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García-Vivar C, Konradsen H, Kolbrun Svavarsdóttir E, Brødsgaard A, Dieperink KB, Luttik ML, Mahrer-Imhof R, Østergaard B, Imhof L. Healthcare interventions for older people with dementia and family caregivers in Europe: A scoping review. Int J Nurs Pract 2024; 30:e13172. [PMID: 37287366 DOI: 10.1111/ijn.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
AIM This study aimed to examine the extent, range and variety of research in Europe describing healthcare interventions for older people with dementia (PwD) and family caregivers. METHODS This was a scoping review and followed the PRISMA Scoping Review guideline. MEDLINE, CINAHL and Cochrane library databases were searched for studies published between 2010 and 2020. Studies reporting healthcare interventions in Europe for PwD over 65 years and their family caregivers were included. RESULTS Twenty-one studies from six European countries were included. The types of healthcare intervention identified were categorized as follows: (1) family unit intervention (interventions for both PwD and their family caregiver), (2) individual intervention (separate interventions for PwD or family caregivers) and (3) family caregiver only intervention (interventions for family caregivers only but with outcomes for both PwD and family caregivers). CONCLUSIONS This review provides insight into healthcare interventions for older PwD and family caregivers in Europe. More studies are needed that focus on the family as a unit of care in dementia.
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Affiliation(s)
- Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Solna, Sweden
| | - Erla Kolbrun Svavarsdóttir
- School of Health Sciences, Faculty of Nursing, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Aarhus, Denmark
- Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Karin B Dieperink
- Family focused healthcare research Center (FaCe), Department of Clinical Research, University of Southern Denmark and Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Romy Mahrer-Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lorenz Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
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Birkelund L, Dieperink KB, Sodemann M, Lindell JF, Steffensen KD, Nielsen DS. Communicating without a Shared Language: A Qualitative Study of Language Barriers in Language-Discordant Cancer Communication. J Health Commun 2024; 29:187-199. [PMID: 38294170 DOI: 10.1080/10810730.2024.2309357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
We use language to achieve understanding, and language barriers can have major health consequences for patients with serious illness. While ethnic minorities are more likely to experience social inequalities in health and health care, communicative processes in language-discordant cancer care remain unexplored. This study aimed to investigate communication between patients with cancer and limited Danish proficiency and oncology clinicians, with special emphasis on how linguistic barriers influenced patient involvement and decision-making. 18 participant observations of clinical encounters were conducted. Field notes and transcriptions of audio recordings were analyzed, and three themes were identified: Miscommunication and uncertainty as a basic linguistic condition; Impact of time on patient involvement; Unequally divided roles and (mis)communication responsibilities. The results showed that professional interpreting could not eradicate miscommunication but was crucial for achieving understanding. Organizational factors related to time and professional interpreting limited patient involvement. Without professional interpreting, patients' relatives were assigned massive communication responsibilities. When no Danish-speaking relatives partook, clinicians' ethical dilemmas further increased as did patient safety risks. Language barriers have consequences for everyone who engages in health communication, and the generated knowledge about how linguistic inequality manifests itself in clinical practice can be used to reduce social inequalities in health and health care.
