Conveying hope in consultations with patients with life-threatening diseases: the balance between supporting and challenging the patient

Objective: There is limited knowledge about the communication of hope and denial in consultations with patients with life-threatening diseases on a practical level. In this study, we explored a real-life medical consultation between a doctor and a patient with incurable cancer, focusing on conveying hope. Design and methods: We found one consultation especially suited for illustrating how a physician can convey and reinforce hope without attaching it to curative treatment. The consultation was analysed using a method for discourse analysis, where we took as a point of departure that discourse means language in use. Results: The doctor communicated in a recognising manner, expressing respect for the patient as a subject and an authority of his own experiences. The doctor and patient succeeded in creating a good working alliance characterised by warmth and trust. Within this context, there was room for the doctor to challenge the patient’s views and communicate disagreement. Conclusions: The doctor succeeds in conveying and maintaining hope. Within a good working alliance with the patient the doctor can convey hope by balancing between supporting and challenging him. Exploring and grasping the patient’s real concerns is essential for being able to relieve and comfort him and convey hope.publishedVersio

Obstacles to continuity of care in young mental health service users’ pathways - an explorative study

Background: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of young adult mental health service users and to identify key obstacles to continuity of care.Method: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pathways in and out of different services in the course of a year.Results: Key obstacles to continuity of care included the mental health system's lack of access to treatment, lack of integration between different specialist services, lack of progress in care and inadequate coordination tools such as ‘Individual Plan’ and case conferences that did not prevent fragmented care pathways.Conclusions: Continuity of care should be more explicitly linked to aspirations for development and progress in the users' care pathways, and how service providers can cooperate with users to actually develop and make progress. Coordination tools such as case conferences and ‘individual plans’ should be upgraded to this end and utilised to the utmost. This may be the most effective way to counteract the system obstacles

Evaluering av LMS Helse Nord

SINTEF Rapport STF78 A68

Evaluering av Nasjonalt kompetansesenter for læring og mestring ved kronisk sykdom

Referansegruppen for Nasjonalt kompetansesenter for læring og mestring ved kronisk sykdom ba i juni 2005 om en ekstern evaluering av NKLMS som ledd i den videre drøftingen av senterets framtidige virksomhet. Tre miljøer ble kontaktet, og hvert av miljøene leverte en skisse til hvordan de tenkte å løse en slik oppgave. SINTEF Helse ble valgt, og gitt i oppdrag å gjennomføre en evaluering av senteret. Evalueringen er gjennomført i perioden november 2005 til mars 2006. Evalueringen belyser tre hovedtema av arbeidsoppgaver ved Nasjonalt kompetansesenter; forskning og fagutvikling, kompetansespredning og kvalitetssikring. Disse behandles hver for seg, i tillegg har evalueringen et eget punkt om organisatoriske og ressursmessige forhold. For hvert av områdene gjennomgås aktiviteten gjort ved Nasjonalt kompetansesenter, det gjøres en vurdering av aktiviteten og det anbefales hvordan temaet bør følges opp videre.  Hovedkonklusjonen er at Nasjonalt kompetansesenter har lyktes i å forankre læring og mestring som nasjonal aktivitet. Framover bør senteret prioritere forskning og fagutvikling, både i egen regi og særlig som koordinator. For å oppnå dette må en allokere større ressurser til drift av senteteret. Det foreslås også at det utvikles en styringsmodell hvor alle RHF i større grad inngår som likeverdige. Det foreslås videre at Nasjonalt kompetansesenter geografisk og organisatorisk skilles fra Aker LMS, og at senteret får direkte kommunikasjonslinje til Helse Øst RHF .publishedVersio

Obstacles to continuity of care in young mental health service users’ pathways - an explorative study

BACKGROUND: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of young adult mental health service users and to identify key obstacles to continuity of care. METHOD: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pathways in and out of different services in the course of a year. RESULTS: Key obstacles to continuity of care included the mental health system's lack of access to treatment, lack of integration between different specialist services, lack of progress in care and inadequate coordination tools such as ‘Individual Plan’ and case conferences that did not prevent fragmented care pathways. CONCLUSIONS: Continuity of care should be more explicitly linked to aspirations for development and progress in the users' care pathways, and how service providers can cooperate with users to actually develop and make progress. Coordination tools such as case conferences and ‘individual plans’ should be upgraded to this end and utilised to the utmost. This may be the most effective way to counteract the system obstacles

