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Bozzetti M, Soncini S, Bassi MC, Guberti M. Assessment of Nursing Workload and Complexity Associated with Oncology Clinical Trials: A Scoping Review. Semin Oncol Nurs 2024; 40:151711. [PMID: 39155154 DOI: 10.1016/j.soncn.2024.151711] [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: 04/11/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES Clinical trials (CTs) play a crucial role in advancing medical knowledge and patient care but are increasingly complex and resource-intensive. This scoping review aims to explore the current approaches for evaluating workload (WL) in oncology CTs and identify tools for measuring clinical research nurses' WL. METHODS The search was conducted through MEDLINE, Scopus, CINAHL, and COCHRANE databases and carried out through the framework developed by Arksey and O'Malley and revised by the Joanna Briggs Institute. Data extraction and synthesis were performed to analyze instruments used for WL assessment and their dimensions. RESULTS Of the 1,005 records identified, 12 meet the inclusion criteria. The complexity and WL associated with CTs can be attributed to five main domains: (1) protocol, (2) single case, (3) data management, (4) regulatory, and (5) worker-related. These instruments varied in their approaches, scoring systems, and domains assessed. Notably, the protocol-related domain was prevalent across most instruments, highlighting its importance in WL evaluation. Furthermore, findings revealed a wide range of WL scores across different studies, emphasizing the complexity and variability in WL management within CTs. CONCLUSIONS This scoping review underscores the importance of evaluating WL in CTs and provides insights into existing tools and approaches. Nurses, as integral members of clinical research teams, bear significant responsibilities in trial management, necessitating a balanced approach to WL allocation. Future research should focus on validating and standardizing assessment tools to optimize resource allocation and enhance research efficiency in CT centers. IMPLICATIONS FOR NURSING PRACTICE Understanding WL dynamics in CTs is essential for nurses involved in research delivery. By utilizing validated WL assessment tools, nurses can advocate for appropriate staffing levels and promote efficient trial management, ultimately improving patient outcomes and research quality in CT settings.
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Affiliation(s)
- Mattia Bozzetti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Soncini
- Azienda USL-IRCCS di Reggio Emilia, EBP & Research Unit of Health Profession, Reggio Emilia, Italy.
| | - Maria Chiara Bassi
- Azienda USL-IRCCS di Reggio Emilia, Medical Library, Reggio Emilia, Italy
| | - Monica Guberti
- Azienda USL-IRCCS di Reggio Emilia, EBP & Research Unit of Health Profession, Reggio Emilia, Italy
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Wohlin Wottrich A, Braekke I, Johansson L, von Koch L. Therapists acting as data collectors in a post stroke research project - a door to development. Top Stroke Rehabil 2023; 30:101-107. [PMID: 34340638 DOI: 10.1080/10749357.2021.1956045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
METHODS Participants in the present study were eight clinically experienced occupational therapists and physiotherapists who collected data in an observational longitudinal study of the rehabilitation process after stroke. Semi-structured interviews were conducted, and transcripts of the interviews were analyzed using content analysis. The transcripts revealed the informants' perspectives and their experiences of follow-ups in the patient's home. RESULTS There was one main category, a door to development, and three subcategories: the entrance, discovery in place, and the exit. All informants expressed that they had gained new knowledge of the situation of people who have had a stroke and that taking part in research uncovered a wider perspective of the patients' situations and the importance of follow-ups in general. CONCLUSION New insights into the patients' situation with clinical implications for interprofessional care can be gained by collecting data in a research project that is related to, but different from, everyday clinical practice. Such an assignment can be experienced as professionally rewarding, and we propose that offering such a role change/transition may open the door to development for rehabilitation team members.
