Psychosocial and physical factors of importance for recovery from curative colorectal cancer surgery among persons ≥80 years old: a mixed method study

Background: Colorectal cancer is the third most common cancer worldwide. Colorectal cancer can be a fatal disease accompanied by suffering if untreated. Surgery is the mainstay for cure and is considered safe for patients of all ages. The median age of diagnosis is approximately 72 years in Norway. With the increase in the older population, it is likely that there will be an equivalent rise in the incidence of colorectal cancer. However, older persons represent a heterogeneous group of patients ranging from patients in good health to patients with increased vulnerability to treatment and complications. An excessive 1-year post-operative mortality rate has been observed among patients aged ≥80 years compared to their younger counterparts. After a year, the 5-year survival rate equals that of younger patients. With improvements in diagnosis and treatment in recent years, more patients are living beyond cancer treatment and into recovery. However, for patients aged ≥80 years in Norway, follow-up is determined in dividually outside systematic follow-up programs. Hence, there is limited knowledge on patients’ experiences and perceptions regarding recovery after discharge. Objectives: The overall aim of this study was to investigate the psychosocial and physical factors that are important for recovery after curative colorectal cancer surgery among persons aged ≥80 years. The following aims were formulated for the different studies: • To explore the experiences of individuals aged ≥80 years recovering from surgery for colorectal cancer and the challenges they may encounter after discharge from hospital • To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥ 80 years treated for curable colorectal cancer. • To explore the experience of persons ≥80 years of age during recovery up to two years after curative colorectal cancer surgery Methods: This project utilized a multiphase mixed method design, with the studies being conducted sequentially in their respective phases. Qualitative and quantitative methods were applied separately in the different phases and comprised the following: 1) qualitative interviews of colorectal cancer patients ≥80 years old (n=10) newly discharged from the hospital after surgery, 2) a quantitative cross-sectional survey of persons ≥80 years (n=56) treated for colorectal cancer 1 to 5 years prior and 3) qualitative interviews of persons ≥80 years old (n=18) treated for curative colorectal cancer 1 to 2 years prior. Results: Recovery from colorectal cancer among persons ≥80 years old appears to be challenging for most in the short term, where psychosocial and physical problems and a lack of information made the recovery more challenging (Study 1). Sense of coherence, that is, coping capacity, was found to correlate with age, physical function and the need for homecare nursing. Perceived social support was found to correlate with readmission, age at time of surgery and gender (Study 2). Long-term recovery was revealed to be a complex process influenced by the lasting effects of the surgery and resources at the persons’ disposal, in addition to other factors such as additional health issues (Study 3). The follow-up care provided was lacking in different areas (Studies 1 and 3). The merging of findings across the recovery process of older individuals after colorectal cancer surgery was found to be a complex affair affected by the older person’s sense of coherence and resources. Conclusions: This thesis demonstrated that recovery among persons aged ≥80 years can be a complex process over a longer period with several psychosocial and physical factors influencing it, the most important of which were the experience of reduced function, occurrence of symptoms and complications, and support from family, friends or healthcare services. The thesis also revealed an opportunity for advancement in follow-up care for older persons in recovery related to care coordination. Additionally, follow-up should be directed towards the management of experienced symptoms and complications and assistance in the management of comorbid condition to minimise their impact on recovery from curative colorectal cancer surgery

BUILDING A COLLABORATIVE RELATIONSHIP WITH AN INVOLUNTARY PARENT IN CHILD PROTECTIVE SERVICES

Building a collaborative relationship with an involuntary parent is challenging; however, the worker-client relationship is essential to promoting the wellbeing of the child and family. This article describes a small-scale qualitative study conducted with child protective workers in one region of Estonia. Findings indicate that in order to encourage involuntary parents to participate, it was crucial to learn what was provoking their resistance. Recognition was used to establish a collaborative relationship with involuntary parents. To reduce the unequal distribution of power, the parent was recognised as an equal partner and negative feelings were validated and understood as a normal reaction to intervention

Ett niche partis påverkan på mainstream partier i den svenska miljöpolitiken - En jämförande studie av Socialdemokraterna, Moderaterna och Miljöpartiets miljöpolitik

