Striving to be prepared for the painful: Management strategies following a family member's diagnosis of advanced cancer

Background: Cancer has consequences not only for the sick person but also for those who have a close relationship with that person. Greater knowledge about how family members manage the situation in the period immediately following the diagnosis means greater opportunity to provide the best possible support for the family. The purpose of this study was to explore management strategies that family members use when the patient is in the early stage of treatment for advanced cancer. Methods: Twenty family members of cancer patients were included in the study shortly after the diagnosis. The patients had been diagnosed 8-14 weeks earlier with advanced lung cancer or gastrointestinal cancer. The data were collected in interviews with family members and subjected to qualitative latent content analysis. Through the identification of similarities and dissimilarities in the units of meaning, abstraction into codes and sub-themes became possible. The sub-themes were then brought together in one overarching theme. Results: The overall function of management strategies is expressed in the theme Striving to be prepared for the painful. The family members prepare themselves mentally for the anticipated tragedy. Family relationships become increasingly important, and family members want to spend all their time together. They try to banish thoughts of the impending death and want to live as normal a life as possible. It becomes important to family members to live in the present and save their energy for the time when they will need it the most. How participants handle their worries, anxiety and sadness can be categorized into seven sub-themes or management strategies: Making things easier in everyday life, Banishing thoughts about the approaching loss, Living in the present, Adjusting to the sick person’s situation, Distracting oneself by being with others, Shielding the family from grief, and Attempting to maintain hope. Conclusions: The findings revealed that the family members have their own resources for handling the early stage of the cancer trajectory in an acceptable way. There is a need for longitudinal studies to generate knowledge for designing evidence-based intervention programmes that can prevent future ill-health in these vulnerable family members

Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision-making

Rationale: Atrial fibrillation (AF) increases the risk of stroke and it can be reduced by treatment with warfarin. Some patients consider that warfarin is a stressful treatment with undesired effects and the perceived barriers include unwillingness to take it. Knowledge of patients resisting warfarin treatment may be useful for the potential threat to maintaining shared decision-making in the consultation as a central tenet of person-centered medicine. Aims and objectives: To identify how patients resist treatment with warfarin and how cardiologists respond to patients’ resistance. The co-constructive perspective of this work analyses the consultations by emphasizing the clinical communication strategies of both patients and cardiologists. Method: Eleven videotaped consultations, in 4 different hospitals, were selected for analysis. Treatment interactions regarding warfarin between patients with AF and cardiologists were analysed, according to the methodology of conversation analysis. Results: There were 4 types of resistance from patients for accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggestion of another treatment option by the patient”, “Stating a treatment preference” and “Questioning or challenging the cardiologist’s treatment recommendation”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information on the recommended treatment” and “Extending the explanation for the purpose of taking the treatment”. Conclusions: By showing resistance, patients are thought to want to participate in their treatment decisions and an awareness of patients’ resistance to treatment enables cardiologists to address the patients’ experience-based views on their treatment and individual concerns as part of clinical strategies to increase the person-centeredness of medical intervention

A treatment strategy for meeting life as it is. Patients' and therapists' experiences of brief therapy in a district psychiatric centre: A qualitative study

Abstract Background: Young adults increasingly seek help for mental health problems. In 2016, a district psychiatric centre in Norway started a brief treatment program to provide early and effective help for moderate depression and anxiety. Aim: Exploring patients' and therapists' experiences of brief therapy, especially how the time limitation influences the treatment process. Methods: Individual interviews with 12 patients and focus group interviews with eight therapists analyzed using systematic text condensation. Results: The results constitute five themes: (1) Time-limit as a frame for targeted change, (2) Clarifying expectations and accountability, (3) Shared agreement on a defined treatment-project, (4) Providing tools instead of searching for causes, and (5) Learning to cope-not being cured. Conclusion: Time-limitation in brief therapy appeared to play a positive role, helping the therapists to structure the therapeutic process and strengthening patients' motivation. Shared understanding and activation during brief therapy may reinforce patients' responsibility and expectations to achieve individual goals. Brief therapy can be viewed as the start of a personal process towards "mastering life as it is". More research is needed to investigate the patients' long-term outcomes after treatment and to shed light on the potential for, and limitations of, mastering everyday-life.publishedVersio

