About me as a person not only the disease - piloting Guided Self-Determination in an outpatient endometriosis setting

Experiences of menstrual health in the Nordic countries: a scoping review of qualitative research, applying an intersectional lens

Achieving menstrual health is fundamental to gender equality, human rights, and the well-being of all people who menstruate. We undertook a scoping review to map the extent and range of qualitative studies on menstrual health in the Nordic countries and applied an intersectional lens in reporting the findings. The specific research questions we aimed to answer were (1) what types of menstrual health experiences were researched, (2) whose experiences and voices were being researched, and (3) what gaps exist in understanding the experiences and challenges encountered by diverse groups. Four databases were searched for peer-reviewed articles published between 2011 and 2023. Searches yielded 2733, and 22 articles met our inclusion criteria. Included studies were undertaken in Denmark (n = 5), Iceland (n = 1), Norway (n = 3), and Sweden (n = 13). The samples included menstruating people, healthcare professionals, and/or other professionals. Most of the included studies reported on menstrual experiences related to menstrual pain and disorders such as endometriosis. Studies focusing on understanding menstrual health experiences among people in vulnerable situations in the Nordic countries are lacking. We found that menstrual health experiences of menstruating people with the following identities were under-researched: people with disabilities, non-Nordic ethnicities, refugees, gender-diverse people, people experiencing homelessness, and young adolescents. The findings suggest that we have little knowledge and understanding of the experiences and challenges that might be faced by these groups in the Nordic countries. Findings of this scoping review can be used to inform future research directions and policy programming.

Randomised controlled pilot trial of the EndoSMS supportive text message intervention for individuals with endometriosis: Feasibility and acceptability results

OBJECTIVE

Diminished quality of life, inadequate support and social isolation are commonly experienced by individuals living with the chronic pain condition, endometriosis. We aimed to determine the feasibility and acceptability of EndoSMS, a psychologically-focused text message intervention designed to support individuals living with endometriosis.

METHODS

As part of a two-arm parallel pilot randomised controlled trial with waitlist control, the feasibility and acceptability of a brief (3-month) version of EndoSMS was assessed using a mixed methods approach. Feasibility data (uptake, attrition, text message delivery analytics) and user acceptability (via self-report survey items and written feedback) were assessed. Qualitative data were thematically analysed using the template approach. Primary trial outcomes are not reported in this paper.

RESULTS

Feasibility was indicated by: high conversion rate (99.1 %), low attrition (14.2 %), few opt-outs (0.02 %) and a high message delivery rate (99.8 %). Most intervention participants indicated user acceptability (mean = 4.02/5) across self-report questions. Most rated the length of the program (65.5 %), and the number (80.9 %) and language (94.5 %) of the text messages to be 'just right'. Thematic analysis created four themes: A shared "battle": Feeling less isolated and alone; "Be kind to yourself": A focus on self-care, self-compassion and active coping; Keeping endometriosis at the forefront: Helpful or stressful?; Mixed perceptions surrounding the provision of general endometriosis information; and, Tailoring of text messages.

CONCLUSION

EndoSMS supportive text message program was feasible and acceptable for individuals with endometriosis. Future developments of the program should consider greater tailoring of content to user needs.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12621001642875).

'Listen to women as if they were your most cherished person': Australian women's perspectives on living with the pain of endometriosis: A mixed-methods study

This mixed-methods study used an online cross-sectional survey to explore perspectives of 533 adult Australian women living with endometriosis pain, and their relationship with biopsychosocial factors. Four themes were constructed: The primary theme, 'Stigma and change' reflected women's experience of dismissal, and the wish to reverse the narrative of pain as normal. Some women emphasised self-education and self-advocacy to affect change, reflecting the theme 'self-empowerment'. Participants described the 'debilitating impact' of endometriosis and the enduring difficulty of 'inadequate healthcare', reflecting themes three and four. Analysis indicated type of social support may impact perceived outcomes for endometriosis. Hierarchical regression analyses indicated too few significant relationships between biopsychosocial factors and themes to indicate meaningful patterns without risk of common method variance. Future research should explore the influence of social support and interventions which develop participant autonomy and practitioner competence and knowledge, using disease-specific measures over time.

A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis

BACKGROUND

The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified.

