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Rodríguez-Gómez M, Pastor-Moreno G, Ruiz-Pérez I, Escribà-Agüir V, Benítez-Hidalgo V. Age- and gender-based social inequalities in palliative care for cancer patients: a systematic literature review. Front Public Health 2024; 12:1421940. [PMID: 39296836 PMCID: PMC11408182 DOI: 10.3389/fpubh.2024.1421940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/16/2024] [Indexed: 09/21/2024] Open
Abstract
Objectives Cancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. The aim of this systematic review was to analyze the available evidence on age- and gender-based social inequalities in access to and use of palliative care in cancer patients. Methods A systematic review was conducted following the PRISMA guidelines. An exhaustive literature research was performed in Pubmed, CINHAL and Embase until November 2022 and were not restricted by language or date of publication. Eligible studies were observational studies analyzing the access and use of palliative care in cancer patients. Results Fifty-three studies were included in the review. Forty-five analyzed age and 44 analyzed gender inequalities in relation to use of and access to palliative care. Our results show that older people receive poorer quality of care, worst symptom control and less preferences for palliative care. In relation to gender, women have a greater preference for the use of palliative care and generally have more access to basic and specialized palliative care services and palliative care facilities. Conclusion This review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.
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Affiliation(s)
| | - Guadalupe Pastor-Moreno
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada. Ibs. GRANADA, Granada, Spain
| | - Isabel Ruiz-Pérez
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada. Ibs. GRANADA, Granada, Spain
| | - Vicenta Escribà-Agüir
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
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Karlsson Rosenblad A, Westman B, Bergkvist K, Segersvärd R, Roos N, Bergenmar M, Sharp L. Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden: a five-year cross-sectional study. Qual Life Res 2024; 33:667-678. [PMID: 37930556 PMCID: PMC10894133 DOI: 10.1007/s11136-023-03548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors. METHODS The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal-Wallis test and linear regression. RESULTS The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items. CONCLUSION HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.
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Affiliation(s)
- Andreas Karlsson Rosenblad
- Regional Cancer Centre Stockholm-Gotland, Box 6909, SE-102 39, Stockholm, Sweden.
- Division of Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Department of Statistics, Uppsala University, Uppsala, Sweden.
| | - Bodil Westman
- Regional Cancer Centre Stockholm-Gotland, Box 6909, SE-102 39, Stockholm, Sweden
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden
| | - Karin Bergkvist
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Segersvärd
- Regional Cancer Centre Stockholm-Gotland, Box 6909, SE-102 39, Stockholm, Sweden
- Department of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Roos
- Regional Cancer Centre Stockholm-Gotland, Box 6909, SE-102 39, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mia Bergenmar
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lena Sharp
- Regional Cancer Centre Stockholm-Gotland, Box 6909, SE-102 39, Stockholm, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
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Garpenhag L, Halling A, Larsson AM, Calling S. The role of primary care in the cancer care continuum: a qualitative study of cancer survivors' experiences. Scand J Prim Health Care 2022; 41:13-22. [PMID: 36380504 PMCID: PMC10088974 DOI: 10.1080/02813432.2022.2145848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore how cancer survivors have experienced their contacts with primary care after being diagnosed with cancer, focusing on the integration between cancer specialist and primary care, and participants' views on what could make primary care services better at catering to the needs of cancer survivors. DESIGN A qualitative study in which data was collected through semi-structured digital focus group interviews and analyzed using a template analysis approach. SETTING AND SUBJECTS Adult residents of Skåne, Sweden, who had been diagnosed with and initiated treatment for either of five common cancer forms, recruited through patient advocacy groups. MAIN OUTCOME MEASURES A qualitative description of participants' experiences and perceptions as expressed in focus group interview data. RESULTS Most participants felt that primary care services had not played a significant role for them, despite patterns of both increased and unmet health needs. Insufficient coordination and communication with specialist cancer care, low availability, lacking personal continuity, low cancer competence and lacking commitment to cancer-related needs were presented as barriers to satisfactory primary care. A strengthened bond between cancer and primary care services, privileged access, and holistic perspectives were all suggested as measures to make primary care more suitable to cancer survivors' needs. CONCLUSION The study suggests that cancer survivors experience a range of issues that hinders primary care services from playing a productive role in the cancer care process. The results speak for a need for interventions to remove barriers to satisfactory primary care contacts in this group of patients.KEY POINTSThe growing number of cancer survivors highlights the role of primary care services in the cancer care continuum.Despite the presence of unmet needs, few cancer survivors felt that primary care services had been significant to their care.Survivors identified a number of barriers to satisfactory primary care, including lacking coordination and communication between cancer and primary care.Strengthened links between healthcare services, privileged access, and holistic perspectives were suggested to improve primary care delivery for cancer survivors.