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Affiliation(s)
- Lisbeth Birkelund
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Family focused healthcare research Center, University of Southern Denmark, Odense, Denmark
| | - Morten Sodemann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Migrant Health Clinic, Odense University Hospital, Odense, Denmark
| | - Johanna F Lindell
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Karina D Steffensen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Dorthe S Nielsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Østervang C, Jensen CM, Coyne E, Dieperink KB, Lassen A. Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study. JMIR Hum Factors 2024; 11:e48445. [PMID: 38381502 PMCID: PMC10918535 DOI: 10.2196/48445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/30/2023] [Accepted: 12/17/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient. OBJECTIVE This study aimed to evaluate the usability and experience of a newly developed information system. The system was developed together with patients and their family members to help provide the information needed in the ED. METHODS We conducted a mixed methods study consisting of quantitative data obtained from the System Usability Scale questionnaire and qualitative interview data obtained from purposively selected participants included in the quantitative part of the study. RESULTS A total of 106 patients and 14 family members (N=120) answered the questionnaire. A total of 10 patients and 3 family members participated in the interviews. Based on the System Usability Scale score, the information system was rated close to excellent, with a mean score of 83.6 (SD 12.8). Most of the participants found the information system easy to use and would like to use it again. The participants reported that the system helped them feel in control, and the information was useful. Simplifications were needed to improve the user experience for the older individuals. CONCLUSIONS This study demonstrates that the usability of the information system is rated close to excellent. It was perceived to be useful as it enabled understanding and predictability of the patient's trajectory in the ED. Areas for improvement include making the system more usable by older individuals. The study provides an example of how a technological solution can be used to diminish the information gap in an ED context.
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Affiliation(s)
- Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Elisabeth Coyne
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Family Focused Healthcare Research Center (FACE), University of Southern Denmark, Odense, Denmark
| | - Annmarie Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Rothausen CS, Clausen AM, Voltelen B, Dieperink KB. Protective Buffering: Nurses Facilitating Communication Between Adults With Cancer and Their Adult Family Caregivers Who Overprotect One Another-An Integrative Review. J Fam Nurs 2023; 29:417-436. [PMID: 36866540 DOI: 10.1177/10748407231156454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The aim of this study was to explore how nurses can alleviate protective buffering between adult patients with cancer and their adult family caregivers (PROSPERO No. CRD42020207072). An integrative review was conducted. PubMed, CINAHL, Embase, and Cochrane Library were searched for primary research articles published between January 2010 and April 2022. Only research conducted in oncology, hematology, or multiple settings and investigating communication between adult patients with cancer and their adult family caregivers and/or the communication between patients, family caregivers, and nurses was included. The constant comparison method outlined the approach to the analysis and synthesis of the included studies. Titles and abstracts of 7,073 references were screened; 22 articles (19 qualitative and three quantitative studies) were included in the review. Three themes emerged during data analysis: (a) family coping, (b) an isolating journey, and (c) the nurse's role. A study limitation was that "protective buffering" is not a common term in the nursing literature. There is a need for further research on protective buffering in families with cancer, particularly on psychosocial interventions that focus on the whole family across various cancer types.
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Affiliation(s)
- Camilla S Rothausen
- University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Denmark
| | - Anne M Clausen
- University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Denmark
| | - Barbara Voltelen
- University of Southern Denmark, Odense, Denmark
- University College Lillebælt, Vejle, Denmark
| | - Karin B Dieperink
- University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Denmark
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Alawi S, Dieperink KB, Agerskov H, Marcussen J, Möller S, Voltelen B, Hyldig N. Translation and Cross-Cultural Validation of the Danish Version of the Family Health Scale-Long Form: A Psychometric Study. Semin Oncol Nurs 2023; 39:151480. [PMID: 37550098 DOI: 10.1016/j.soncn.2023.151480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The Family Health Scale is a new instrument for evaluating family health. The instrument is reported as valid and reliable in investigating family health among different types of adult family members. This study aimed to translate the Family Health Scale into Danish and investigate its validity and reliability in families with a family member affected by chronic or serious illness. DATA SOURCES Translation was performed through forward and backward bilingual practice consisting of 10 steps. A cross-sectional study included 406 participants, of whom 94 also participated in a follow-up study within 3 weeks for the test-retest. Content validity was examined by conducting cognitive interviews with nine family members. Internal consistency reliability was assessed using Cronbach α. The test-retest reliability was evaluated using intraclass correlation coefficients. Model fit was assessed using confirmatory factor analysis. CONCLUSION The Family Health Scale demonstrated good content validity and a moderate model fit. Both Internal consistency reliability and test-retest reliability were satisfying. Cronbach α ranged from 0.73 to 0.89, while the intraclass correlation coefficient value was 0.88. The confirmatory factor analysis estimated a satisfying model fit, with an acceptable root-mean-square error of 0.076 and a moderate comparative fit index of 0.794. IMPLICATION FOR NURSING PRACTICE The Family Health Scale instrument has the potential to identify vulnerable families or families affected by chronic or serious illnesses, such as cancer. The assessment tool can consequently be used to target interventions to promote family health and improve the health of both the individual and his/her family.
