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Hultstrand C, Coe AB, Lilja M, Hajdarevic S. Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways - an observational study in primary care. BMC Health Serv Res 2020; 20:46. [PMID: 31952534 PMCID: PMC6969453 DOI: 10.1186/s12913-020-4893-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). METHODS Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. RESULTS One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. CONCLUSIONS Patients and GPs seem to be mutually dependent on each other and both patients' expertise and GPs' medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients' needs as to standardized routines as CPPs.
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Affiliation(s)
- Cecilia Hultstrand
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Anna-Britt Coe
- Department of Sociology, Umeå University, SE-901 87, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, SE-901 87, Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87, Umeå, Sweden
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Öhlén J, Sawatzky R, Pettersson M, Sarenmalm EK, Larsdotter C, Smith F, Wallengren C, Friberg F, Kodeda K, Carlsson E. Preparedness for colorectal cancer surgery and recovery through a person-centred information and communication intervention - A quasi-experimental longitudinal design. PLoS One 2019; 14:e0225816. [PMID: 31830066 PMCID: PMC6907786 DOI: 10.1371/journal.pone.0225816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/23/2019] [Indexed: 12/11/2022] Open
Abstract
To meet patients’ information and communication needs over time in order to improve their recovery is particularly challenging for patients undergoing cancer surgery. The aim of the study was to evaluate whether an intervention with a person-centred approach to information and communication for patients diagnosed with colorectal cancer undergoing surgery can improve the patients’ preparedness for surgery, discharge and recovery during six months following diagnosis and initial treatment. The intervention components involving a novel written interactive patient education material and person-centred communication was based on critical analysis of conventional information and communication for these patients. During 2014–2016, 488 consecutive patients undergoing elective surgery for colorectal cancer were enrolled in a quasi-experimental longitudinal study. In three hospitals, first a conventional care group (n = 250) was recruited, then the intervention was introduced, and finally the intervention group was recruited (n = 238). Patients’ trajectories of preparedness for surgery and recovery (Preparedness for Colorectal Cancer Surgery Questionnaire—PCSQ) health related quality of life (EORTC QLQ-C30) and distress (NCCS Distress Thermometer) were evaluated based on self-reported data at five time points, from pre-surgery to 6 months. Length of hospital stay and patients’ behavior in seeking health care pre- and post-surgery were extracted from patient records. Longitudinal structural equation models were used to test the hypothesized effects over time. Statistically significant positive effects were detected for two of the four PCSQ domains (patients searching for and making use of information, and making sense of the recovery) and for the role functioning domain of the EORTC QLQ-C30. Patients in the intervention group were also more likely to contact their assigned cancer “contact nurse” (a.k.a. nurse navigator) instead of contacting a nurse on duty at the ward or visiting the emergency department. In conclusion, the overall hypothesis was not confirmed. Further research is recommended on written and oral support tools to facilitate person-centred communication.
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Affiliation(s)
- Joakim Öhlén
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital Västra Götaland Region, Gothenburg, Sweden
- * E-mail:
| | - Richard Sawatzky
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- School of Nursing, Trinity Western University, Langley, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Monica Pettersson
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Vascular Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Kenne Sarenmalm
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Research & Development Unit, Skaraborg Hospital, Skövde, Sweden
| | - Cecilia Larsdotter
- Department of Nursing science, Sophiahemmet University, Stockholm, Sweden
| | - Frida Smith
- Center for Health Care Improvement, Department of Technology Management and Economics, Division of Service Management and Logistics, Chalmers University of Technology, Gothenburg, Sweden
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Catarina Wallengren
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Febe Friberg
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karl Kodeda
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Eva Carlsson
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Carlsson E, Pettersson ME. Communicative and pedagogical strategies in nurses' and surgeons' discharge consultations with patients undergoing surgery for colorectal cancer. J Adv Nurs 2018; 74:2840-2850. [PMID: 30019343 DOI: 10.1111/jan.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/21/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
AIM To describe the structure, content, and the communicative and pedagogic strategies in discharge consultations between patients and professionals after colorectal cancer surgery. BACKGROUND Both nurses and surgeons play an important role in preparing patients for discharge from hospital following surgery for colorectal cancer (CRC). DESIGN An explorative quantitative and qualitative research based on analysis of transcriptions of 13 audio-taped discharge consultations between patients and nurses and patients and surgeons conducted between January - March 2012. METHODS In the quantitative analysis, the structure of each consultation was described in phases, subtopics, and main topics. The proportion of the main topics in relation to the whole conversation was counted in percentages. The text from the consultations was then analysed qualitatively with the support from Ricoeur's theory of interpretation. RESULTS The language constituted the essence in the consultations regardless of other communicative and pedagogical strategies. The pedagogic strategies used were explanation model, information transfer, task orientation, and dialogue. Topics occurring in the consultations were Operation, Symptoms, Medication, Thromboprophylaxis, Recovery after surgery, Bowel function, Spreading, and Follow-up. The surgeons and nurses used similar topics, but the surgeons used more communicative and pedagogic strategies. CONCLUSION Language was fundamental for communication and independent of the communicative and pedagogical strategies. Using preparedness communication more consistent in discharge consultation can help patients to better understand the recovery process after CRC surgery and regain control over their life. It is important that the consultations build on the patient as an active and learning person.