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Anders Halling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Anna-Maria Larsson
- Regional Cancer Center South, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Westman B, Bergkvist K, Karlsson Rosenblad A, Sharp L, Bergenmar M. Patients with low activation level report limited possibilities to participate in cancer care. Health Expect 2022; 25:914-924. [PMID: 35049103 PMCID: PMC9122461 DOI: 10.1111/hex.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Cancer care trajectories are often complex, with potent multimodality treatments and multiple interactions with health care providers. Communication and coordination are challenging and the patients' responsibilities to take on more active roles in their own care are increasing. Objective This study aimed to investigate associations between patient activation level and participation in cancer care, sociodemographic characteristics, clinical data, health‐related quality of life (HRQoL) and helpfulness of received information. Methods In this cross‐sectional population‐based study, patients completed questionnaires on patient activation, perceived participation, HRQoL, helpfulness of received information and sociodemographic characteristics. Responses to the patient activation measures (PAMs) were classified into four levels (higher levels indicating more activation). Data on age, sex and cancer diagnosis were collected from the Swedish Cancer Register. Results Data from 682 patients were analysed. On comparing patients at PAM levels 1 and 4, the latter reported significantly higher possibilities to influence care decisions (46.6% vs. 20.8%) and to ask questions regarding treatment and care (93.4% vs. 68.4%). Patients at PAM level 4 reported wanting to influence decision‐making to a higher extent, compared with patients at other PAM levels, and reported clinically significantly higher HRQoL. No significant differences were found regarding sociodemographic characteristics. Conclusion We found strong associations between perceived patient participation and activation levels, with limited possibility for participation among those with lower activation levels. Patient or Public Contribution Discussions with patient representatives have raised the importance of participation. The preliminary findings were presented and discussed in a workshop with representatives from 21 cancer patient advocacy groups.
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Affiliation(s)
- Bodil Westman
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Department of Care Science, Sophiahemmet University, Stockholm, Sweden
| | - Karin Bergkvist
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Karlsson Rosenblad
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Division of Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Sharp
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Division of Innovative Care Research, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Mia Bergenmar
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Psychosocial Unit, Karolinska University Hospital, Stockholm, Sweden
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McHutchion LD, Pringle JM, Tran MHN, Ostevik AV, Constantinescu G. A survey of public awareness of dysphagia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:614-621. [PMID: 33938340 DOI: 10.1080/17549507.2021.1912179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Purpose: Dysphagia affects a wide cross-section of society. Reports of stigma and missed diagnoses suggest limited public awareness of this prevalent condition, exacerbating the hidden disability stemming from this impairment. This study explored the public awareness of dysphagia among people both with and without occupational ties to healthcare to assess the level of awareness and identify topics where public knowledge may be deficient. METHODS Method: An online purpose-built survey was administered to determine self-assessed awareness of dysphagia, and researcher-assessed understanding of the causes, symptoms, assessment and treatment of swallowing disorders. Survey answers (n = 374) were grouped by healthcare (n = 105) and non-healthcare (n = 269) respondents. Responses were analysed using both qualitative and quantitative methods. RESULTS Result: Self-assessed respondent awareness was low among 71% of non-healthcare and 29% of healthcare respondents, corroborating the limited demonstrated knowledge of the causes, symptoms, assessment and treatment of dysphagia. Self-assessed and researcher-assessed awareness was more limited among non-healthcare respondents. CONCLUSIONS Conclusion: Survey results confirm limited public knowledge of dysphagia and demonstrate the need for greater public awareness of this largely invisible disorder.