Hälso- och sjukvårdens utbildningsuppdrag : Utlandsutbildade med kompletteringsutbildning, Utbildningstjänstgörande medarbetare, Studenter, Elever

Mot bakgrund av behovet att påskynda nyanlända personers etablering på arbetsmarknaden avser rapporten bidra till att utifrån erfarenheter, kontakter med andra samt svenska publikationer, beskriva hur det växande behovet av auskultation/praktik och praktiktjänstgöringsplatser kan tillgodoses. Detta kan även och bör beröra ett flertal andra utbildningsgrupper. Rapporten avser att identifiera sätt att förbättra och effektivisera lärande och handledning. Målet är att skapa ett underlag för det fortsatta arbetet avseende professionella praktiker, lärandemiljöer och lärandemetoder. Rapporten kan dels vara ett stöd i att skapa en gemensam hållning inom landsting, regioner och kommunal hälso- och sjukvård vad gäller utbildningsområdet, dels fungera som ett underlag i den fortsatta dialogen mellan intressenterna inom området. Rapporten innehåller tre delar; en bakgrund, ett case som används som utgångspunkt samt en avslutande del med slutsatser och rekommendationer. I bakgrunden beskrivs den teoretiska ramen om lärande i professionella praktiker samt olika perspektiv på adepters lärande i vårdpraktiker. Synen på adepternas lärande i vården varierar beroende på vilket perspektiv som tas. Under senare decennier har antalet yrkesgrupper ökat i antal, utbildningsnivåer höjts och antalet områden med krav på specialistkompetens ökat. De professionsutbildningar som mer eller mindre har praktiska utbildningsmoment inom hälso- och sjukvård presenteras och utlandsutbildade personers specifika utbildningsbehov med hänsyn tagen till svenska regelverk och individuella omständigheter beskrivs. Case Region Jönköpings län (RJL) beskriver hur lärandet med olika förutsättningar och stödjande funktioner kan se ut i en hälso- och sjukvårdskontext. Adepters lärande i vårdpraktiker konkretiseras och därefter beskrivs de funktioner och infrastrukturer som bidrar till förutsättningarna för deras lärande. För att skapa bra förutsättningar för adepternas lärande beskrivs därför lärandet utifrån ett systemperspektiv. Med hjälp av ett mer omfattande exempel på organisering och genomförande av utlandsutbildade, beskrivs läkares lärande inom primärvården Bra Liv där Nässjö utbildningscentrum har ett specifikt utbildningsuppdrag. Slutsatserna och rekommendationerna är kopplade till att uppdraget är komplext och har dessutom en avsevärd tyngd då dess innebörd troligen kan få konsekvenser för hälso- och sjukvårdens framtida prioriteringar och styrning. Utbildningsuppdragen bör betraktas utifrån vårdverksamheternas perspektiv. Stöd och förutsättningar för nyckelfunktioner måste tydliggöras, i såväl mikro-, meso- och makrosystemen, Med ett transparent system kan samverkan för god och effektiv kvalitet förbättras i de olika utbildningsuppdragen, avseende professionella praktiker, lärandemiljöer, lärandemetoder och stödjande och ledande infrastrukturer

Hälso- och sjukvårdens utbildningsuppdrag : Utlandsutbildade med kompletteringsutbildning, Utbildningstjänstgörande medarbetare, Studenter, Elever

