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Checklin M, O'Halloran R, Foster AM, Hutchison A, Wilson T, Bowen A, Vat L, Lawson N, Lenne P, Packer RL. The health care experiences of people with head and neck cancer: A scoping review. Head Neck 2024; 46:74-85. [PMID: 37882242 DOI: 10.1002/hed.27558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Understanding health care experience in head and neck cancer (HNC) is becoming increasingly important due to changes in the disease profile, survivorship, and a greater appreciation of patient health care experience as an important outcome measure. People with HNC encounter many different types of health care professionals and health care touchpoints. METHOD Through systematic database searching, this scoping review of qualitative English-language studies describes the self-reported care experiences of those with HNC across the health care continuum, and describes the current state of the literature. RESULTS Overall, the 95 studies identified were heterogeneous and investigated a broad range of topics. Trends across studies showed research centered on hospital-based care, conducted in developed countries, with more studies on feeding than other aspects of care. Generic qualitative research frameworks, with individual interviews, were the preferred method of data collection. CONCLUSION Despite identifying many studies, there are significant gaps in our understanding of the HNC patient experience.
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Affiliation(s)
- Martin Checklin
- Epworth Healthcare, Richmond, Victoria, Australia
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Abby M Foster
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Aphasia Recovery & Rehabilitation, Melbourne, Victoria, Australia
| | - Alana Hutchison
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Alanna Bowen
- Alanna Bowen Speech Pathology, Melbourne, Victoria, Australia
| | - Laura Vat
- Epworth Healthcare, Richmond, Victoria, Australia
| | | | | | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Granström B, Isaksson J, Westöö N, Holmlund T, Tano K, Laurell G, Tiblom Ehrsson Y. Perceptions of life and experiences of health care support among individuals one year after head and neck cancer treatment - An interview study. Eur J Oncol Nurs 2023; 66:102383. [PMID: 37506610 DOI: 10.1016/j.ejon.2023.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To examine how individuals treated for head and neck cancer perceive life one year after the end of treatment and how they experience supportive efforts from health care. METHODS A semi-structured interview study of 21 patients was performed one year after the end of treatment. The patients gave their views concerning physical, psychological, and return-to-work issues, and their experiences concerning rehabilitative efforts from health care and particularly the contact nurse were captured. A thematic analysis was conducted. RESULTS One year after treatment the patients were still suffering from side effects and from fear of recurrence, but they strived to live as they did before the cancer diagnosis, such as having returned to work and resuming leisure activities. Moreover, the rehabilitative efforts from health care had ended. Having access to a contact nurse, also known as a clinical nurse specialist, was positive, however, the participants lacked regular long-term follow-ups with the contact nurse regarding rehabilitation needs. Improvement possibilities were seen in clarifying the role of the contact nurse and that the contact nurse should show engagement and make the initial contact with the patients. CONCLUSION Despite the sequelae from treatment, the patients strived to live as before their diagnosis. By regular, engaged, and long-term follow-ups by the contact nurse, remaining needs may be uncovered, and appropriate individualized support and rehabilitation can be offered.
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Affiliation(s)
- Brith Granström
- Department of Clinical Science, Otorhinolaryngology, Umeå University, Umeå, Sweden.
| | - Joakim Isaksson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Nilla Westöö
- Ear, Nose, and Throat Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - Thorbjörn Holmlund
- Department of Clinical Science, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Krister Tano
- Department of Clinical Science/ENT/Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
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Affiliation(s)
- P Salander
- Department of Social Work, Umeå University, Umeå, Sweden.