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Affiliation(s)
- Sharifa Alawi
- Department of Oncology, Research Unit of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark.
| | - Karin B Dieperink
- Department of Oncology, Research Unit of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Jette Marcussen
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Health Sciences, University College Lillebaelt, Vejle, Denmark; Department of Nature and Health, University of Greenland
| | - Sören Möller
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Barbara Voltelen
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Department of Nursing Education and Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Nana Hyldig
- Department of Haematology, Research Unit of Haematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Justesen RM, Ikander TM, Thomsen TG, Dieperink KB. Nursing Roles in Cancer Rehabilitation: An Integrative Review. Cancer Nurs 2023:00002820-990000000-00141. [PMID: 37158677 DOI: 10.1097/ncc.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Because of cancer survivors' increased need for help and support, cancer rehabilitation should be an essential part of cancer treatment, where focusing on patients' individual needs is essential. OBJECTIVE To provide an overview of existing evidence about nurses' roles and participation in cancer rehabilitation, based on both nurses' and patients' perspectives. METHODS A systematic search was conducted in PubMed, CINAHL, EMBASE and Cochrane databases for studies published from January 2001-January 2022. Whittemore and Knafl's methodology for data extraction and synthesis was used, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. The review was registered in PROSPERO (CRD42021223683). RESULTS Ten qualitative studies and 7 quantitative studies were included, encompassing 306 patients and 1847 clinicians (1164 nurses). Three nursing roles emerged: (1) relationship-forming, in which nurses described ongoing involvement in patients' rehabilitation and patients described nurses as trusted partners; (2) coordinating, in which nurses described a lack of time and resources and a focus on medical treatment, and patients described nurses as expert coordinators; and (3) follow-up, in which patients described nurses as good communicators and trusted partners in their follow-up, and nurses described their natural interest in patients' rehabilitation outcomes during follow-up. CONCLUSIONS Patients were comfortable with nurses as trusted partners during cancer rehabilitation. Significant barriers such as lack of time, resources, and education about rehabilitation may negatively influence rehabilitation planning, implementation, and monitoring. IMPLICATIONS FOR PRACTICE Clinicians can use the findings to improve cancer rehabilitation with the nurse as a central provider and conduct further research on the coordinating and follow-up roles.
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Affiliation(s)
- Rikke M Justesen
- Author Affiliations: Department of Clinical Research, University of Southern Denmark (Ms Justesen and Drs Ikander, Dieperink, and Thomsen); Research Unit of Oncology, Odense University Hospital (Dr Dieperink), Odense; Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge (Dr Thomsen); and REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg (Dr Ikander), Denmark
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Dieperink KB, Møller JJK, Mikkelsen TB, Nissen NK, La Cour K, Rottmann N. The Danish landscape of providing support for caregivers of people with potentially life-threatening disease: A cross-sectional study among representatives of health services in Danish municipalities and hospitals. Scand J Public Health 2023:14034948231159464. [PMID: 37026179 DOI: 10.1177/14034948231159464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
AIMS (a) To investigate support for caregivers of people diagnosed with stroke, cancer, chronic obstructive pulmonary disease (COPD), dementia, or heart disease provided across healthcare settings in Denmark; (b) to assess differences in caregiver support across diagnoses and settings. METHODS A cross-sectional nationwide survey among professionals representing healthcare settings at municipalities (n = 479) and hospital wards and outpatient clinics (n = 425). The survey assessed identification of caregivers and support initiatives. RESULTS The response rate was 81% for municipalities and 49% for hospitals. Identification of caregivers was frequent in dementia care (81% and 100%) and less frequent in COPD care (58% and 64%) in municipalities and hospitals, respectively. Caregiver support differed significantly across diagnoses within municipalities (p = 0.009) and hospitals (p < 0.001). Systematic identification of vulnerable caregivers was <25% for all diagnoses except dementia. The most common support initiatives involving caregivers were primarily aimed at the ill person and included guidance about the disease and consequences for everyday life and lifestyle changes. Caregivers were least involved in support initiatives addressing physical training, work retention, sexuality, or cohabitation. CONCLUSIONS
Disparities and significant differences across diagnoses exist in the identification of caregivers and the provision of support initiatives. Support initiatives involving caregivers primarily targeted patients. Future studies should investigate how caregivers' needs can be met across different diagnoses and healthcare settings and investigate potential changes in caregivers' needs during disease trajectories. In clinical practice, identification of vulnerable caregivers should be a major focus, and disease-specific clinical guidelines may be required to ensure sufficient support for caregivers.
