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Erlik M, Timm H, Larsen ATS, Quist M. Reasons for non-participation in cancer rehabilitation: a scoping literature review. Support Care Cancer 2024; 32:346. [PMID: 38743121 PMCID: PMC11093823 DOI: 10.1007/s00520-024-08553-9] [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: 11/09/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Rehabilitation plays an important role in addressing the many challenges of living with cancer, but a large proportion of people with cancer do not participate in available cancer rehabilitation. Hence, reasons for non-participation in cancer rehabilitation need to be explored. OBJECTIVE The present study undertakes a scoping review of research examining reasons for non-participation in cancer rehabilitation among people with cancer. DESIGN A systematic search was conducted in PubMed, Scopus and CINAHL for articles published until July 2023. Included studies were hand searched for relevant references and citations. ELIGIBILITY CRITERIA Method: Studies with qualitative, quantitative or mixed-method design. POPULATION Studies targeting adults (> 18) living with cancer, not participating in rehabilitation. Program type: The review included all studies defining program as rehabilitation but excluded clinical trials. OUTCOME Studies examining reasons for non-participation in available rehabilitation. DATA EXTRACTION The extracted data included author(s)/year of publication, aim, population, information, rehabilitation type and main reasons for non-participation. RESULTS A total of nine studies were included (n = 3 quantitative, n = 2 qualitative, n = 4 mixed methods). Reasons for non-participation included physical, psychosocial and practical aspects. The main reason across studies was 'no need for public support' related to receiving sufficient support from family and friends. All studies focused on individual reasons, and structural conditions were rarely present. CONCLUSION Research within this field is sparse. Future research should explore how individual reasons for non-participation relate to structural conditions, especially among people in socially disadvantaged positions living with cancer.
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Affiliation(s)
- Mikala Erlik
- UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark.
| | - Helle Timm
- UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Faculty of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Morten Quist
- UCSF-Centre for Health Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark
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Langballe R, Svendsen L, Jakobsen E, Dalton SO, Karlsen RV, Iachina M, Freund KM, Leclair A, Jørgensen LB, Skou ST, Ehlers JH, Torenholt R, Svendsen MN, Envold Bidstrup P. Nurse navigation, symptom monitoring and exercise in vulnerable patients with lung cancer: feasibility of the NAVIGATE intervention. Sci Rep 2023; 13:22744. [PMID: 38123657 PMCID: PMC10733288 DOI: 10.1038/s41598-023-50161-w] [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] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
We developed the Navigate intervention to improve survival among vulnerable lung cancer patients. In this intervention-only study, we examined feasibility in terms of recruitment, retention, attendance, adherence, and acceptability to specify adjustments to study procedures and intervention components prior to a randomized trial. The Navigate intervention includes nurse navigation, patient-reported outcomes, and physical exercise. Patients ≥ 18 years old, diagnosed with non-small cell lung cancer at any stage, with performance status ≤ 2, eligible for cancer treatment and vulnerable according to a screening instrument were included. The recruitment goal of eligible patients was 40% while the retention goal was 85%. The predefined cut-offs for sufficient attendance and adherence were ≥ 75%. Acceptability was evaluated by semi-structured interviews with participants, nurse navigators, and physiotherapists. Seventeen (56%) out of 30 screened patients were considered vulnerable and eligible for the study, 14 (82%) accepted participation, and 3 (21%) were subsequently excluded due to ineligibility, leaving 11 patients. Four patients dropped out (36%) and four patients died (36%) during follow-up and 3 (27%) were retained. All 11 patients participated in nurse sessions (mean 16, range 1-36) with 88% attendance and dialogue tools being applied in 68% of sessions. Ninety-one percent of patients responded to PROs (mean of 9 PROs, range 1-24) with 76% of the PRO questionnaires used (attendance) and 100% adherence (completion of all questions in PRO questionnaires), and 55% participated in exercise sessions with 58% attendance and 85% adherence. We identified important barriers primarily related to transportation, but overall acceptability was high. The Navigate intervention was feasible with high participation, acceptability and satisfactory adherence. Retention and exercise attendance were low, which resulted in adjustments.Trial registration: The feasibility study was initiated prior to the multicenter randomized controlled trial registered by ClinicalTrials.gov (number: NCT05053997; date 23/09/2021).
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark.
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark.
| | - Lukas Svendsen
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
- The Danish Lung Cancer Registry, Odense University Hospital, Odense, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Randi Valbjørn Karlsen
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Amy Leclair
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Lars Bo Jørgensen
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jeanette Haar Ehlers
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Rikke Torenholt
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Mads Nordahl Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
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Navntoft S, Andreasen J, Petersen KS, Rossau HK, Jørgensen L. Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives. Disabil Rehabil 2023:1-13. [PMID: 37961874 DOI: 10.1080/09638288.2023.2280073] [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: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.