OBJECTIVE AND RATIONALE

The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women's QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show?

SEARCH METHODS

The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms 'EHP30', 'EHP5', 'EHP-30', 'EHP-5', 'endometriosis health profile 30', and 'endometriosis health profile 5'. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT).

OUTCOMES

The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs' robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the 'control and powerlessness' domain post-intervention, followed by 'pain'. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review.

WIDER IMPLICATIONS

Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.

A comprehensive interventional program to improve the sexual function of women with endometriosis: a mixed-methods protocol study

BACKGROUND

Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis.

MATERIALS AND METHODS

This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women's sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research.

CONCLUSION

Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

Patients' experiences with participating in a team-based person-centred intervention for patients at risk of or diagnosed with COPD in general practice

BACKGROUND

Symptoms and complications of chronic obstructive pulmonary disease (COPD) can affect daily activities and quality of life, and patients with COPD require long-term follow-up by their general practitioner. Providing patients with or at risk of COPD practical skills and motivation to improve their self-management is important. On this background, an interdisciplinary follow-up program was designed based on the Guided Self-Determination counselling method to facilitate problem-solving and mutual decision-making between healthcare professionals and patients. The aim of the study was to explore patients and healthcare professionals` experiences with the Guided Self-Determination-program to investigate feasibility issues.

METHODS

A qualitative design was used to get insights in the experiences of receiving the Guided Self-Determination counselling program. In total, 13 patients with COPD (mean age 71.7 ± 7.7 years) 4 were current smokers, and 7 at risk of COPD (mean age 54.1 ± 9.9 years) all current smokers, received the Guided Self-Determination program. The researchers performed individual semi-structured telephone interviews after the 12 months Guided Self-Determination program with two patients at risk of COPD, four patients with COPD, three nurses, and five general practitioners. The intervention consisted of structured consultations with the nurse and patient in collaboration with the general practitioner at baseline and after 3, 6, and 12 months. The Guided Self-Determination method comprised facilitation of a mutual reflection process between the patient and the nurse to enhance self-management skills. Each consultation lasted for 60 min. The interviews were analysed using thematic analyses.

RESULTS

Two themes were identified: (1) A structured follow-up is challenging but motivating. (2) A counselling method that opens for conversation, but it requires resources.

CONCLUSIONS

The findings indicated that patients with or at risk of COPD experienced enhanced self-management skills after participating in a structured and systematic team-based follow-up in general practice with use of the Guided Self-Determination method. The regularity of the follow-up seemed to be important to succeed to help the patients making lifestyle changes to increase health benefits. However, the Guided Self-Determination method was experienced as time consuming among the general practitioners and nurses, and there are currently no available financial rates for this type of treatment in Norway which may be a barrier to further implementation.

TRIAL REGISTRATION

The trial is registered in ClinicalTrials.gov (ID: NCT04076384).

Impact of the person-centred intervention guided self-determination across healthcare settings-An integrated review

AIM

To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings.

METHODS

An integrated five-stage review.

RESULTS

Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets-appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice-a decision from above, (2) A new role-unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach.

CONCLUSION

Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice.

Measures used to assess interventions for increasing patient involvement in Danish healthcare setting: a rapid review

OBJECTIVE

To identify measures used within Denmark evaluating any type of intervention designed to facilitate patient involvement in healthcare.

DESIGN

Environmental scan employing rapid review methods.

DATA SOURCES

MEDLINE, PsycInfo and CINAHL were searched from 6-9 April 2021 from database inception up to the date of the search.

ELIGIBILITY CRITERIA

Quantitative, observational and mixed methods studies with empirical data on outcomes used to assess any type of intervention aiming to increase patient involvement with their healthcare. Language limitations were Danish and English.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data from 10% of the included studies and, due to their agreement, the data from the rest were extracted by first author. Data were analysed with reference to existing categories of measuring person-centred care; findings were synthesised using narrative summaries. Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were used to guide reporting.

RESULTS

Among 3767 records, 43 studies met the inclusion criteria, including 74 different measures used to evaluate interventions aimed at increasing patient involvement within healthcare in Danish hospital and community settings. Generic measures assessed: patient engagement (n=3); supporting self-management (n=8); supporting shared decision-making (n=9); patient satisfaction and experiences of care (n=11); health-related patient-reported outcome (n=20).