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Affiliation(s)
- Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Denmark
- Family focused healthcare Research (FaCe), University of Southern Denmark, Nyborg, Denmark
| | - Jens-Jakob K Møller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Tina B Mikkelsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Nina Konstantin Nissen
- DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, Odense, Denmark
| | - Karen La Cour
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Public Health, Research Unit for User involvement and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
| | - Nina Rottmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Psychology, University of Southern Denmark, Denmark
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Kotronoulas G, Miguel S, Dowling M, Fernández-Ortega P, Colomer-Lahiguera S, Bağçivan G, Pape E, Drury A, Semple C, Dieperink KB, Papadopoulou C. An Overview of the Fundamentals of Data Management, Analysis, and Interpretation in Quantitative Research. Semin Oncol Nurs 2023; 39:151398. [PMID: 36868925 DOI: 10.1016/j.soncn.2023.151398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES To provide an overview of three consecutive stages involved in the processing of quantitative research data (ie, data management, analysis, and interpretation) with the aid of practical examples to foster enhanced understanding. DATA SOURCES Published scientific articles, research textbooks, and expert advice were used. CONCLUSION Typically, a considerable amount of numerical research data is collected that require analysis. On entry into a data set, data must be carefully checked for errors and missing values, and then variables must be defined and coded as part of data management. Quantitative data analysis involves the use of statistics. Descriptive statistics help summarize the variables in a data set to show what is typical for a sample. Measures of central tendency (ie, mean, median, mode), measures of spread (standard deviation), and parameter estimation measures (confidence intervals) may be calculated. Inferential statistics aid in testing hypotheses about whether or not a hypothesized effect, relationship, or difference is likely true. Inferential statistical tests produce a value for probability, the P value. The P value informs about whether an effect, relationship, or difference might exist in reality. Crucially, it must be accompanied by a measure of magnitude (effect size) to help interpret how small or large this effect, relationship, or difference is. Effect sizes provide key information for clinical decision-making in health care. IMPLICATIONS FOR NURSING PRACTICE Developing capacity in the management, analysis, and interpretation of quantitative research data can have a multifaceted impact in enhancing nurses' confidence in understanding, evaluating, and applying quantitative evidence in cancer nursing practice.
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Affiliation(s)
- Grigorios Kotronoulas
- Reader, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, UK.