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Einarsson S, Laurell G, Tiblom Ehrsson Y. Experiences and coping strategies related to food and eating up to two years after the termination of treatment in patients with head and neck cancer. Eur J Cancer Care (Engl) 2018; 28:e12964. [DOI: 10.1111/ecc.12964] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 08/20/2018] [Accepted: 10/21/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery; Uppsala University; Uppsala Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery; Uppsala University; Uppsala Sweden
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Salander P. Patients with cancer react differently - Training in breaking bad news can therefore not be reduced to learning pre-defined behaviours. PATIENT EDUCATION AND COUNSELING 2017; 100:1955-1956. [PMID: 28535927 DOI: 10.1016/j.pec.2017.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Pär Salander
- Dept of Social Work, Umeå University, 901 87 Umeå, Sweden.
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Stenhammar C, Isaksson J, Granström B, Laurell G, Ehrsson YT. Changes in intimate relationships following treatment for head and neck cancer—A qualitative study. J Psychosoc Oncol 2017; 35:614-630. [DOI: 10.1080/07347332.2017.1339224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Christina Stenhammar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Brith Granström
- Department of Clinical Science, Unit of Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala, Sweden
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Blaschke S. The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis. BMC Cancer 2017; 17:370. [PMID: 28545539 PMCID: PMC5445345 DOI: 10.1186/s12885-017-3366-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background A systematic review and meta-synthesis was conducted to identify, compare and synthesize the published qualitative literature contributing to our understanding of the role of nature in cancer patients’ lives. Method An electronic search of Medline, CINAHL, PsycINFO and Cochrane Databases was conducted to identify qualitative studies focused on cancer patients’ nature experiences published between January 1985 and May 2015. Records were assessed according to pre-defined inclusion criteria. Data were extracted on study characteristics and evaluated using the COREQ guidelines for comprehensive quality reporting. Qualitative data from ‘results’ and ‘findings’ sections were entered into data management software NVivo in order to identify recurring themes and facilitate interpretation across studies. Results From 11 eligible publications, seven inter-related core themes with descriptive themes were identified as follows: connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences. Conclusions Nature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a “secure base” offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3366-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Blaschke
- Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, Melbourne, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia.
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Milberg A, Friedrichsen M. Attachment figures when death is approaching: a study applying attachment theory to adult patients' and family members' experiences during palliative home care. Support Care Cancer 2017; 25:2267-2274. [PMID: 28220315 PMCID: PMC5445221 DOI: 10.1007/s00520-017-3634-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Attachment theory is currently receiving much attention in relation to how adults cope with severe illness. The study aims were using the experiences of patients and family members to explore attachment figures (a central concept within the theory) during palliative home care. METHODS Twelve patients and 14 family members were interviewed during ongoing palliative home care. The interviews were analysed using qualitative content analysis. RESULTS Four types of attachment figures were identified: (i) family and friends, (ii) health care practitioners, (iii) pets and (iv) God. Both non-physical and physical contact with the attachment figures facilitated a sense of security. In addition, the patient/family members and their attachment figures were described by some as a "we", and when one part of the "we" felt insecure, this made the other also feel insecure. The patients' unstable and progressing illnesses constituted a threat to the patients' and family members' sense of security. The availability of the attachment figures made them feel secure, and they could then divert their attention from the patients' illnesses to other things in everyday life, e.g. socialising with family and friends. Some family members also had to cope with the loss of their own attachment figure, when the patient, who had previously been a source of security for them, was no longer able to offer protection and comfort due to the progression of the illness. CONCLUSION Important aspects of attachment figures in the end-of-life context were identified, and their clinical implications will be discussed.
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Affiliation(s)
- Anna Milberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
- Department of Advanced Home Care and Department of Social and Welfare Studies, Vrinnevi hospital, Linköping University, 601 82, Norrköping, Sweden.