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Affiliation(s)
- Lindsay D McHutchion
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
- Institute for Reconstructive Sciences in Medicine, Edmonton, AB, Canada
| | - Julia M Pringle
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - My-Han N Tran
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Amberley V Ostevik
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Gabriela Constantinescu
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
- Institute for Reconstructive Sciences in Medicine, Edmonton, AB, Canada
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A survey of cancer patients, caregivers, and providers regarding familiarity, importance, and utilization of supportive and integrative oncology services. Support Care Cancer 2021; 29:5777-5785. [PMID: 33740131 DOI: 10.1007/s00520-021-06081-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Supportive and integrative oncology services aim to improve the quality of life of cancer patients. This study characterizes the views of these services among cancer patients, caregivers, and providers at a comprehensive cancer center. METHODS A cross-sectional survey was administered in 2017-2018. The survey asked about participants' familiarity, perceived importance, use, accessibility, and barriers to 19 supportive and integrative oncology services using a Likert scale. Data were analyzed using the Kruskal-Wallis test and a proportional odds regression model. RESULTS A total of 976 surveys were obtained (604 patient surveys, 199 caregiver surveys, 173 provider surveys). Patients were mostly female (56.3%), ≥60 years old (59.4%), and Caucasian (66%). Providers were an even distribution of nurses, physicians, and advanced practice providers. Patients felt social work and nutrition services were the most familiar (36.4% and 34.8%) and the most important (46.3% and 54.5%). Caregivers were also most familiar with those two services, but felt that nutrition and learning resources were most important. Social work and nutrition were easiest to access and used the most by both patients and providers. There was a positive correlation between accessibility and perceived importance. Being unaware was the most common barrier identified by patients (38.4%), providers (67.1%), and caregivers (33.7%). CONCLUSION Social work and nutrition services were most familiar to respondents, and also generally the most important, accessible, and utilized. Lack of awareness was the most common barrier cited and suggests that increased efforts to educate patients and providers about other services available are needed.
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Ullgren H, Sharp L, Olofsson A, Fransson P. Factors associated with healthcare utilisation during first year after cancer diagnose-a population-based study. Eur J Cancer Care (Engl) 2020; 30:e13361. [PMID: 33216423 PMCID: PMC8047913 DOI: 10.1111/ecc.13361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
Background Improved cancer treatments and models of care (such as early palliative care) has developed during recent years. Aspects of healthcare utilisation—unplanned care have been used for evaluation of coordination and quality. The aim was to explore factors associated with cancer healthcare utilisation, during the first year after a cancer diagnosis. Methods Population‐based registry and patient‐reported data, (The European Organisation of Research and Treatment of Cancer (EORTC), QLQ‐ C30 questionnaire and study‐specific questions) were collected. Descriptive statistics and multivariate regression models were performed. Results The sample consists of 1718 patients (haematological, gynaecological, upper gastrointestinal and head and neck cancers). Living alone were associated with unplanned hospital admissions (OR 1.35; 95% CI [1.15, 1.59], p < 0.001). Patients with specialised palliative home care had a higher likelihood of unplanned hospital admissions, (OR 4.35; 95% CI [3.22‐5.91], p < 0.001) and re‐admissions within 30 days, (OR, 5.8; 95% CI [4.12‐8.19], p < 0.001). Conclusions Sociodemographic and clinical factors, such as living alone and disease stage, is associated with healthcare utilisation. Patients with specialised palliative home care report lower levels of HRQoL and higher levels of unplanned care, and our findings stresses the importance of a holistic view when planning care.
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Affiliation(s)
- Helena Ullgren
- Department of nursing, Umeå University, Umeå, Sweden.,Regional Cancer Center, Stockholm-Gotland, Sweden.,Head & Neck, Lung -and Skin cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Sharp
- Regional Cancer Center, Stockholm-Gotland, Sweden.,Department of Innovative Care, LIME, Innovative care, Stockholm, Sweden
| | | | - Per Fransson
- Department of nursing, Umeå University, Umeå, Sweden
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Dawson C, Roe J, Starmer H, Brady G, Nund R, Coffey M, Govender R, Patterson JM, Nankivell P, Topping A, Sharma N, Parmar S, Elkington C, Merrit M, Stanbury D, Pracy P. Patient advocacy in head and neck cancer: Realities, challenges and the role of the multi‐disciplinary team. Clin Otolaryngol 2020; 45:437-444. [DOI: 10.1111/coa.13508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Justin Roe
- Department of Speech & Language Therapy The Royal Marsden NHS Foundation Trust London UK
- Department of Surgery and Cancer Imperial College Healthcare NHS Trust London UK
- National Centre for Airway ReconstructionImperial College Healthcare Trust London UK
| | - Heather Starmer
- Department of Otolaryngology and Head and Neck Cancer Speech and Swallowing Rehabilitation Stanford Cancer Center CA USA
| | - Grainne Brady
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
| | - Rebecca Nund
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Qld. Australia
| | | | - Roganie Govender
- University College London Hospital NHS Foundation Trust London UK
| | | | | | | | - Neil Sharma
- Queen Elizabeth Hospital Birmingham Birmingham UK
| | - Sat Parmar
- Queen Elizabeth Hospital Birmingham Birmingham UK
| | | | | | | | - Paul Pracy
- Queen Elizabeth Hospital Birmingham Birmingham UK
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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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