| | - Susana Miguel
- Clinical Nurse Specialist, Department of Head and Neck and ENT Cancer Surgery of the Portuguese Institute of Oncology of Francisco Gentil, Lisbon, Portugal
| | - Maura Dowling
- Senior Lecturer, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Paz Fernández-Ortega
- Associate Professor, Catalan Institute of Oncology and Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Sara Colomer-Lahiguera
- Senior Nurse Scientist, Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, and Lausanne University Hospital, Lausanne, Switzerland
| | - Gülcan Bağçivan
- Associate Professor, School of Nursing, Koc University, Istanbul, Turkey
| | - Eva Pape
- Clinical Nurse Specialist, Department of Gastrointestinal Surgery, Cancer Center, Ghent University Hospital, Ghent, Belgium
| | - Amanda Drury
- Associate Professor, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Cherith Semple
- Reader, School of Nursing, Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Karin B Dieperink
- Professor, Department of Clinical Research, University of Southern Denmark, Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Constantina Papadopoulou
- Reader, School of Health and Life Sciences, University of the West of Scotland, South Lanarkshire, Scotland, UK
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Konradsen H, Brødsgaard A, Østergaard B, García-Vivar C, Svavarsdottir EK, Dieperink KB, Imhof L, Luttik MLA, Mahrer-Imhof R. The COVID-19 Post Pandemic: Family Nursing Now More Than Ever. J Fam Nurs 2023; 29:3-5. [PMID: 36647809 PMCID: PMC9850070 DOI: 10.1177/10748407221147965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Ikander T, Dieperink KB, Hansen O, Raunkiær M. Patient, Family Caregiver, and Nurse Involvement in End-of-Life Discussions During Palliative Chemotherapy: A Phenomenological Hermeneutic Study. J Fam Nurs 2022; 28:31-42. [PMID: 34551643 DOI: 10.1177/10748407211046308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to investigate current nursing practice related to end-of-life discussions with incurable lung cancer patients and their family caregivers from the perspectives of patients, family caregivers, and nurses in an oncology outpatient clinic. This phenomenological hermeneutic study included nine patients, eight family caregivers, and 11 nurses. Data were collected using participant observation, informal and semi-structured individual or joint interviews with patients and family caregivers, and focus group interviews with nurses. A Ricoeur-inspired approach was used to analyze the data. Three themes were identified: (a) content of end-of-life discussions, (b) timing of end-of-life discussions, and (c) challenges in end-of-life discussions. End-of-life discussions were seldom initiated; when they were, it was often too late. Discussions addressed treatment, place of care, practical/economic concerns, and existential matters. The physical environment at the outpatient clinic, lack of continuity, and nurses' instrumental task workloads and time pressure posed challenges to initiating end-of-life discussions.
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Affiliation(s)
- Tine Ikander
- Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark
- Family-focused healthcare research Centre (FaCe). Department of Clinical Research, University of Southern Denmark
- Department of Clinical Research, University of Southern Denmark
| | - Karin B Dieperink
- Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- Family-focused healthcare research Centre (FaCe). Department of Clinical Research, University of Southern Denmark
- Department of Clinical Research, University of Southern Denmark
| | - Olfred Hansen
- Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark
| | - Mette Raunkiær
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark
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Tolstrup LK, Pappot H, Bastholt L, Möller S, Dieperink KB. Impact of patient-reported outcomes on symptom monitoring during treatment with checkpoint inhibitors: health-related quality of life among melanoma patients in a randomized controlled trial. J Patient Rep Outcomes 2022; 6:8. [PMID: 35061112 PMCID: PMC8782960 DOI: 10.1186/s41687-022-00414-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction In a randomized controlled trial, we previously investigated if melanoma patients receiving checkpoint inhibitors had fewer severe immune-related adverse events (irAEs) when they reported symptoms using electronic patient-reported outcomes (ePRO) with triggered alerts as an add-on to standard care, compared to standard care alone. The aim of this study is to examine between-group differences in health-related quality of life (HRQoL) and associations between irAEs severity and HRQoL. Methods The study population of 138 patients completed the EuroQol EQ-5D-5L Index and FACT-M questionnaires at baseline and weeks 24 and 48. We analyzed HRQoL from all patients who completed at least one questionnaire. Missing FACT-M items were imputed following existing guidelines. Results There was no difference in HRQoL at baseline as measured EQ-5D-5L between the intervention and the control group. Between baseline and 48 weeks, mean EQ-5D-5L scores were unchanged among patients in the intervention group (p = 0.81) but decreased significantly among patients in the control group (p = 0.03). Consequently, patients in the intervention group had higher mean scores than those in the control group (p = 0.05) at 48 weeks. Mean FACT-M scores did not differ significantly between the two groups at any of the time points. There were observed no between-group differences in mean EQ-5D-5 and mean FACT-M scores between patients with severe irAEs and patients who had none. Conclusion Melanoma patients receiving CPIs who self-reported irAEs using ePRO with triggered alerts as a supplement to standard care maintained their HRQoL compared to patients who received standard care alone. Patients in the intervention group had a significantly better HRQoL measured by EQ-5D-5L than controls 48 weeks after baseline. The results suggest that including ePRO in standard care increases melanoma patients´ well-being. Further and larger studies are needed to confirm this finding and examine the impact of severe irAEs on cancer patients’ HRQoL. Trial registration: Clinicaltrials.gov NCT03073031 Registered 8 March 2017, Retrospectively registeredhttps://clinicaltrials.gov/. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00414-5.