CONCLUSIONS

Across Denmark, complex interventions designed to improve patient involvement with healthcare vary in their goals and content. Some targeting healthcare professionals, some patient health literacy and some service infrastructure. A plethora of measures assess the impact of these interventions on patient, professional and service delivery outcomes. Few measures assessed patient involvement directly, and it is unclear which proxy measures capture indicators of perceived involvement. Lack of conceptual clarity between intervention goals, the components of change and measures makes it difficult to see what types of intervention can best support change in services to ensure patients are more effectively involved in their healthcare.

Multidimensional factors determine skill acquisition development in Guided Self‐Determination : A qualitative study

AIM

The aim of the study was to investigate nurses' skill acquisition in Guided Self-Determination according to the Dreyfus model of skill acquisition and Patricia Benner's studies based on the same model.

BACKGROUND

Globally, person-centred care is acknowledged as an essential aspect of quality in health care. To succeed with person-centred care methods and skills are necessary. Guided Self-Determination is a person-centred method developed in the field of nursing. The method represents a new way of skill acquisition requiring knowledge of how skills are acquired, unfolded and best supported in Guided Self-Determination.

DESIGN

Qualitative interview study.

METHOD

From January 2019 to August 2019, 16 nurses were interviewed about their experiences of learning and using Guided Self-Determination in three different gynaecological settings: cancer, endometriosis and sexual abuse. The study was registered with the Danish Data Protection Agency (file no.: VD-2018-445, I-Suite no.: 6700).

RESULTS

The spectrum in Guided Self-Determination acquisition skills ranged from following schematical procedures in a rigorous way to an extended understanding of exploring and supporting the person-centred concept. Two main themes were identified: Elements in the transition of knowledge from theory to practice and Aspects associated with Guided Self-Determination skill acquisition.

CONCLUSIONS

Nurses practised Guided Self-Determination at different levels. Quantity of practising Guided Self-Determination was not the only aspect determining rapid progression. The Dreyfus model lacked several explanatory components of skill acquisition, such as personal dispositions, preferences, motivation, personal values and context.

Guided self-determination in treatment of chronic pain - a randomized, controlled trial

OBJECTIVES

To test whether Guided Self-Determination (GSD) used in chronic pain management could improve the health-related quality of life, patient activation and sense of coherence (SoC) as a measurement of life skills in patients with chronic pain. The method has been shown to be effective in other chronic conditions, but has not been tested in chronic pain.

METHODS

A three-site randomised, controlled trial at three major multidisciplinary pain centres in Denmark. 200 patients were included and randomised. In the intervention period, both groups had regular visits to the pain centre with both doctors and nurses. The intervention group additionally received the GSD intervention with weekly sessions for eight weeks. Data were collected from February 2013 to July 2016 and consisted of three questionnaires answered before and after the 8-week intervention period, and after six months. The primary outcome was self-reported health related quality of life. Secondary outcomes included self-reported activation and SoC.

RESULTS

We found no clinically relevant difference between the groups for health-related quality of life, patient activation or SoC at either baseline, at three months or at six months. We also analysed data for trends over time using mixed model analysis, and this did not show any significant differences between groups.

CONCLUSIONS

GSD did not improve health-related quality of life, patient activation or SoC when administered to patients with chronic pain treated in a multidisciplinary pain centre. New research is recommended using a combination of self-reported and objective measures and longer follow-up.

Endometriosis-associated pain: a review of quality of life, sexual health and couple relationship

INTRODUCTION

Endometriosis is a chronic gynecological disease that affects women's quality of life, sexuality, and relationship. Endometriosis-associated pain plays an essential role in well-being impairment. The present review aimed to analyze literature about endometriosis-associated pain and quality of life, sexual health, and quality of the relationship, assessing the role of the biopsychosocial factors involved and the women's pain experience.

EVIDENCE ACQUISITION

Bibliographic research of relevant articles published from 2015 to 2020 in PubMed, Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library.

EVIDENCE SYNTHESIS

Endometriosis is associated with impairing all women's quality of life domains, and pain appears to be the most influential variable. The pain mechanism is not simple and implies several biological, psychological, and social factors. Women's sexual health is also impaired, and patients report dyspareunia, sexual dysfunctions, dissatisfaction, and distress. Partners' sexual well being is compromised as well. Endometriosis negatively influences relationship quality, and the illness burden affects both couple members.