Uppsatsen har som ambition att undersöka ifall bildandet av Miljöpartiet och deras intåg i Sveriges riksdag har orsakat förändringar i Socialdemokraterna och Moderaternas miljöpolitik. Uppsatsen fokusera på hur Socialdemokraterna och Moderaterna har valt att hantera miljöpartiet utifrån tre strategier utvecklade av forskaren Bonnie Meguid. Vi har analyserat valmanifest från 1985, 1988 och 1991 från samtliga partier för att studera vilken av dessa strategier Socialdemokraterna och Moderaterna har valt. För att undersöka ifall det är Miljöpartiet som har påverkat Socialdemokraterna och Moderaternas miljöpolitik jämför vi med hur den folkliga opinionens stöd för miljöskydd sett ut under samma tidsperiod. Analysmetoden är en kvalitativ innehållsanalys med fokus på att undersöka både det manifesta och det latenta budskapen som berör miljöpolitik i partiernas valmanifest. Denna studie har resulterat i att det inte med full säkerhet går att bevisa att Miljöpartiet har påverkat Socialdemokraterna och Moderaternas miljöpolitik. Dock går det inte heller att endast baserat på folklig opinion fastställa Socialdemokraterna och Moderaternas miljöpolitik.Uppsatsen har som ambition att undersöka ifall bildandet av Miljöpartiet och deras intåg i Sveriges riksdag har orsakat förändringar i Socialdemokraterna och Moderaternas miljöpolitik. Uppsatsen fokusera på hur Socialdemokraterna och Moderaterna har valt att hantera miljöpartiet utifrån tre strategier utvecklade av forskaren Bonnie Meguid. Vi har analyserat valmanifest från 1985, 1988 och 1991 från samtliga partier för att studera vilken av dessa strategier Socialdemokraterna och Moderaterna har valt. För att undersöka ifall det är Miljöpartiet som har påverkat Socialdemokraterna och Moderaternas miljöpolitik jämför vi med hur den folkliga opinionens stöd för miljöskydd sett ut under samma tidsperiod. Analysmetoden är en kvalitativ innehållsanalys med fokus på att undersöka både det manifesta och det latenta budskapen som berör miljöpolitik i partiernas valmanifest. Denna studie har resulterat i att det inte med full säkerhet går att bevisa att Miljöpartiet har påverkat Socialdemokraterna och Moderaternas miljöpolitik. Dock går det inte heller att endast baserat på folklig opinion fastställa Socialdemokraterna och Moderaternas miljöpolitik

Exploring variables affecting sense of coherence and social support in recovery after colorectal cancer surgery among the oldest old

Objective To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. Methods This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. Results Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. Conclusion The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery.publishedVersio

Experiences of recovery from colorectal cancer surgery after hospital discharge among the oldest old: a qualitative study

Colorectal cancer affects a large number of people aged ≥80 years. Little is known about how they manage after discharge from hospital. The aim of this study was to explore the experiences of individuals aged ≥80 years recovering from surgery for colorectal cancer, and the challenges they may encounter after discharge from hospital. Data were collected between January and March 2016 through in-depth interviews with ten participants approximately one month after surgery. Inductive thematic analysis was employed to analyse the data. The COREQ checklist was used in reporting this study. Two themes were identified: Managing the recovery from CRC surgery, and Insufficient follow-up from the healthcare services after CRC surgery. The findings indicate that older people treated for colorectal cancer manage surprisingly well after discharge despite challenges in their recovery; however, there are seemingly areas of improvement in their follow-up healthcare.publishedVersio

Long-term recovery after colorectal cancer surgery among the old: a qualitative study

Background Colorectal cancer is the third most frequently diagnosed cancer worldwide, disproportionally affecting older people. With modern treatment, older people are surviving cancer treatment and recovery. However, only a limited number of studies on the older person’s experience of recovery exist. Knowledge of the experience of recovery among people 80 years or older is essential to optimize recovery and follow-up care. Objective The aim of this study was to explore the experiences of persons 80 years or older during recovery up to 2 years after curative colorectal cancer surgery. Methods This exploratory inductive qualitative study was conducted through 18 individual in-depth interviews between July 2020 and June 2021. Content analysis was used to analyze the data. Results The main theme identified was Recovery among the old is a complex process. It indicated that older people operated on for colorectal cancer may have intricate health challenges that affect recovery in addition to their cancer and treatment. The main theme is built upon the subthemes Individual factors affect colorectal cancer recovery and External support systems facilitate and impede colorectal recovery. Conclusion Important resources for recovery among old patients included their own coping ability and support from social networks and healthcare services. The identified barriers to recovery included other health problems and issues with healthcare services delivery. Implications for Practice It is essential for healthcare personnel in contact with older patients to be aware of factors that influence their recovery to identify and preserve the older person’s resources and implement health-promoting initiatives to optimize recovery when needed.publishedVersio

Equity in digital healthcare – the case of Denmark

As digital healthcare services are expanding in use and purpose in a Danish context so are the functionalities embedded in these, constituting citizens’ access to healthcare services and personal health data. In Denmark, the impact of inequalities in digital healthcare remains largely unexplored, making it crucial to pay close attention to this aspect as the digital transformation of the sector progresses. According to the Danish Health Act (2019), the Danish healthcare system is required to ensure easy and equal access to healthcare, high-quality treatment, coherent patient pathways, freedom of choice, easy access to information, transparency, and short waiting times for every citizen. These are focal law-based requirements influenced by the digitalisation of healthcare. Hence, based on insights from a highly digitalised country, in this case, Denmark, this paper aims to initiate a discussion on inequities in digital healthcare, address current challenges, and consider future directions by elaborating on conceptual, ethical, evidence-informed, and methodological issues linked to inequities in digital healthcare. Specifically, this paper discusses why inequities in digital healthcare in a Danish context need increased attention, how health equity is embedded in Danish legislation and how it can be approached from an ethical perspective. The central focus revolves around the essential principles of empowerment, emancipation, and equity, which are being highlighted to emphasise that the digitalisation of healthcare should actively work towards preventing and avoiding the perpetuation of healthcare inequalities. The paper concludes by discussing future directions for ensuring a more sustainable, robust, and equitable digital healthcare system