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Affiliation(s)
| | - Isidor Braekke
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Lisa Johansson
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.,Theme Neuro, Karolinska University Hospital, Stockholm, Sweden
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Farrar N, Elliott D, Houghton C, Jepson M, Mills N, Paramasivan S, Plumb L, Wade J, Young B, Donovan JL, Rooshenas L. Understanding the perspectives of recruiters is key to improving randomised controlled trial enrolment: a qualitative evidence synthesis. Trials 2022; 23:883. [PMID: 36266700 PMCID: PMC9585862 DOI: 10.1186/s13063-022-06818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recruiting patients to randomised controlled trials (RCTs) is often reported to be challenging, and the evidence base for effective interventions that could be used by staff (recruiters) undertaking recruitment is lacking. Although the experiences and perspectives of recruiters have been widely reported, an evidence synthesis is required in order to inform the development of future interventions. This paper aims to address this by systematically searching and synthesising the evidence on recruiters’ perspectives and experiences of recruiting patients into RCTs. Methods A qualitative evidence synthesis (QES) following Thomas and Harden’s approach to thematic synthesis was conducted. The Ovid MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, ORRCA and Web of Science electronic databases were searched. Studies were sampled to ensure that the focus of the research was aligned with the phenomena of interest of the QES, their methodological relevance to the QES question, and to include variation across the clinical areas of the studies. The GRADE CERQual framework was used to assess confidence in the review findings. Results In total, 9316 studies were identified for screening, which resulted in 128 eligible papers. The application of the QES sampling strategy resulted in 30 papers being included in the final analysis. Five overlapping themes were identified which highlighted the complex manner in which recruiters experience RCT recruitment: (1) recruiting to RCTs in a clinical environment, (2) enthusiasm for the RCT, (3) making judgements about whether to approach a patient, (4) communication challenges, (5) interplay between recruiter and professional roles. Conclusions This QES identified factors which contribute to the complexities that recruiters can face in day-to-day clinical settings, and the influence recruiters and non-recruiting healthcare professionals have on opportunities afforded to patients for RCT participation. It has reinforced the importance of considering the clinical setting in its entirety when planning future RCTs and indicated the need to better normalise and support research if it is to become part of day-to-day practice. Trial registration PROSPERO CRD42020141297 (registered 11/02/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06818-4.
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Affiliation(s)
- Nicola Farrar
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland Galway, Galway, Ireland
| | - Marcus Jepson
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sangeetha Paramasivan
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Lucy Plumb
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,UK Kidney Association, UK Renal Registry, Bristol, UK
| | - Julia Wade
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, L69 3GB, UK
| | - Jenny L Donovan
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Leila Rooshenas
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Nordling P, Jakobsson A, Hensing G. The Capacity Note: a communication facilitator in the sick leave process of patients with common mental disorders - a qualitative study of user perceptions. BMJ Open 2022; 12:e054436. [PMID: 35487752 PMCID: PMC9058774 DOI: 10.1136/bmjopen-2021-054436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe the development of a communication facilitator, the Capacity Note, for the sick leave process of patients with common mental disorders (CMDs) in primary care, and to explore users' perceptions of it. DESIGN Qualitive study. SETTING Primary healthcare in Region Västra Götaland, Sweden. PARTICIPANTS AND METHODS The Capacity Note was developed inductively based on data from six qualitative studies of work capacity and CMD and was introduced at primary healthcare centres during 2018-2019. Individual semistructured interviews were performed with 13 informants (8 patients, 2 general practitioners and 3 managers) who had used the Capacity Note at least once. Interviews were audiorecorded and transcribed verbatim and inductive manifest qualitative content analysis was used to analyse the data. RESULTS The Capacity Note comprised questions about work situation, work capacity limitations and possible work adjustments. Based on the interviews, four categories relating to its role as a facilitator for communication about work and health were identified: content and format, understanding, legitimacy and action, openness and timing, and time and efficiency. The participants considered the Capacity Note relevant and easy to use, and as having the potential to improve communication about and understanding of the patient's situation. The increased understanding was perceived as contributing to a sense of legitimacy and agency. Achieving these benefits required, according to the participants, openness, an investment of time and using the Capacity Note at the right time in the sick leave process. CONCLUSION The Capacity Note was found to be relevant and as having, under the right conditions, the potential to improve communication and facilitate the sick leave process.