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Møller PK, Pappot H, Bernchou U, Schytte T, Mortensen ZV, Brúnni MFÁ, Dieperink KB. Feasibility, usability and acceptance of weekly electronic patient-reported outcomes among patients receiving pelvic CT- or online MR-guided radiotherapy - A prospective pilot study. Tech Innov Patient Support Radiat Oncol 2022; 21:8-15. [PMID: 34977367 PMCID: PMC8686059 DOI: 10.1016/j.tipsro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Recruitment for weekly self-reporting of symptoms in radiotherapy is feasible. The frequency and time spent on responding to 18 symptomatic AEs weekly is feasible. Adherence to weekly self-reporting is high in a population with a sizable proportion of patients age 70 or above. Real-time feedback from clinicians is requested by the patients.
Introduction The potential of patient symptoms being monitored longitudinally in radiotherapy (RT) is still unexploited. When novel technologies like online adaptive MR-guided radiotherapy (MRgRT) are evaluated, weekly electronic patient-reported outcomes (ePROs) may add knowledge about the symptom trajectory. This study aimed at evaluating feasibility, usability and acceptance of weekly ePRO among patients receiving pelvic radiotherapy. Materials and Methods In a mixed-methods convergent design, a prospective pilot study enrolled patients referred to pelvic radiotherapy with curative intent. Patients used their own device at home to self-report PRO weekly during and four weeks following radiotherapy and week 8, 12, and 24 (paper-questionnaire as an alternative). Feasibility was extracted from the ePRO software. The Patient Feedback Form and patient interviews were used to explore usability and patient acceptance. Patients were informed that clinicians had no access to PRO responses. Results In total, 40 patients were included; 32 patients with prostate cancer and 8 with cervical cancer (consent rate 87%), median age 68 (36–76). The majority did digital reporting (93%). 85% of patients responded to ≥80% of the weekly questionnaires with 91% average adherence to weekly completion (60% for follow-up), although lower for patients ≥age 70. Time spent on ePRO (97%) and frequency of reporting (92%) was considered appropriate. Interviews (n = 14) revealed the application was usable and the patients requested real-time feedback from the clinicians. Conclusion Recruitment for ePRO during radiotherapy was feasible and adherence to weekly self-reporting high. The digital application was usable and weekly frequency and time spent acceptable. Real-time feedback from the clinicians is requested by the patients.