- Palliative Education & Research Centre, and Department of Social and Welfare Studies, Vrinnevi hospital, Linköping University, 601 82, Norrköping, Sweden.
| | - Maria Friedrichsen
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
- Department of Advanced Home Care and Department of Social and Welfare Studies, Vrinnevi hospital, Linköping University, 601 82, Norrköping, Sweden
- Palliative Education & Research Centre, and Department of Social and Welfare Studies, Vrinnevi hospital, Linköping University, 601 82, Norrköping, Sweden
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Lilliehorn S, Salander P. Living at a residency away from home during radiotherapy as narrated by 52 patients with breast cancer: a cage of safety and discomfort. Disabil Rehabil 2016; 40:450-456. [DOI: 10.1080/09638288.2016.1261412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Sara Lilliehorn
- Department of Social Work, Umeå University, Umeå, Sweden
- Department of Radiation Sciences – Oncology, Umeå University, Umeå, Sweden
| | - Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden
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Blaschke S, O'Callaghan CC, Schofield P, Salander P. Cancer patients' experiences with nature: Normalizing dichotomous realities. Soc Sci Med 2016; 172:107-114. [PMID: 27839897 DOI: 10.1016/j.socscimed.2016.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
AIMS To explore cancer patients' subjective experiences with nature in order to examine the relevance of nature-based care opportunities in cancer care contexts. The rationale was to describe the underlying mechanisms of this interaction and produce translatable knowledge. METHODS Qualitative research design informed by grounded theory. Sampling was initially convenience and then theoretical. Competent adults with any cancer diagnosis were eligible to participate in a semi-structured interview exploring views about the role of nature in their lives. Audio-recorded and transcribed interviews were analyzed using inductive, cyclic, and constant comparative analysis. RESULTS Twenty cancer patients (9 female) reported detailed description about their experiences with nature from which a typology of five common nature interactions emerged. A theory model was generated constituting a core category and two inter-related themes explaining a normalization process in which patients negotiate their shifting realities (Core Category). Nature functioned as a support structure and nurtured patients' inner and outer capacities to respond and connect more effectively (Theme A). Once enabled and comforted, patients could engage survival and reconstructive maneuvers and explore the consequences of cancer (Theme B). A dynamic relationship was evident between moving away while, simultaneously, advancing towards the cancer reality in order to accept a shifting normality. From a place of comfort and safety, patients felt supported to deal differently and more creatively with the threat and demands of cancer diagnosis, treatment and outlook. CONCLUSIONS New understanding about nature's role in cancer patients' lives calls attention to recognizing additional forms of psychosocial care that encourage patients' own coping and creative processes to deal with their strain and, in some cases, reconstruct everyday lives. Further research is required to determine how nature opportunities can be feasibly delivered in the cancer care setting.
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Affiliation(s)
- Sarah Blaschke
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Clare C O'Callaghan
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, Australia; Palliative Care Service, Cabrini Health, Melbourne, Australia.
| | - Penelope Schofield
- Department of Psychology, Faculty of Health Sciences, Swinburne University of Technology, Melbourne, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Pär Salander
- Department of Social Work, Umeå University, Sweden.
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Salander P, Isaksson J, Granström B, Laurell G. Motives that head and neck cancer patients have for contacting a specialist nurse - an empirical study. J Clin Nurs 2016; 25:3160-3166. [PMID: 27301274 DOI: 10.1111/jocn.13283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study is to systematically explore the motives for patients with head and neck cancer to contact a specialist nurse during two years postdiagnosis. BACKGROUND Research focusing on the role of specialist nurses in cancer care almost exclusively concern cancers other than head and neck cancer. DESIGN Qualitative, descriptive study based on the contacts between patients with head and neck cancer and a specialist nurse. METHODS Patients were invited to contact a specialist nurse by telephone. The specialist nurse took systematic field notes, that is, she registered who contacted her, the nature of the call and the outcome. Sixty patients were included. RESULTS In descending order, the motives for contact were questions about practical and uncomplicated matters, consultations about medical troubles/worries, presenting a report of the patient's situation, requests for additional information about the treatment plan and requests for medical information. The pattern of the patients' motivations for calling was not related to medical or social factors, suggesting that the initiative to make contact is very much a question of the complexity of individual life circumstances. Very few referrals were sent from the specialist nurse to other professionals. CONCLUSIONS The specialist nurse turned out to be more than just a coordinator of health-care resources. The findings bring up questions about the potential of the nurse's function as a coordinator, but also as a potential attachment figure, and questions about the nurse's relationships to other professionals. RELEVANCE TO CLINICAL PRACTICE When implementing a specialist nurse function, it is important to decide whether the function should be inspired by a broader relational perspective. In addition to the indispensible competence and experience in the clinical field of head and neck cancer, training in counselling and acquaintance with object-relational psychology will then be desirable.