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Affiliation(s)
- Paula Nordling
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Healthcare, Region Västra Götaland, Gothenburg, Sweden
| | - Annika Jakobsson
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Prout H, Tod A, Neal R, Nelson A. Maximising recruitment of research participants into a general practice based randomised controlled trial concerning lung diagnosis—staff insights from an embedded qualitative study. Trials 2022; 23:225. [PMID: 35313926 PMCID: PMC8935731 DOI: 10.1186/s13063-022-06125-y] [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: 12/31/2020] [Accepted: 02/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background The ELCID Trial was a feasibility randomised controlled trial examining the effect on lung cancer diagnosis of lowering the threshold for referral for urgent chest X-ray for smokers and recent ex-smokers, aged over 60 with new chest symptoms. The qualitative component aimed to explore the feasibility of individually randomising patients to an urgent chest X-ray or not and to investigate any barriers to patient recruitment and participation. This would inform the design of any future definitive trial. This paper explores general practice staff insights into participating in and recruiting to diagnostic trials for possible/suspected lung cancer. Methods Qualitative interviews were conducted with 11 general practice staff which included general practitioners, a nurse practitioner, research nurses and practice managers. Interviews were analysed using a framework approach. Results Findings highlight general practice staff motivators to participate in the trial as recruiters, practice staff interactions with patients recruited onto the study, methods of organisation staff used to undertake the trial, the general impact of the trial on practice staff, how the trial research team supported the practices and lastly practice staff suggestions for trial delivery improvement. Conclusions The integration of a qualitative component focused on staff experiences participating in a lung diagnostic trial has demonstrated the feasibility to recruit for similar future studies within general practice. Although recruitment into trials can be difficult, results from our study offer suggestions on maximising patient recruitment not just to trials in general but also specifically for a lung diagnosis study. Trial registration ClinicalTrials.gov, NCT01344005. Registered on 27 April 2011
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Saghdaoui LB, Onida S, Davies AH, Wells M. Why nurses in primary care need to be research active: the case of venous leg ulceration. Br J Community Nurs 2020; 25:422-428. [PMID: 32881607 DOI: 10.12968/bjcn.2020.25.9.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous leg ulceration (VLU) is predominantly managed in primary care by district nurses, however much of the research takes place in secondary care. This study aimed to identify to what extent nurses are involved in publishing VLU research and to ascertain how much VLU research is conducted in primary care. Three searches of literature published between 2015 and 2020 were undertaken, reviewing VLU publications on interventions, quality of life and qualitative research. Some 37% of intervention studies had one or more nurse authors, compared with 65% of quality of life studies and 86% of qualitative research publications. Of papers that providing details of recruitment, 39% of intervention and quality of life studies included primary care as a recruitment setting. Qualitative studies were more likely to recruit from primary as well as secondary care (50%). Nurses are involved in leading VLU research but are more likely to publish quality of life and qualitative research than intervention studies. The majority of nurse authors in this field are based in academic institutions. A minority of studies utilise primary care as a recruitment setting for VLU research. More must be done to enable VLU research in community settings and to promote the involvement of clinical nurses in research.
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Affiliation(s)
- Layla Bolton Saghdaoui
- Clinical Research Nurse and Pre-doctoral Fellow, Imperial College Healthcare NHS Trust and Imperial College London
| | - Sarah Onida
- National Institute for Health Research Clinical Lecturer in Vascular Surgery and Vascular Specialty Registrar, Imperial College Healthcare NHS Trust and Imperial College London
| | - Alun Huw Davies
- Professor of Surgery and Honorary Consultant, Imperial College Healthcare NHS Trust and Imperial College London
| | - Mary Wells
- Professor of Practice in Cancer Nursing and Lead Nurse for Research, Imperial College Healthcare NHS Trust and Imperial College London