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Key Words
- AE, Adverse event
- Acceptance
- CTCAE, Common Terminology Criteria of Adverse Events
- ECOG, Eastern Cooperative Oncology Group
- EORTC, European Organization for Research and Treatment of Cancer
- Feasibility
- Gy, Gray
- MR, Magnetic resonance
- MRgRT, Magnetic resonance guided radiotherapy
- NCI, National Cancer Institute
- Online MRgRT
- PRO, Patient-Reported Outcome
- PRO-CTCAE, Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events
- Patient-reported outcome (PRO)
- QLQ-C30, EORTC general core module
- QoL, Quality of life
- RT, Radiotherapy
- Radiotherapy
- Usability
- WHO, World Health Organization Performance Status
- ePRO, Electronic Patient-Reported Outcome
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Affiliation(s)
- P K Møller
- Department of Oncology, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Denmark.,Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - T Schytte
- Department of Oncology, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Z V Mortensen
- Department of Oncology, Odense University Hospital, Denmark
| | - M F Á Brúnni
- Department of Oncology, Odense University Hospital, Denmark
| | - K B Dieperink
- Department of Oncology, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
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13
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Mahrer-Imhof R, Østergaard B, Brødsgaard A, Konradsen H, Svavarsdóttir EK, Dieperink KB, Imhof L, García-Vivar C, Luttik ML. Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review. Scand J Caring Sci 2021; 36:320-345. [PMID: 34786754 DOI: 10.1111/scs.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. AIMS This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. MATERIALS & METHODS A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. RESULTS A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. DISCUSSION This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.
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Affiliation(s)
- Romy Mahrer-Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark.,Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Erla Kolbrun Svavarsdóttir
- School of Health Sciences, Faculty of Nursing, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Karin B Dieperink
- Family Focused Healthcare Research Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lorenz Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | | | - Marie-Louise Luttik
- Family Care, Hanze University of Applied Sciences, Groningen, The Netherlands
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14
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Møller PK, Pappot H, Bernchou U, Schytte T, Dieperink KB. Correction to: Development of patient-reported outcomes item set to evaluate acute treatment toxicity to pelvic online magnetic resonance-guided radiotherapy. J Patient Rep Outcomes 2021; 5:62. [PMID: 34313870 PMCID: PMC8316503 DOI: 10.1186/s41687-021-00333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P K Møller
- Department of Oncology, Odense University Hospital, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - T Schytte
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - K B Dieperink
- Department of Oncology, Odense University Hospital, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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15
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Nordentoft S, Dieperink KB, Johansson SD, Jarden M, Piil K. Evaluation of a multimodal rehabilitative palliative care programme for patients with high-grade glioma and their family caregivers. Scand J Caring Sci 2021; 36:815-829. [PMID: 34296773 DOI: 10.1111/scs.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients diagnosed with high-grade glioma and their family caregivers often experience intense disease and treatment trajectories. Fluctuations in patient's symptoms lead to enormous burdens for caregivers and the risk of developing symptoms of stress, anxiety, and depression. AIM The study aim is to explore patient and caregiver experiences and evaluate the relevance of and satisfaction with a multimodal rehabilitative palliative care programme for patients diagnosed with a high-grade glioma and their family caregivers. METHODS In a longitudinal multi-methods study, adult patients with high-grade glioma (n = 17) and their family caregivers (n = 16) completed a 4-day residential programme and a 2-day follow-up programme 3 months later. Participants completed questionnaires after each programme, scoring relevance and satisfaction on a 5-point Likert scale. Qualitative data were collected during four evaluation group interviews with patients and caregivers. RESULTS The mean overall satisfaction score was 4.80 (standard deviation [SD], 0.55) for the initial 4-day programme and 4.28 (SD, 0.83) for the follow-up programme. Three themes emerged in the evaluation group interviews: (1) meeting peers strengthens social well-being, (2) the value of information and focusing on individual needs, and (3) accepting life as an unpredictable passage. CONCLUSION Participants found completing the REHPA-HGG programme feasible and rated all sessions highly for relevance and satisfaction. Qualitative findings confirm the value of individualised information, acceptance, and peer interactions. IMPLICATION FOR PRACTICE A multimodal rehabilitative palliative care programme addressed unmet patient and caregiver needs. Peer-to-peer interventions for family caregivers may address individual support needs. Similar programmes may maximise benefit by avoiding planned behaviour changes and enhancing palliative approaches.