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Affiliation(s)
- Sophie Navntoft
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Jane Andreasen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Cancer Treatment & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Aagesen M, la Cour K, Møller JJK, Stapelfeldt CM, Hauken MA, Pilegaard MS. Rehabilitation interventions for young adult cancer survivors: A scoping review. Clin Rehabil 2023; 37:1347-1374. [PMID: 37083478 DOI: 10.1177/02692155231168720] [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] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To map existing research concerning rehabilitation interventions for young adult cancer survivors (YACS) that address at least one factor from the biopsychosocial health model. DESIGN Scoping review. DATA SOURCES Searches were performed in EMBASE, MEDLINE, PsycINFO, CINAHL and Cochrane in January 2022 and updated in March 2023, and grey literature between February and April 2022. METHODS The review followed Joanna Briggs Institute's methodology for scoping reviews. Quantitative, qualitative and mixed methods studies evaluating interventions for YACS of any cancer who had completed primary treatment and were between 18 and 39 years old at diagnosis were included. Two authors independently screened studies for eligibility, and standardised forms were used for data extraction. Descriptive statistics, narrative summaries and thematic analysis were used to analyse the data. RESULTS The search revealed 5706 records, of which 70 were full-text screened. The 20 included studies represented a heterogeneous group of 444 young adults with different cancer types, mean age above 25, and an overrepresentation of females. Most studies were feasibility and pilot studies. The 20 studies consisted of 14 unique interventions focusing primarily on one dimension of the biopsychosocial health model like biological or psychological factors. In the 14 interventions, the most frequent intervention element was peer-to-peer support (n = 12). The interventions were often delivered online (n = 9), lasting 3-12 months (n = 8). A wide variety of theories, providers and outcome measures were used. CONCLUSION The results show that current research on multicomponent, biopsychosocial and age-specific rehabilitation for YACS remains at an early stage.
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Affiliation(s)
- Maria Aagesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- The Research Unit for User Perspectives and Community-Based Interventions, The Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- The Research Unit for User Perspectives and Community-Based Interventions, The Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina M Stapelfeldt
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - May Aasebø Hauken
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Marc Sampedro Pilegaard
- Central Region Denmark, DEFACTUM, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
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Sánchez-Cárdenas MA, Iriarte-Aristizábal MF, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, Cañón-Piñeros A, Parra SL. Rural Palliative Care Telemedicine for Advanced Cancer Patients: A Systematic Review. Am J Hosp Palliat Care 2023; 40:936-944. [PMID: 36331174 DOI: 10.1177/10499091221130329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Context: Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced diseases. Objectives: Establish a telemedicine model of rural palliative care for advanced cancer patients with difficulties in accessing standard care. Methods: This review comports with the minimum standards described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and uses the palliative care literature review iterative method (PALETTE) proposed by Zwakman et al in 2018. Results: Three hundred, ninety-two articles were identified in PubMed and EMBASE databases and alternative search engines such as Google Scholar and OpenGrey. A telemedicine delivery model was developed for patients with limited access to standard care, which consists of identifying the candidate population, establishing the most convenient telemedicine modality, agreeing with patients and caregivers on palliative care needs, and evaluating the interventions effectiveness. Conclusion: Telemedicine is a revolutionary tool to provide palliative care to advanced cancer patients whose clinical condition or location prevent them from accessing conventional care.
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Affiliation(s)
| | | | | | | | - Juan Esteban Correa-Morales
- School of Medicine, Universidad de La Sabana, Chía, Colombia
- Department of Pain Medicine and Palliative Care, National Cancer Institute, Bogotá, Colombia
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Langballe R, Dalton SO, Jakobsen E, Karlsen RV, Iachina M, Freund KM, Leclair A, Nielsen AS, Andersen EAW, Rosthøj S, Jørgensen LB, Skou ST, Bidstrup PE. NAVIGATE: improving survival in vulnerable patients with lung cancer through nurse navigation, symptom monitoring and exercise - study protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e060242. [PMID: 36316074 PMCID: PMC9628541 DOI: 10.1136/bmjopen-2021-060242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION AND AIM Low socioeconomic position (SEP) has been shown to be strongly associated with impaired lung cancer survival. Barriers related to receiving recommended treatment among patients with lung cancer with low SEP may include adverse health behaviour and limited physical and psychosocial resources influencing the ability to react on high-risk symptoms and to navigate the healthcare system. To address the underlying factors that drive both decisions of treatment, adherence to treatment and follow-up in vulnerable patients with lung cancer, we developed the Navigate intervention. The aim of this randomised controlled trial is to investigate the effect of the intervention on survival (primary outcome), lung cancer treatment adherence, health-related quality of life and other psychosocial outcomes as well as health costs and process evaluation (secondary outcomes) in a study population of vulnerable patients with lung cancer. METHODS AND ANALYSIS This two-armed multicentre randomised trial will recruit patients from five lung cancer clinics in Denmark identified as vulnerable according to a screening instrument with nine clinical and patient-reported vulnerability criteria developed for the study. We will enrol 518 vulnerable patients >18 years old diagnosed with non-small cell lung cancer at all stages with a performance status <2. Participants will be randomly allocated to either standard treatment and intervention or standard treatment alone. The Navigate intervention is based on principles from motivational interviewing and includes three components of nurse navigation, systematic monitoring of patient-reported outcomes (PROs) and physical exercise in a person-centred delivery model. Data will be collected at baseline and 3, 6, 12 months after randomisation using questionnaires, clinical data and physical function tests. ETHICS AND DISSEMINATION Ethics Committee, Region Zealand (SJ-884/EMN-2020-37380) and the Data Protection Agency in Region Zealand (REG-080-2021) approved the trial. Participants will provide written informed consent. Results will be reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05053997.