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Nejati S, Ariai N, Björkelund C, Skoglund I, Petersson EL, Augustsson P, Hange D, Svenningsson I. Correspondence Between the Neuropsychiatric Interview M.I.N.I. and the BDI-II and MADRS-S Self-Rating Instruments as Diagnostic Tools in Primary Care Patients with Depression. Int J Gen Med 2020; 13:177-183. [PMID: 32523369 PMCID: PMC7234955 DOI: 10.2147/ijgm.s243150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the correspondence between the diagnoses received by patients with symptoms of common mental disorder attending primary care, based on the diagnostic instrument International Neuropsychiatric Interview (M.I.N.I.) and the self-assessment instruments such as Beck Depression Inventory (BDI-II) and Montgomery-Asberg Depression Rating Scale - self-rating version (MADRS-S), respectively. Design Data were collected from a prospective observational study, ADAS, between 2014 and 2015. Setting Twenty-eight primary care centers in Region Västra Gotaland, Sweden. Patients A total of 192 patients, 18-60 years of age, on sick leave ≥14 days, with mild/moderate depression, anxiety syndrome, and stress-related mental illness were included. Main Outcome Measures Scores of the assessment instruments (BDI-II and MADRS-S) on inclusion, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for BDI-II and MADRS-S, respectively, with M.I.N.I used as diagnostic instrument. Results Using M.I.N.I. as gold standard, the BDI-II and MADRS-S showed almost the same sensitivity (86.9% and 87.4%, respectively), but specificity for MADRS-S was doubled compared to BDI-II (36% and 18%, respectively). There was a significant association between MADRS-S and M.I.N.I. (p=0.027). However, the same analysis between BDI and M.I.N.I. was not statistically significant (p= 0.635). NPV and PPV were calculated from assumed prevalences (10% and 75%) and were higher for MADRS-S compared to BDI-II. The PPV differences were between 2% and 7% and NPV differences were between 3% and 19%. Conclusion With M.I.N.I. as gold standard, MADRS-S performs better than BDI-II as a self-assessment tool in the primary care context for depression diagnostics.
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Affiliation(s)
- Shabnam Nejati
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Nashmil Ariai
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ingmarie Skoglund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Pia Augustsson
- Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Irene Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
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Reimer T, Lee SJC, Garcia S, Gill M, Duncan T, Williams EL, Gerber DE. Cancer Center Clinic and Research Team Perceptions of Identity and Interactions. J Oncol Pract 2017; 13:e1021-e1029. [PMID: 29028418 PMCID: PMC5728363 DOI: 10.1200/jop.2017.024349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Conduct of cancer clinical trials requires coordination and cooperation among research and clinic teams. Diffusion of and confusion about responsibility may occur if team members' perceptions of roles and objectives do not align. These factors are critical to the success of cancer centers but are poorly studied. METHODS We developed a survey adapting components of the Adapted Team Climate Inventory, Measure of Team Identification, and Measure of In-Group Bias. Surveys were administered to research and clinic staff at a National Cancer Institute-designated comprehensive cancer center. Data were analyzed using descriptive statistics, t tests, and analyses of variance. RESULTS Responses were received from 105 staff (clinic, n = 55; research, n = 50; 61% response rate). Compared with clinic staff, research staff identified more strongly with their own group ( P < .01) but less strongly with the overall cancer center ( P = .02). Both clinic staff and research staff viewed their own group's goals as clearer than those of the other group ( P < .01) and felt that members of their groups interacted and shared information within ( P < .01) and across ( P < .01) groups more than the other group did. Research staff perceived daily outcomes as more important than did clinic staff ( P = .05), specifically research-related outcomes ( P = .07). CONCLUSION Although there are many similarities between clinic and research teams, we also identified key differences, including perceptions of goal clarity and sharing, understanding and alignment with cancer center goals, and importance of outcomes. Future studies should examine how variation in perceptions and group dynamics between clinic and research teams may impact function and processes of cancer care.
