KVINNAN I CENTRUM. Hur kvinnor som skall genomgå eller har genomgått bröstkirurgi till följd av bröstcancer upplever stöd från hälso- och sjukvårdspersonal

Bakgrund: Bröstcancer är den vanligaste cancerformen som drabbar kvinnor världen över. En vanlig behandling är att genomgå olika typer av bröstkirurgi, såsom mastektomi eller partiell mastektomi tillsammans med andra kompletterande behandlingar. Denna typ av operation kan medföra mycket olika tankar och känslor. Det kan uppstå en rädsla för döden, men även osäkerhet kring sin nya kropp och hur man ser sig själv. Brösten har en stark koppling till kvinnlighet, sexualitet och amning. Sjuksköterskan skall möta patientens sociala- och hälso- och sjukvårdsbehov och stödja patienten. Stöd från sjuksköterskan förklaras som emotionellt-, praktiskt- och socialt stöd, varav samtliga delar är lika viktiga för att möta patientens behov och hur patienten ser på sig själv. Syfte: Syftet med denna litteraturöversikt är att skapa ökad förståelse för hur kvinnor som skall genomgå eller har genomgått bröstkirurgi till följd av bröstcancer upplever stöd från hälso- och sjukvårdspersonal. Metod: Metoden för denna studie var en litteraturöversikt som består av nio kvalitativa artiklar och en kvantitativ artikel. De har tagits fram genom en strukturerad litteratursökning och som sedan analyserats och kvalitetsgranskats. Huvudfynd: Resultatet tyder på att kvinnor upplever stöd genom att bland annat få information genom hela processen kring operation, att bli sedd som en person, att hälso- och sjukvårdspersonalen är tillgänglig och har ett gott bemötande. När samtliga punkter upplevs som motsatsen, kan ett bristande stöd från hälso- och sjukvårdspersonal upplevas av kvinnorna. Slutsatser: Hälsooch sjukvårdspersonalen bör ta initiativ till dialog med kvinnor för att kunna identifiera kvinnors behov av stöd. Dialogen är även viktig för att se till att kvinnan förstått informationen som getts och i vilken mån kvinnan känner sig förberedd inför att se sin nya kropp

Patients' and health care professionals' perceptions of the potential of using the digital Diabetes Questionnaire to prepare for diabetes care meetings : Qualitative focus group interview study

BACKGROUND: In effective diabetes management, it is important that providers and health care systems prioritize the delivery of patient-centered care and that they are respectful of and responsive to individual patient preferences and barriers. OBJECTIVE: The objective of the study was to conduct focus group interviews to capture patients' and health care professionals' perceptions and attitudes regarding digital technology and to explore how the digital Diabetes Questionnaire can be used to support patient participation in diabetes care, as a basis for an implementation study. METHODS: A qualitative study was conducted with six focus group discussions with diabetes specialist nurses and medical doctors (n=29) and four focus group discussions with individuals with diabetes (n=23). A semistructured focus group interview guide was developed, including probing questions. The data were transcribed verbatim, and qualitative content analysis was performed using an inductive approach. RESULTS: Two main categories were revealed by the qualitative analysis: perceptions of digital technology and the digital questionnaire in diabetes management and care and perceptions of participation in diabetes care. An overarching theme that emerged from the focus group interviews was patients' and professionals' involvement in diabetes care using digital tools. CONCLUSIONS: The analysis identified important factors to consider when introducing the digital Diabetes Questionnaire in clinical use. Both professionals and patients need support and training in the practical implementation of the digital questionnaire, as well as the opportunity to provide feedback on the questionnaire answers

Implementing the Digital Diabetes Questionnaire as a clinical tool in routine diabetes care : Focus group discussions with patients and health care professionals

BACKGROUND: The Diabetes Questionnaire is a digital patient-reported outcome and experience measure for adults living with diabetes. The Diabetes Questionnaire is intended for use in routine clinical visits in diabetes care and to enable patient perspectives to be integrated into the Swedish National Diabetes Register. The Diabetes Questionnaire was developed on the basis of patients' perspectives, and evidence for its measurement qualities has been demonstrated. Patients receive an invitation to complete the questionnaire before clinical visits, and the patient and health care professional (HCP) can discuss the findings, which are instantly displayed during the visit. Implementation processes for new tools in routine care need to be studied to understand the influence of contextual factors, the support needed, and how patients and HCPs experience clinical use. OBJECTIVE: The aim of this study was to describe patients' and HCPs' experiences of initiating the use of the digital Diabetes Questionnaire as a clinical tool in routine diabetes care, supported by a structured implementation strategy involving initial education, local facilitators, and regular follow-ups. METHODS: In this qualitative study, semistructured focus group discussions were conducted 12 months after the use of the Diabetes Questionnaire was initiated. Participants were diabetes specialist nurses and physicians (20 participants in 4 groups) at hospital-based outpatient clinics or primary health care clinics and adults with type 1 or type 2 diabetes (15 participants in 4 groups). The audiotaped transcripts were analyzed using inductive qualitative content analysis. RESULTS: The results revealed 2 main categories that integrated patients' and HCPs' experiences, which together formed an overarching theme: While implementation demands new approaches, the Diabetes Questionnaire provides a broader perspective. The first main category (The Diabetes Questionnaire supports person-centered clinical visits) comprised comments expressing that the digital Diabetes Questionnaire can initiate and encourage reflection in preparation for clinical visits, bring important topics to light during clinical visits, and broaden the scope of discussion by providing additional information. The second main category (The process of initiating the implementation of the Diabetes Questionnaire) comprised comments that described differences in engagement among HCPs and their managers, challenges of establishing new routines, experiences of support during implementation, thoughts about the Diabetes Questionnaire, need to change local administrative routines, and opportunities and concerns for continued use. CONCLUSIONS: The Diabetes Questionnaire can broaden the scope of health data in routine diabetes care. While implementation demands new approaches, patients and HCPs saw potential positive impacts of using the questionnaire at both the individual and group levels. Our results can inform further development of implementation strategies to support the clinical use of the questionnaire