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Affiliation(s)
- Eva Carlsson
- The Surgical Department, Sahlgrenska University Hospital/Östra, Göteborg, Sweden.,Institute of Health and Care Sciences, and Gothenburg Centre for Person-centred Care, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Monica E Pettersson
- Institute of Health and Care Sciences, and Gothenburg Centre for Person-centred Care, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.,The Vascular Department Sahlgrenska University Hospital/Sahlgrenska, Göteborg, Sweden
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Friberg F, Wallengren C, Håkanson C, Carlsson E, Smith F, Pettersson M, Kenne Sarenmalm E, Sawatzky R, Öhlén J. Exploration of dynamics in a complex person-centred intervention process based on health professionals' perspectives. BMC Health Serv Res 2018; 18:441. [PMID: 29895285 PMCID: PMC5998552 DOI: 10.1186/s12913-018-3218-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/21/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The assessment and evaluation of practical and sustainable development of health care has become a major focus of investigation in health services research. A key challenge for researchers as well as decision-makers in health care is to understand mechanisms influencing how complex interventions work and become embedded in practice, which is significant for both evaluation and later implementation. In this study, we explored nurses' and surgeons' perspectives on performing and participating in a complex multi-centre person-centred intervention process that aimed to support patients diagnosed with colorectal cancer to feel prepared for surgery, discharge and recovery. METHOD Data consisted of retrospective interviews with 20 professionals after the intervention, supplemented with prospective conversational data and field notes from workshops and follow-up meetings (n = 51). The data were analysed to construct patterns in line with interpretive description. RESULTS Although the participants highly valued components of the intervention, the results reveal influencing mechanisms underlying the functioning of the intervention, including multiple objectives, unclear mandates and competing professional logics. The results also reveal variations in processing the intervention focused on differences in using and talking about intervention components. CONCLUSIONS The study indicates there are significant areas of ambiguity in understanding how theory-based complex clinical interventions work and in how interventions are socially constructed and co-created by professionals' experiences, assumptions about own professional practice, contextual conditions and the researchers' intentions. This process evaluation reveals insights into reasons for success or failure and contextual aspects associated with variations in outcomes. Thus, there is a need for further interpretive inquiry, and not only descriptive studies, of the multifaceted characters of complex clinical interventions and how the intervention components are actually shaped in constantly shifting contexts.
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Affiliation(s)
- Febe Friberg
- Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway. .,University of Gothenburg Centre for Person-Centered Care (GPCC), Gothenburg, Sweden.
| | - Catarina Wallengren
- University of Gothenburg Centre for Person-Centered Care (GPCC), Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O.Box 457, 40530, Gothenburg, Sweden
| | - Cecilia Håkanson
- Department of Nursing Science, Sophiahemmet University, P.O. Box 5605, 11486, Stockholm, Sweden
| | - Eva Carlsson
- University of Gothenburg Centre for Person-Centered Care (GPCC), Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O.Box 457, 40530, Gothenburg, Sweden.,Department of Surgery Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden
| | - Frida Smith
- Chalmers University of Technology Division of Service Management and Logistics Department of Technology Management and Economics Chalmers University of Technology, Vasa hus 2, 412 96, Göteborg, Sweden
| | - Monica Pettersson
- University of Gothenburg Centre for Person-Centered Care (GPCC), Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O.Box 457, 40530, Gothenburg, Sweden.,The Vascular Department, Sahlgrenska University Hospital/Sahlgrenska, 416 85, Göteborg, Sweden
| | - Elisabeth Kenne Sarenmalm
- University of Gothenburg Centre for Person-Centered Care (GPCC), Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O.Box 457, 40530, Gothenburg, Sweden.,Research and Development, Skaraborg Hospital, Skövde, Sweden
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Rd, Langley, BC, V2Y 1Y1, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588 - 1081 Burrard Street, St. Paul´s Hospital, Vancouver, BC, V6Z 1Y6, Canada
| | - Joakim Öhlén
- University of Gothenburg Centre for Person-Centered Care (GPCC), Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O.Box 457, 40530, Gothenburg, Sweden
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