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Affiliation(s)
- Torsten Reimer
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Simon J. Craddock Lee
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Sandra Garcia
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary Gill
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Tobi Duncan
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Erin L. Williams
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - David E. Gerber
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
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Hange D, Ariai N, Kivi M, Eriksson MC, Nejati S, Petersson EL. The impact of internet-based cognitive behavior therapy on work ability in patients with depression - a randomized controlled study. Int J Gen Med 2017; 10:151-159. [PMID: 28579817 PMCID: PMC5446974 DOI: 10.2147/ijgm.s129710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives The aim of this randomized controlled trial (RCT) was to investigate the effects of internet-based cognitive behavior therapy (ICBT) treatment for depression compared to treatment-as-usual (TAU) on improving work ability and quality of life in patients with mild-to-moderate depression. We also examined whether patients treated with ICBT returned to work more rapidly, that is, had fewer days of sick leave, than patients treated with TAU. Design This study is based on material from the PRIM-NET RCT that took place between 2010 and 2013. Setting Primary care centers in Region Vastra Gotaland, Sweden, population about 1.6 million. Patients A total of 77 patients with depression randomized to either ICBT (46 patients) or TAU (31 patients). Mean age of participants was 35.8 years, and 67.5% were women. Main outcome measures Work ability was measured with the Work Ability Index, depressive symptoms with Montgomery Asberg Depression Rating Scale – self-rating version (MADRS-S), quality of life with EuroQoL-5D (EQ-5D), and number of sick leave days. Results Both groups showed an association between improved work ability and reduction of depressive symptoms and between improved work ability and better quality of life. ICBT could not be shown to improve work ability more than TAU among patients with mild-to-moderate depression. There were no differences between the groups concerning number of patients with sick leave or number of sick leave days. Conclusion Our study indicates that a high level of work ability has an association with high health-related quality of life in patients with mild-to-moderate depression, whether they are treated with ICBT or TAU. ICBT has previously been found to be cost-effective and can be seen as a good alternative to TAU. In addition to the ICBT, an intervention oriented toward the work place might improve work ability and reduce the number of sick leave days among patients with depression.
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Affiliation(s)
- Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nashmil Ariai
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Maria Cm Eriksson
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
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10
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Holst A, Nejati S, Björkelund C, Eriksson MCM, Hange D, Kivi M, Wikberg C, Petersson EL. Patients' experiences of a computerised self-help program for treating depression - a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scand J Prim Health Care 2017; 35:46-53. [PMID: 28277055 PMCID: PMC5361419 DOI: 10.1080/02813432.2017.1288813] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore primary care patients' experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment. DESIGN Qualitative study. Data were collected from focus group discussions and individual interviews. SETTING Primary care. METHOD Data were analysed by systematic text condensation by Malterud. SUBJECTS Thirteen patients having received iCBT for depression within the PRIM-NET study. MAIN OUTCOME MEASURES Analysis presented different aspects of patients' experiences of iCBT. RESULTS The informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT. CONCLUSION iCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression. Key points Internet mediated cognitive behavioural therapy (iCBT) can be effective in treating depression in primary care, but patients' experiences of iCBT are rarely studied • Most patients express a need for human contact, real-time interaction, dialogue and guidance when treated for depression. • The patient's opportunity to influence the practical circumstances about iCBT is a success factor, though this freedom brings a large responsibility upon the receiver. • An individual treatment design seems to be crucial, and elements of iCBT could be included as a complement to face-to-face meetings.
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Affiliation(s)
- Anna Holst
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- CONTACT Anna Holst Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 454, SE 405 30 Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria C. M. Eriksson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Carl Wikberg
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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11
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Wikberg C, Westman J, Petersson EL, Larsson MEH, André M, Eggertsen R, Thorn J, Ågren H, Björkelund C. Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care - does it really make a difference? A randomised controlled study. BMC FAMILY PRACTICE 2017; 18:6. [PMID: 28103816 PMCID: PMC5244530 DOI: 10.1186/s12875-016-0578-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little information is available about whether the use of self-assessment instruments in primary care affects depression course and outcome. The purpose was to evaluate whether using a depression self-rating scale in recurrent person-centred GP consultations affected depression severity, quality of life, medication use, and sick leave frequency. METHODS Patients in the intervention group met their GP regularly at least 4 times during the 3 months intervention. In addition to treatment as usual (TAU), patients completed a self-assessment instrument (Montgomery-Asberg Depression Rating Scale) on each occasion, and then GPs used the completed instrument as the basis for a person-centred discussion of changes in depression symptoms. The control group received TAU. Frequency of visits in the TAU arm was the result of the GPs' and patients' joint assessments of care need in each case. Depression severity was measured with Beck Depression Inventory-II (BDI-II), quality of life with EQ-5D, and psychological well-being with the General Health Questionnaire-12 (GHQ-12). Data on sick leave, antidepressant and sedatives use, and care contacts were collected from electronic patient records. All variables were measured at baseline and 3, 6, and 12 months. Mean intra-individual changes were compared between the intervention and TAU group. RESULTS There were no significant differences between the intervention and control group in depression severity reduction or remission rate, change in quality of life, psychological well-being, sedative prescriptions, or sick leave during the whole 12-month follow-up. However, significantly more patients in the intervention group continued antidepressants until the 6 month follow-up (86/125 vs 78/133, p < 0.05). CONCLUSIONS When GPs used a depression self-rating scale in recurrent consultations, patients more often continued antidepressant medication according to guidelines, compared to TAU patients. However, reduction of depressive symptoms, remission rate, quality of life, psychological well-being, sedative use, sick leave, and health care use 4-12 months was not significantly different from the TAU group. These findings suggest that frequent use of depression rating scales in person-centred primary care consultations has no further additional effect on patients' depression or well-being, sick leave, or health care use. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01402206 . Registered June 27 2011(retrospectively registered).