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Survivorship and Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
- The Danish Lung Cancer Registry, Odense University Hospital, Odense, Denmark
| | - Randi Valbjørn Karlsen
- Psychological Aspects of Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense Universityhospital, Odense, Denmark
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Amy Leclair
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Susanne Rosthøj
- Statistics and Data Analysis, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Søren Thorgaard Skou
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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Møller JJK, la Cour K, Pilegaard MS, Möller S, Jarlbaek L. Identification of socially vulnerable cancer patients - development of a register-based index (rSVI). Support Care Cancer 2022; 30:5277-5287. [PMID: 35275294 DOI: 10.1007/s00520-022-06937-3] [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: 11/04/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Social vulnerability is a complex construct which is beyond relying on single measures. If socially vulnerable patients should be identified, we need a composite measure capturing the patient's overall circumstances. This study presents the development of a social vulnerability index (rSVI) for cancer patients based on administrative data from population-based registers. METHODS All patients, who died from cancer within 5 years after the cancer diagnosis during 2013-2018 (n = 44,187), were identified and divided in four subcohorts according to survival; index cohort surviving 3-5 years (n = 3044 surviving 3-5 years), cohort 1 (n = 27,170 surviving < 1 year), cohort 2 (n = 9450 surviving 1-2 years), and cohort 3 (n = 4523 surviving 2-3 years). Variables from ten registries on health and social issues were linked to each individual patient. Variables of interest were weighted to construct the rSVI using the index-cohort. rSVI was subsequently tested on the three other cohorts for validation. RESULTS The rSVI included weighted values for marital status, ethnicity, education, income, unemployment, psychiatric comorbidity, and somatic comorbidity. The validity of the rSVI was supported by the expected trend in proportions of vulnerable patients when applied on the other cohorts. Single social measures appeared insufficient in identification of vulnerable patients when compared with the rSVI. CONCLUSION The rSVI provides a tool for identification of socially vulnerable cancer patients using administrative data. The index requires further validation in other patient groups and is tested against other measures of vulnerability. Future perspectives are to use the rSVI as predictor of advanced cancer patients' use of healthcare services.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark.
| | - Karen la Cour
- Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark
- Research Unit for User Perspectives and Community-based Interventions, the Research group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for User Perspectives and Community-based Interventions, the Research group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Nissen N, Rossau HK, Pilegaard MS, la Cour K. Cancer rehabilitation and palliative care for socially vulnerable patients in Denmark: an exploration of practices and conceptualisations. Palliat Care Soc Pract 2022; 16:26323524221097982. [PMID: 35800415 PMCID: PMC9253993 DOI: 10.1177/26323524221097982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Despite a tax-funded, needs-based organisation of the Danish health system,
social inequality in cancer rehabilitation and palliative care (PC) has been
noted repeatedly. Little is known about how best to improve access and
participation in cancer rehabilitation and PC for socio-economically
disadvantaged and socially vulnerable patients. Aim: To gather, synthesise and describe practice-orientated development studies
presented in Danish-language publications and examine the underpinning
conceptualisations of social inequality and vulnerability; explore related
views of stakeholders working in the field. Methods: The study comprised a narrative review of Danish-language literature on
practice-orientated development studies which address social inequality and
vulnerability in cancer rehabilitation and PC and an online stakeholder
consultation workshop with Danish professionals and academics working in the
field. Results: Two themes characterise the included publications (n = 8):
types of interventions; conceptualisations of social inequality and
vulnerability; three themes were identified in the workshop data: focus and
type of interventions; organisation of cancer care; and vulnerability of the
healthcare system. The publications and the workshop participants
(n = 12) favoured approaches which provide additional
individualised resources throughout the cancer trajectory for this patient
group. The terms social inequality and social vulnerability are largely used
interchangeably, and associated with low income and no or little education
yet qualified with multiple descriptors, which reflect the diverse
socio-economic situations professionals encounter in cancer patients and
their psychosocial needs. Conclusion: Addressing social inequality and vulnerability in cancer rehabilitation and
PC in Denmark entails practical and conceptual challenges. Of importance is
individualised support and the integration of rehabilitation and PC into
standardised care pathways. To conceive of social vulnerability as a
layered, dynamic, relational and contextual concept reflects current
practice in identifying the diversity of cancer patients who may benefit
from additional support in accessing and participating in rehabilitation and
PC.
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Affiliation(s)
- Nina Nissen
- Independent Researcher, Berlin, Germany
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Henriette Knold Rossau
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Marc Sampedro Pilegaard
- User Perspectives and Community-Based Interventions, Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- User Perspectives and Community-Based Interventions, Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
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