Mot bakgrund av behovet att påskynda nyanlända personers etablering på arbetsmarknaden avser rapporten bidra till att utifrån erfarenheter, kontakter med andra samt svenska publikationer, beskriva hur det växande behovet av auskultation/praktik och praktiktjänstgöringsplatser kan tillgodoses. Detta kan även och bör beröra ett flertal andra utbildningsgrupper. Rapporten avser att identifiera sätt att förbättra och effektivisera lärande och handledning. Målet är att skapa ett underlag för det fortsatta arbetet avseende professionella praktiker, lärandemiljöer och lärandemetoder. Rapporten kan dels vara ett stöd i att skapa en gemensam hållning inom landsting, regioner och kommunal hälso- och sjukvård vad gäller utbildningsområdet, dels fungera som ett underlag i den fortsatta dialogen mellan intressenterna inom området. Rapporten innehåller tre delar; en bakgrund, ett case som används som utgångspunkt samt en avslutande del med slutsatser och rekommendationer. I bakgrunden beskrivs den teoretiska ramen om lärande i professionella praktiker samt olika perspektiv på adepters lärande i vårdpraktiker. Synen på adepternas lärande i vården varierar beroende på vilket perspektiv som tas. Under senare decennier har antalet yrkesgrupper ökat i antal, utbildningsnivåer höjts och antalet områden med krav på specialistkompetens ökat. De professionsutbildningar som mer eller mindre har praktiska utbildningsmoment inom hälso- och sjukvård presenteras och utlandsutbildade personers specifika utbildningsbehov med hänsyn tagen till svenska regelverk och individuella omständigheter beskrivs. Case Region Jönköpings län (RJL) beskriver hur lärandet med olika förutsättningar och stödjande funktioner kan se ut i en hälso- och sjukvårdskontext. Adepters lärande i vårdpraktiker konkretiseras och därefter beskrivs de funktioner och infrastrukturer som bidrar till förutsättningarna för deras lärande. För att skapa bra förutsättningar för adepternas lärande beskrivs därför lärandet utifrån ett systemperspektiv. Med hjälp av ett mer omfattande exempel på organisering och genomförande av utlandsutbildade, beskrivs läkares lärande inom primärvården Bra Liv där Nässjö utbildningscentrum har ett specifikt utbildningsuppdrag. Slutsatserna och rekommendationerna är kopplade till att uppdraget är komplext och har dessutom en avsevärd tyngd då dess innebörd troligen kan få konsekvenser för hälso- och sjukvårdens framtida prioriteringar och styrning. Utbildningsuppdragen bör betraktas utifrån vårdverksamheternas perspektiv. Stöd och förutsättningar för nyckelfunktioner måste tydliggöras, i såväl mikro-, meso- och makrosystemen, Med ett transparent system kan samverkan för god och effektiv kvalitet förbättras i de olika utbildningsuppdragen, avseende professionella praktiker, lärandemiljöer, lärandemetoder och stödjande och ledande infrastrukturer

Striving to be prepared for the painful: Management strategies following a family member's diagnosis of advanced cancer

Abstract Background Cancer has consequences not only for the sick person but also for those who have a close relationship with that person. Greater knowledge about how family members manage the situation in the period immediately following the diagnosis means greater opportunity to provide the best possible support for the family. The purpose of this study was to explore management strategies that family members use when the patient is in the early stage of treatment for advanced cancer. Methods Twenty family members of cancer patients were included in the study shortly after the diagnosis. The patients had been diagnosed 8-14 weeks earlier with advanced lung cancer or gastrointestinal cancer. The data were collected in interviews with family members and subjected to qualitative latent content analysis. Through the identification of similarities and dissimilarities in the units of meaning, abstraction into codes and sub-themes became possible. The sub-themes were then brought together in one overarching theme. Results The overall function of management strategies is expressed in the theme Striving to be prepared for the painful. The family members prepare themselves mentally for the anticipated tragedy. Family relationships become increasingly important, and family members want to spend all their time together. They try to banish thoughts of the impending death and want to live as normal a life as possible. It becomes important to family members to live in the present and save their energy for the time when they will need it the most. How participants handle their worries, anxiety and sadness can be categorized into seven sub-themes or management strategies: Making things easier in everyday life, Banishing thoughts about the approaching loss, Living in the present, Adjusting to the sick person's situation, Distracting oneself by being with others, Shielding the family from grief, and Attempting to maintain hope. Conclusions The findings revealed that the family members have their own resources for handling the early stage of the cancer trajectory in an acceptable way. There is a need for longitudinal studies to generate knowledge for designing evidence-based intervention programmes that can prevent future ill-health in these vulnerable family members.</p