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Affiliation(s)
- C. Wikberg
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J. Westman
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - E-L. Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - M. E. H. Larsson
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - M. André
- Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - R. Eggertsen
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - J. Thorn
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - H. Ågren
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - C. Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Jörgensdotter Wegnelius C, Petersson EL. Cultural Background and Societal Influence on Coping Strategies for Physical Activity Among Immigrant Women. J Transcult Nurs 2016; 29:54-63. [PMID: 27815551 DOI: 10.1177/1043659616676317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of the study was to examine, from an intersectional perspective, how immigrant women with prolonged illness experience the conditions for physical activity. METHOD Focus groups were used. Twenty-two women from primary care representing 14 countries were included. Systematic text condensation was applied for analysis. RESULTS Five conditions were identified: Dual cultures to relate to, Isolation an invisible danger, Keys to physical activity, Physical activity for whom, The power to decide the agenda. DISCUSSION AND CONCLUSION This study shows the importance of raising the intersectional perspective for immigrant women's possibilities to perform physical activity. Immigrant women's vulnerability to power relations and their adjustment to society's expectations are significant considerations to be aware of. IMPLICATIONS FOR PRACTICE Our findings emphasize the significance of collaborating in biomedical and psychosocial issues, considering that the obstacles are more comprehensive than society assumes regarding prior knowledge, isolation, and cultural rules.
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13
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Gerber DE, Reimer T, Williams EL, Gill M, Loudat Priddy L, Bergestuen D, Schiller JH, Kirkpatrick H, Craddock Lee SJ. Resolving Rivalries and Realigning Goals: Challenges of Clinical and Research Multiteam Systems. J Oncol Pract 2016; 12:1020-1028. [PMID: 27624948 PMCID: PMC5455413 DOI: 10.1200/jop.2016.013060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article describes the care processes for a 64-year-old man with newly diagnosed advanced non-small-cell lung cancer who was enrolled in a first-line clinical trial of a new immunotherapy regimen. The case highlights the concept of multiteam systems in cancer clinical research and clinical care. Because clinical research represents a highly dynamic entity-with studies frequently opening, closing, and undergoing modifications-concerted efforts of multiple teams are needed to respond to these changes while continuing to provide consistent, high-level care and timely, accurate clinical data. The case illustrates typical challenges of multiteam care processes. Compared with clinical tasks that are routinely performed by single teams, multiple-team care greatly increases the demands for communication, collaboration, cohesion, and coordination among team members. As the case illustrates, the described research team and clinical team are separated, resulting in suboptimal function. Individual team members interact predominantly with members of their own team. A considerable number of team members lack regular interaction with anyone outside their team. Accompanying this separation, the teams enact rivalries that impede collaboration. The teams have misaligned goals and competing priorities that create competition. Collective identity and cohesion across the two teams are low. Research team and clinical team members have limited knowledge of the roles and work of individuals outside their team. Recommendations to increase trust and collaboration are provided. Clinical providers and researchers may incorporate these themes into development and evaluation of multiteam systems, multidisciplinary teams, and cross-functional teams within their own institutions.
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Affiliation(s)
- David E. Gerber
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Torsten Reimer
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Erin L. Williams
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Mary Gill
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Laurin Loudat Priddy
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Deidi Bergestuen
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Joan H. Schiller
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Haskell Kirkpatrick
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
| | - Simon J. Craddock Lee
- University of Texas Southwestern Medical Center and Texas Oncology, Dallas, TX; and Purdue University, West Lafayette, IN
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