Accessing care for Long Covid from the perspectives of patients and healthcare practitioners: A qualitative study

BACKGROUND

Long Covid is an emerging long-term condition, with those affected raising concerns about lack of healthcare support.

OBJECTIVE

We conducted a qualitative study to identify facilitators and barriers to healthcare access for people with Long Covid, aiming to enhance our understanding of the specific nature of these barriers and how patient experiences may vary.

SETTING AND PARTICIPANTS

In the context of the Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE-ICP) Delphi study, a nationally distributed online survey was conducted. Eight patients and eight healthcare practitioners (HCP) were interviewed via telephone or video call. Framework analysis, sensitised by the candidacy theory, was used to identify barriers and facilitators over four levels of access to care.

RESULTS

Three themes were identified: (i) patients' efforts to navigate emerging pathways for Long Covid, (ii) the patient-HCP interaction and (iii) service resources and structural constraints. Barriers to specialist care included long waiting times, communication gaps across services and a lack of continuity in care. Facilitators included collaborative, patient-centred approaches, patients' active role in their healthcare and blended approaches for appointments. The perspectives of both patients and HCPs largely aligned.

DISCUSSION

The candidacy framework was valuable in understanding the experiences of people with Long Covid seeking access to healthcare. Individuals perceived themselves as eligible for care, but they often encountered obstacles in obtaining the expected level of care or, in some cases, did not receive it at all. Our findings are discussed in the context of the candidacy model through multiple processes of identification, negotiation, permeability and appearances at health services. These themes seem to be especially important for the emerging new pathway model and are relevant to both primary and secondary care.

CONCLUSIONS

This study highlights that despite these interviews being conducted two years after the start of the COVID-19 pandemic, people with Long Covid still struggle to access healthcare, emphasising the ongoing need to provide equitable timely healthcare access for people with Long Covid.

PATIENT OR PUBLIC CONTRIBUTION

People with Long Covid advised on all stages of this research.

Multiple Symptoms in Family Caregivers of Intensive Care Unit Patients

CONTEXT

Intensive care unit (ICU) patients experience physical and psychological challenges related to ICU admission in the acute and recovery phases after a critical illness. Involvement of family caregivers (FCs) is essential in the patients' struggle to survive critical illness. FCs report a high symptom burden related to ICU admission. Previous research has investigated mainly single symptoms. Little is known about multiple symptom burden related to FC experiences in an ICU.

OBJECTIVE

This study aimed: 1) to describe the occurrence, severity, and distress related to multiple symptoms in FCs of ICU patients, and 2) to identify associations between the background characteristics and symptom burden of FCs.

METHODS

This cross-sectional study investigated multiple symptoms in adult FCs of ICU patients. FCs completed a self-report symptom assessment questionnaire within 2 weeks after the patient's admission to the ICU.

RESULTS

FCs (N=211) experienced a median of 9 (range 0-24) symptoms, among which, worrying (91%) was the most occurring. Severity and distress varied between symptoms. Younger age, being a spouse of an ICU patient, and having more comorbidities were significantly associated with the number of symptoms.

CONCLUSIONS

FCs of ICU patients experience multiple symptoms, among which, psychological symptoms are most occurring. Age, relationship to the patient, and comorbidities were significantly associated with the number of symptoms reported by FCs. Comprehensive symptom assessment may identify FCs who are at risk of developing a high symptom burden when the patient is admitted to the ICU.

Somatic symptom profiles in the general population: a latent class analysis in a Danish population-based health survey

Purpose

The aim of this study was to identify and describe somatic symptom profiles in the general adult population in order to enable further epidemiological research within multiple somatic symptoms.

Methods

Information on 19 self-reported common somatic symptoms was achieved from a population-based questionnaire survey of 36,163 randomly selected adults in the Capital Region of Denmark (55.4% women). The participants stated whether they had been considerably bothered by each symptom within 14 days prior to answering the questionnaire. We used latent class analysis to identify the somatic symptom profiles. The profiles were further described by their association with age, sex, chronic disease, and self-perceived health.

Results

We identified 10 different somatic symptom profiles defined by number, type, and site of the symptoms. The majority of the population (74.0%) had a profile characterized by no considerable bothering symptoms, while a minor group of 3.9% had profiles defined by a high risk of multiple somatic symptoms. The remaining profiles were more likely to be characterized by a few specific symptoms. The profiles could further be described by their associations with age, sex, chronic disease, and self-perceived health.