CONCLUSIONS

A multidisciplinary team using a couple-centered and a biopsychosocial approach is crucial to provide appropriate treatment for endometriosis-associated pain. A better comprehension of all bio-psycho-social aspects implicated in women's well-being and pain experience needs more research.

The patient's agenda: nurses' experience of learning and using guided self-determination

OBJECTIVES

Health care has seen a shift towards person-centred care to encompass the entirety of a person's needs and preferences, but research is sparse on healthcare professionals learning and using person-centred care.

AIM

To investigate nurses' experiences of learning and using the person-centred method guided self-determination (GSD) in three different gynaecological settings and to determine whether, and potentially, how new tasks introduced by the GSD method influence their professional identity.

DESIGN

A qualitative interview study conducted between January 2019 and January 2020.

METHOD

We conducted 16 semi-structured interviews with nurses educated in using GSD. Applying inductive and deductive reasoning, we analysed the interviews using thematic analysis. The study was registered with the Danish Data Protection Agency (file no.: VD-2018-445, I-Suite no.: 6700).

RESULTS

The analysis generated three main themes with two subthemes each: (a) prerequisites and barriers to learning and using GSD in terms of personal factors and organisational and method-related factors; (b) new knowledge and understanding of illness with the subthemes expanded understanding of illness and a different relationship; and (c) nursing undergoing change with the subthemes, a new role and a professional self shaped through interaction with other professions.

CONCLUSIONS

Although other professionals may have either supported or challenged the use of GSD, most nurses indicated that it supplemented their professional role and identity as they gained new knowledge about person-centred challenges and felt more confident. When introducing GSD in nursing, the organisation must not only consider individual characteristics, multidisciplinary collaboration and communication but also plan individual education and supervision. This is necessary because all these factors affect how a new professional role is constructed and adopted, not to mention how it influences the nurses' perception of their professional identity and use of GSD. Establishing a helpful person-centred environment must also be considered.

Care and treatment needs of immunosuppressive therapy patients with warts and impact on everyday life: a qualitative study

INTRODUCTION

Patients receiving immunosuppressive therapy have an increased risk of developing verrucae vulgaris (warts). They often suffer from dissemination of numerous warts, complicated by low treatment response and long-term treatment. How patients experience these challenges is not well characterized. The aim of this study was to explore how patients on immunosuppressive therapy experience everyday life with warts on the hands and feet, and their needs related to care and treatment.

METHODS

The study took a phenomenological-hermeneutic approach. Semi-structured interviews were conducted with 10 adults. Data were analyzed using the thematic analysis described by Braun and Clark.

RESULTS

Warts on the hands and feet impact everyday life and cause feelings of stigma and pain. Patients request treatment and hope to be cured although the prospects are poor. Self-treatment is experienced as a burden, because of the need for more specific information about and skills to treat the warts, and because individual patients' resources are not considered. Patients experience a lack of care continuity.

CONCLUSIONS

Patients request a person-centred care and treatment approach, to establish a relationship with health care professionals. Establishing care continuity might reduce patients' treatment-related insecurity.

The Burden of Endometriosis on Women's Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing

Endometriosis is a chronic, inflammatory disease affecting more than 170 million women worldwide and up to 10% of women of reproductive age. As a consequence of inflammatory reaction and infiltration of anatomic structures, endometriosis can cause “pain symptoms” including dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain. In this review, we summarized the impact of endometriosis on quality of life in all its aspects including sexual life, work, and social relationships. The data research was conducted using web-based search engines and/or various electronic research databases querying for all articles related to endometriosis and quality of life from the inception of the database up to February 2020. Endometriosis has not only physical but also psychological effects, causing depression, anxiety, and compromising social relationships. Furthermore, endometriosis negatively impacts sexual life and social relationships. At last, the economic burden of endometriosis should not be underestimated, both individually and for the community, as this pathology leads to a loss of productivity at work and large use of health resources. Thus, endometriosis-related symptoms control women’s lives compromising the quality of life in all aspects. In this review, we summarized the impact of endometriosis on various aspects of women’s lives.