført av sykepleiere med en avansert funksjon sammenliknet med legespesialister med ulik ekspertise på ultralyd ble analysert. Resultater: Seks studier oppfylte inklusjonskriteriene. Totalt 35 sykepleiere i avanserte funksjoner innhentet til sammen 336 bilder av vena cava inferior. For innhenting av ultralydbilder var korrelasjon mellom sykepleierne og legespesialistene moderat til utmerket. For vurdering av volumstatus var korrelasjon adekvat til utmerket. Konklusjon: Sammenstilling av funnene viste at sykepleiere med en avansert funksjon kan innhente korrekte ultralydbilder av vena cava inferior samt gjøre pålitelige vurderinger av volumstatus sammenliknet med legespesialister. Tilstrekkelig opplæring og trening er viktig

Changes in and predictors of pain and mortality in patients with chronic obstructive pulmonary disease

This longitudinal study of patients with chronic obstructive pulmonary disease (COPD) aimed to investigate changes in pain characteristics (i.e., occurrence, intensity, and interference) and covariates associated with pain from study enrollment to 12 months, and to investigate if the different pain characteristics were associated with 5-year mortality. In total, 267 patients with COPD completed questionnaires five times over 1 year. The mean age of the patients was 63 years (standard deviation: 9.0), 53% were women, and 46% had very severe COPD. Median number of comorbidities was 2.0 (range: 0–11) and 47% of patients reported back/neck pain. Mixed models and Cox regression models were used for analyses. In total, 60% of the patients reported pain at baseline, and 61% at 12 months. The mixed model analyses revealed that those with better forced expiratory volume in 1 second (% predicted), more comorbidities, only primary school education, and more respiratory symptoms reported significantly higher average pain intensity. Moreover, those with more comorbidities, more respiratory symptoms, and more depression reported higher pain interference with function. At the 5-year follow-up, 64 patients (24%) were deceased, and the cumulative 5-year mortality rate was 22% (95% confidence interval [19–25]). Older age, lower forced expiratory volume in 1 second (% predicted), and higher pain interference at enrollment were all independently and significantly associated with higher 5-year mortality. Our findings show that many patients with COPD have persistent pain, and awareness regarding comorbidities and how pain interferes with their lives is needed.acceptedVersio

Validation of the Norwegian pain sensitivity questionnaire

Background and purpose: There is a large variation in people’s reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ. Methods: Construct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach’s alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable. Results: The factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach’s alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women. Conclusion: This study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain

Validation of the Norwegian pain sensitivity questionnaire

Background and purpose: There is a large variation in people’s reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ. Methods: Construct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach’s alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable. Results: The factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach’s alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women. Conclusion: This study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain

Distinct symptom experiences in subgroups of patients with COPD

This is an open access article originally published in the International Journal of COPD.Background: In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms. Objectives: The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life. Patients and methods: Patients with moderate, severe, and very severe COPD (n = 267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale. Results: Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named “high”, “intermediate”, and “low”. Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients’ symptom burden and their specific needs for symptom management. While patients in both the “high” and “intermediate” classes had high occurrence rates for respiratory symptoms, patients in the “high” class had the highest occurrence rates for psychological symptoms. Compared with the “intermediate” class, patients in the “high” class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores. Conclusion: These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function

Patients experiences with a welfare technology application for remote home care: A longitudinal study

To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home-based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self-governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness-management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase

Patients experiences with a welfare technology application for remote home care: A longitudinal study

Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home-based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self-governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness-management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase.publishedVersio