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Affiliation(s)
- Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden.
| | | | - Brith Granström
- Department of Clinical Sciences/Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences - Otolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
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Abstract
Disabling sequelae occur in a majority of patients diagnosed with brain tumor, including glioma, such as cognitive deficits, weakness, and visual perceptual changes. Often, multiple impairments are present concurrently. Healthcare staff must be aware of the "biographic disruption" the patient with glioma has experienced. While prognostic considerations factor into rehabilitation goals and expectations, regardless of prognosis the treatment team must offer cohesive support, facilitating hope, function, and quality of life. Awareness of family and caregiver concerns plays an important role in the overall care. Inpatient rehabilitation, especially after surgical resection, has been shown to result in functional improvement and homegoing rates on a par with individuals with other neurologic conditions, such as stroke or traumatic brain injury. Community integration comprises a significant element of life satisfaction, as has been shown in childhood glioma survivors. Employment is often affected by the glioma diagnosis, but may be ameliorated, when appropriate, by addressing modifiable factors such as depression, fatigue, or sleep disturbance, or by workplace accommodations. Further research is needed into many facets of rehabilitation in the setting of glioma, including establishing better care models for consistently identifying and addressing functional limitations in this population, measuring outcomes of various levels of rehabilitation care, identifying optimal physical activity strategies, delineating the long-term effects of rehabilitation interventions, and exploring impact of rehabilitation interventions on caregiver burden. The effective elements of cognitive rehabilitation, including transition of cognitive strategies to everyday living, need to be better defined.
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Affiliation(s)
- Mary Vargo
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | | | - Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden
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Isaksson J, Wilms T, Laurell G, Fransson P, Ehrsson YT. Meaning of work and the process of returning after head and neck cancer. Support Care Cancer 2015; 24:205-213. [PMID: 26003423 DOI: 10.1007/s00520-015-2769-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purposes of this study were (1) to investigate employment status at diagnosis, sick leave, and returning to work patterns in correlation to quality of life, anxiety, and depression in patients treated for head and neck cancer (HNC) and (2) to explore patients' experiences of the process of returning to work. METHODS Sixty-six patients with HNC (aged 34-66 years) were repeatedly interviewed over a period of 24 months. Interview responses that concerned the patients' experiences and ideas about work were categorised using the similarities-differences technique. Questionnaires on quality of life, anxiety, and depression were used to describe the patient characteristics and the differences between groups. RESULTS In total, 53% of the patients had returned to work at 24 months after treatment, and 17% were deceased. Several quality of life parameters were significantly worse for patients not working at 24 months after treatment. Nine categories were found to describe the return-to-work process starting with symptoms causing sick leave, thoughts about the sick leave, and ending with the return to work and/or retirement. CONCLUSIONS Returning to work is an important part of life because it structures everyday life and strengthens the individual's identity. The quality of life results showed significant differences between workers and non-workers at the 24-month follow-up. The patients need to be both physically and mentally prepared for the process of returning to work. It is important to take an individual rehabilitation approach to guide and support the patients in returning to work and regaining an important aspect of their everyday life. In such an approach, it is vital to understand the patients' overall life context and the patients' own perspective on the process and meaning associated with work.
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Affiliation(s)
- Joakim Isaksson
- Department of Social Work, Umeå University, SE-901 87, Umeå, Sweden.
| | - Torben Wilms
- Department of Medical Biosciences, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
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