"We found a solution, sort of” : qualitative interview study with children and parents on their experiences of the coordinated individual plan (CIP) in Sweden

Children and adolescents receiving services from two professional parties may obtain support with a coordinated individual plan (CIP). The Swedish law prescribes that CIP must incorporate service user participation. This study aims to explore children and parents’ experiences of participating in CIP-process to generate knowledge with practical implications of how children and parents may be involved in the CIP-process. A descriptive qualitative interview study with 13 service users was conducted during November 2014 to March 2016. Data were audio-recorded and transcribed, and further subjected to qualitative content analysis. Three main descriptive categories with six subcategories emerged. The category “Struggle for coordination” includes service users’ need for participation which are limited by professionals’ lack of consensus. The category “Alliance for coordination” points out the importance of relationship and personal support to accomplish functional coordination. The category “Structure for coordination” shows how the structure facilitate service user involvement on a high level. Service user involvement seemed limited by professionals’ actions, but could be facilitated by support of professionals working in the child’s daily life. Structured coordination seems to relieve the pressure on parents, as well as children, but CIP needs to be individually tailored to reach its full potential.Included in thesis in its submitted form.</p

Agenda för samverkan eller verksamhetens agenda? Om professionellas erfarenheter av samverkan enligt samordnad individuell plan (SIP)

Agenda for collaboration or an agency agenda? Professionals’ experiences of colla­boration according to a coordinated individual plan (CIP) An increasing number of children and adolescents develop complex needs that require simultaneous action by different professionals. Several reports state that efforts for these children and adolescents have become increasingly specialized and fragmented. Since 2010, there are statutory requirements for collaboration according to a coordinated individual plan (SIP) between health care and social services. Pre-school and school can after regional agreement be involved in the co-ordination as equal partner. Collaboration in line with CIP is expected to offset the fragmentation for benefit of the service users’ ability to monitor and comprehend interventions. The aim was to investigate professionals’ experiences of CIP. The study consists of qualitative analysis of 12 focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. The results indicate that the participants act according to their core mission: nurturing, teaching and investigation. Two main categories with four sub-categories each appeared in the analysis. The main category, hindering factors, contains the categories: different mandates and requirements, requirements for presence initiative, questioning and censure, and timelines and prioritization. The main category of facilitating factors contains the categories: similar interpretation of common agreement, mutual respect and shared learning, common terminology and documentation, and willingness to collaborate. The analysis indicate that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument

Residents’ and supervisors’ experiences when using a feedback-model in post-graduate medical education

Background: Supervisors play a key part as role models and supporting the learning during residents’ post-graduate medical education, but sometimes lack sufficient pedagogic training and are challenged by high demands in today’s healthcare. The aim of this study was to describe the strengths and areas for improvement identified in the supervision process by residents and supervisors in post-graduate medical education. Methods: This study included supervisors and residents working at departments and health centres who have used a web-based questionnaire, as a part of the Evaluation and Feedback For Effective Clinical Teaching (EFFECT) model, during the period 2016–2019. Descriptive statistics and content analysis were used to analyse ratings and comments to describe strengths and areas for improvement in the supervision process. Results: The study included 287 resident evaluations of supervisors and 78 self-evaluations by supervisors. The supervisor as a role model, being available, and, giving personal support, were the three most important strengths identified by the residents and supervisors. Residents in primary care also identified the role modelling of general practice competence as a strength, whereas residents and supervisors in hospital departments addressed supervisors as energetic and showing work was fun. The area with the need of most improvement was, Giving and receiving feedback. Conclusions: To be able to give feedback, residents and supervisors, needed to see each other in work, and the learning environment had to offer time and space to pedagogical processes, like feedback, to improve the learning environment