Conclusion

The identified somatic symptom profiles could be distinguished by number, type, and site of the symptoms. The profiles have the potential to be used in further epidemiological studies on risk factors and prognosis of somatic symptoms but should be confirmed in other population-based studies with specific focus on symptom burden.

Symptoms and musculoskeletal diseases in hospital nurses and in a group of university employees: a cross-sectional study

BACKGROUND

Most studies have shown that nurses have a higher risk of developing musculoskeletal symptoms compared with other occupational groups.

AIM

A cross-sectional study was performed to gain more insight into the prevalence rates of musculoskeletal disorders (MSDs) in nurses.

METHODS

The presence of musculoskeletal symptoms was revealed by personal interviews in a sample of 177 hospital nurses and in a reference group of 185 university employees. Musculoskeletal diseases were based on radiological examinations in all subjects.

RESULTS

Lower back pain (61% vs 42.2%) was the most frequently reported symptom, followed by neck pain (48.6% vs 38.4%) and shoulder pain (36.7% vs 25.9%), with a significantly higher prevalence in nurses. Women had about a 2-fold risk of upper limb region and neck pain compared with men. The most common abnormal findings on radiological examinations were disc herniations (n = 40).

CONCLUSIONS

Nurses showed a significantly higher risk of MSDs. Prevalence rates in nurses increased significantly with age. Musculoskeletal symptoms were also common in university employees. This suggests the need for effective intervention strategies involving workers' active participation, in order to improve the process and organization of work and promote a positive psychosocial work environment.

Patterns of symptoms and functional impairments in children with cancer

BACKGROUND

Children with cancer experience multiple symptoms due to their disease and as a result of treatment. The purpose of this study was to demonstrate the feasibility and potential utility of using latent profile analysis (LPA), a type of cluster analysis, in children with cancer to identify groups of patients who experience similar levels of symptom severity and impairment of physical function.

PROCEDURE

We analyzed patient-reported symptom and functional data previously collected using the Pediatric Patient Reported Outcomes Measurement Information System (PROMIS). LPA was used to identify and characterize groups of patients who reported similar levels of symptom severity and functional impairment. We then used the multinomial logit model to examine demographic and disease characteristics associated with symptom/function profile membership.

RESULTS

The analysis included 200 patients in treatment or in survivorship. We identified four symptom/function profiles; children currently receiving cancer treatment and those with at least one other medical problem were more likely to be members of the profile with the highest levels of symptom severity and functional impairment. Gender, age, race/ethnicity, and tumor type were not associated with profile membership.

CONCLUSIONS

LPA is a cluster research methodology that provides clinically useful results in pediatric oncology patients. Future studies of children with cancer using LPA could potentially lead to development of clinical scoring systems that predict patients' risk of developing more severe symptoms and functional impairments, allowing clinicians, patients, and parents to better anticipate and prevent the multiple symptoms that occur during and after treatment for childhood cancer.

A review of the prevalence and impact of multiple symptoms in oncology patients

Findings from several studies suggest that oncology patients undergoing active treatment experience multiple symptoms, and that these symptoms can have a negative effect on patient outcomes. However, no systematic review has summarized the findings from studies that assessed multiple symptoms in these patients. Therefore, the purposes of this review were to: 1) compare and contrast the characteristics of the three most commonly used instruments to measure multiple symptoms; 2) summarize the prevalence rates for multiple symptoms in studies of oncology patients receiving active treatment; 3) describe the relationships among selected demographic, disease, and treatment characteristics and multiple symptoms; and 4) describe the relationships between the occurrence of multiple symptoms and patient outcomes (i.e., functional status, quality of life). Only 18 studies were found that met the inclusion criteria for this review. The majority of the studies were cross-sectional with sample sizes that ranged from 26 to 527. Approximately 40% of patients experienced more than one symptom. However, little is known about the relationships between demographic and clinical characteristics and the occurrence of multiple symptoms. Findings from this review suggest that the occurrence of multiple symptoms is associated with decreased functional status and quality of life. However, given the large number of oncology patients who undergo active treatment each year, additional research is warranted on the prevalence and impact of multiple symptoms. Only when this descriptive research is completed with homogenous samples of patients in terms of cancer diagnoses and treatments can intervention studies for multiple symptoms be developed and tested.