Utilizing a New Graphical Elicitation Technique to Collect Emotional Narratives Describing Disease Trajectories

Elicitation techniques in connection with semi-structured interviews are scantily used, but reported to be beneficial to research. We developed and tested a new visual technique to be utilized in the latter part of semi-structured interviews. It has proved to be feasible and beneficial to use, and it could possibly be used by others. This way of extending the interviews generates more data in a visual form, as well as in a verbal form, by supporting the participants in remembering nearly forgotten parts of their experiences and in expressing emotions associated with those significant experiences. As a contribution to qualitative research, our study showed that the visual data, created by the participants, also contributed to getting the elaborated narratives

Benefits and challenges perceived by patients with cancer when offered a nurse navigator

<p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Introduction: </span></strong><span style="font-family: " lang="EN-US">Lack of communication, care and respect from healthcare professionals can be challenges for patients in trajectories of cancer, possibly accompanied by experienced fragmentation of the care, anxiety and worries. One way to try to improve delivery of care is additional help from Nurse Navigators (NN) offered in a predefined shorter or longer period, but patients´ experiences with this have seldom been investigated.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Aims: </span></strong><span style="font-family: " lang="EN-US">To explore patients´ experiences of an NN offered in a short period of a longer trajectory of cancer. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Methods: </span></strong><span style="font-family: " lang="EN-US">NN worked from the hospital side in the transition between primary care and a university hospital before admission. A phenomenological-hermeneutical longitudinal study was performed from referral and until two months after discharge from the hospital. Semi-structured interviews provided data for the analysis, which started open-minded.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Results: </span></strong><span style="font-family: " lang="EN-US"><span style="mso-spacerun: yes;"> </span>Affectional bonds were made to NN and patients felt that they benefited from her presence and her help,<strong style="mso-bidi-font-weight: normal;"> </strong>which they requested until one month after discharge. They were deeply disappointed and felt rejected when the contact to the NN stopped. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Conclusion:</span></strong><span style="font-family: " lang="EN-US"> In efforts to increase quality of care for patients with cancer we recommend paying special attention to critical periods in their trajectories, as well as to the theory of attachment to supplement thoughts of continuity of care and coordination in the care for women. In short, it is fine to offer additional help to those who can use it, but in practice as well as in research we call attention to awareness on how and when to stop the help, to prevent patients from feeling hurt.</span></span></p

Case management used to optimize cancer care pathways: A systematic review

<p>Abstract</p> <p>Background</p> <p>Reports of inadequate cancer patient care have given rise to various interventions to support cancer care pathways which, overall, seem poorly studied. Case management (CM) is one method that may support a cost-effective, high-quality patient-centred treatment and care.</p> <p>The purpose of this article was to summarise intervention characteristics, outcomes of interest, results, and validity components of the published randomized controlled trials (RCTs) examining CM as a method for optimizing cancer care pathways.</p> <p>Methods</p> <p>PubMed, Embase, Web of Science, CINAHL and The Cochrane Central Register of Controlled Trials were systematically searched for RCTs published all years up to August 2008. Identified papers were included if they passed the following standards. Inclusion criteria: 1) The intervention should meet the criteria for CM which includes multidisciplinary collaboration, care co-ordination, and it should include in-person meetings between patient and the case manager aimed at supporting, informing and educating the patient. 2) The intervention should focus on cancer patient care. 3) The intervention should aim to improve subjective or objective quality outcomes, and effects should be reported in the paper.</p> <p>Exclusion criteria: Studies centred on cancer screening or palliative cancer care.</p> <p>Data extraction was conducted in order to obtain a descriptive overview of intervention characteristics, outcomes of interest and findings. Elements of CONSORT guidelines and checklists were used to assess aspects of study validity.</p> <p>Results</p> <p>The searches identified 654 unique papers, of which 25 were retrieved for scrutiny. Seven papers were finally included. Intervention characteristics, outcomes studied, findings and methodological aspects were all very diverse.</p> <p>Conclusion</p> <p>Due to the scarcity of papers included (seven), significant heterogeneity in target group, intervention setting, outcomes measured and methodologies applied, no conclusions can be drawn about the effect of CM on cancer patient care.</p> <p>It is a major challenge that CM shrouds in a "black box", which means that it is difficult to determine which aspect(s) of interventions contribute to overall effects. More trials on rigorously developed CM interventions (opening up the "black box") are needed as is the re-testing of interventions and outcomes studied in various settings.</p

Furosemide versus placebo for fluid overload in intensive care patients—The randomised GODIF trial second version : Statistical analysis plan

Publisher Copyright: © 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.Background: Fluid overload is associated with increased mortality in intensive care unit (ICU) patients. The GODIF trial aims to assess the benefits and harms of fluid removal with furosemide versus placebo in stable adult patients with moderate to severe fluid overload in the ICU. This article describes the detailed statistical analysis plan for the primary results of the second version of the GODIF trial. Methods: The GODIF trial is an international, multi-centre, randomised, stratified, blinded, parallel-group, pragmatic clinical trial, allocating 1000 adult ICU patients with moderate to severe fluid overload 1:1 to furosemide versus placebo. The primary outcome is days alive and out of hospital within 90 days post-randomisation. With a power of 90% and an alpha level of 5%, we may reject or detect an improvement of 8%. The primary analyses of all outcomes will be performed in the intention-to-treat population. For the primary outcome, the Kryger Jensen and Lange method will be used to compare the two treatment groups adjusted for stratification variables supplemented with sensitivity analyses in the per-protocol population and with further adjustments for prognostic variables. Secondary outcomes will be analysed with multiple linear regressions, logistic regressions or the Kryger Jensen and Lange method as suitable with adjustment for stratification variables. Conclusion: The GODIF trial data will increase the certainty about the effects of fluid removal using furosemide in adult ICU patients with fluid overload. Trial Registrations: EudraCT identifier: 2019-004292-40 and ClinicalTrials.org: NCT04180397.Peer reviewe

Gynecological cancer patients’ differentiated use of help from a nurse navigator: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Fragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context.</p> <p>Methods</p> <p>A longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels.</p> <p>Results</p> <p>Prior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help.</p> <p>Conclusions</p> <p>Not everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients’ guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients’ trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.</p