Obstacles to continuity of care in young mental health service users’ pathways - an explorative study

<span style="font-size: x-small;"><strong>Background</strong>: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of </span><span style="font-size: x-small;">young adult mental health service users and to identify key obstacles to continuity of care.</span> <span style="font-size: x-small;"><strong>Method</strong>: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pathways in and out of different services in the course of a year.</span> <span style="font-size: x-small;"><strong>Results</strong>: Key obstacles to continuity of care included the mental health system's lack of access to treatment, lack of integration between different specialist services, lack of progress in care and inadequate coordination tools such as ‘Individual Plan’ and case conferences that </span><span style="font-size: x-small;">did not prevent fragmented care pathways.</span> <span style="font-size: x-small;"><strong>Conclusions</strong>: Continuity of care should be more explicitly linked to aspirations for development and progress in the users' care pathways, and how service providers can cooperate with users to actually develop and make progress. Coordination tools such as case conferences and ‘individual plans’ should be upgraded to this end and utilised to the utmost. This may be the most effective way to counteract the system obstacles.</span

Conveying hope in consultations with patients with life-threatening diseases: the balance between supporting and challenging the patient

Objective: There is limited knowledge about the communication of hope and denial in consultations with patients with life-threatening diseases on a practical level. In this study, we explored a real-life medical consultation between a doctor and a patient with incurable cancer, focusing on conveying hope. Design and methods: We found one consultation especially suited for illustrating how a physician can convey and reinforce hope without attaching it to curative treatment. The consultation was analysed using a method for discourse analysis, where we took as a point of departure that discourse means language in use. Results: The doctor communicated in a recognising manner, expressing respect for the patient as a subject and an authority of his own experiences. The doctor and patient succeeded in creating a good working alliance characterised by warmth and trust. Within this context, there was room for the doctor to challenge the patient’s views and communicate disagreement. Conclusions: The doctor succeeds in conveying and maintaining hope. Within a good working alliance with the patient the doctor can convey hope by balancing between supporting and challenging him. Exploring and grasping the patient’s real concerns is essential for being able to relieve and comfort him and convey hope

Evaluering av Nasjonalt kompetansesenter for læring og mestring ved kronisk sykdom

Referansegruppen for Nasjonalt kompetansesenter for læring og mestring ved kronisk sykdom ba i juni 2005 om en ekstern evaluering av NKLMS som ledd i den videre drøftingen av senterets framtidige virksomhet. Tre miljøer ble kontaktet, og hvert av miljøene leverte en skisse til hvordan de tenkte å løse en slik oppgave. SINTEF Helse ble valgt, og gitt i oppdrag å gjennomføre en evaluering av senteret. Evalueringen er gjennomført i perioden november 2005 til mars 2006. Evalueringen belyser tre hovedtema av arbeidsoppgaver ved Nasjonalt kompetansesenter; forskning og fagutvikling, kompetansespredning og kvalitetssikring. Disse behandles hver for seg, i tillegg har evalueringen et eget punkt om organisatoriske og ressursmessige forhold. For hvert av områdene gjennomgås aktiviteten gjort ved Nasjonalt kompetansesenter, det gjøres en vurdering av aktiviteten og det anbefales hvordan temaet bør følges opp videre.  Hovedkonklusjonen er at Nasjonalt kompetansesenter har lyktes i å forankre læring og mestring som nasjonal aktivitet. Framover bør senteret prioritere forskning og fagutvikling, både i egen regi og særlig som koordinator. For å oppnå dette må en allokere større ressurser til drift av senteteret. Det foreslås også at det utvikles en styringsmodell hvor alle RHF i større grad inngår som likeverdige. Det foreslås videre at Nasjonalt kompetansesenter geografisk og organisatorisk skilles fra Aker LMS, og at senteret får direkte kommunikasjonslinje til Helse Øst RHF