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Affiliation(s)
- Sara Nordentoft
- Research Unit, Center for Cancer and Organ Disease, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Center for Cancer and Organ Diseases, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Danish Center for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark.,Family Focused Healthcare Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susan D Johansson
- Danish Center for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark
| | - Mary Jarden
- Department of Hematology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Piil
- Center for Cancer and Organ Diseases, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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16
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Møller PK, Pappot H, Bernchou U, Schytte T, Dieperink KB. Development of patient-reported outcomes item set to evaluate acute treatment toxicity to pelvic online magnetic resonance-guided radiotherapy. J Patient Rep Outcomes 2021; 5:47. [PMID: 34160732 PMCID: PMC8220120 DOI: 10.1186/s41687-021-00326-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
Background A new technology in cancer treatment, the MR-linac, provides online magnetic resonance-guided radiotherapy (MRgRT) that combines real-time visualization of the tumor and surrounding tissue with radiation therapy to deliver treatment more accurately. Online MRgRT makes it possible to minimize treatment volume, potentially reducing acute treatment toxicity. Patient-reported outcomes (PRO) add the patient perspective to evaluating treatment toxicity related to new technology. The objective of this mixed-methods study was to develop and explore the content validity of a set of PRO items to evaluate acute pelvic toxicity to radiotherapy including online MRgRT. Methods A literature review and chart audit were conducted to identify symptomatic adverse events (AEs) to be selected from the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) library and European Organisation for Research and Treatment of Cancer (EORTC) item library. To validate the content, the item set was applied in a prospective pilot cohort of patients referred for primary pelvic RT with curative intent. Patients reported symptoms weekly during RT (4–8 weeks) and the subsequent 4 weeks. Follow-up reports were collected at 8, 12, and 24 weeks after RT. To ensure symptom coverage clinician-reported toxicity and individual patient interviews were conducted. The symptomatic AEs were included in the final item set if ≥20% of patients reported them. Results Eighteen acute symptomatic AEs were selected for the initial item set. Forty patients (32 prostate cancer, 8 cervical cancer) were included in the pilot study. Patients with prostate cancer and those with cervical cancer both reported all 18 acute AEs. However, vomiting was not reported by > 20% of patients thus excluded from the item set. Adding a few diagnosis-specific AEs to the final item set was required for both prostate and cervical cancer patients. Conclusions A PRO item set for patients with pelvic cancer treated with radiotherapy with a curative intent was developed and content validity explored. In the pilot study, the item set captured the most common acute symptomatic AEs for patients with prostate and cervical cancer related to pelvic RT including online MRgRT. Further validation of the content in broader disease sites would be needed in future studies. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00326-w.
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Affiliation(s)
- P K Møller
- Department of Oncology, Odense University Hospital, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - T Schytte
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - K B Dieperink
- Department of Oncology, Odense University Hospital, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Tolstrup LK, Bastholt L, Dieperink KB, Möller S, Zwisler AD, Pappot H. The use of patient-reported outcomes to detect adverse events in metastatic melanoma patients receiving immunotherapy: a randomized controlled pilot trial. J Patient Rep Outcomes 2020; 4:88. [PMID: 33125537 PMCID: PMC7599285 DOI: 10.1186/s41687-020-00255-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background A randomized controlled pilot trial was conducted to assess if melanoma patients treated with immunotherapy had the number of grade 3 or 4 adverse events during treatment reduced by 50% using a tailored electronic patient-reported outcomes tool in addition to standard toxicity monitoring compared to standard monitoring alone. Secondary endpoints were: if more AEs were reported in the intervention group, if there was a difference between the two groups in the number of telephone consultations, extra out-patient visits, number of days in the hospital, days in steroid treatment and the time patients experienced grade 2 or higher toxicity. Patients and methods Melanoma patients receiving immunotherapy at the Department of Oncology, Odense University Hospital, Denmark participated. Standard care included assessment of AEs by a clinician before each treatment cycle using the Common Terminology Criteria for Adverse Events. In addition, patients randomized to the intervention reported their AEs weekly by an electronic PRO-tool based on the PRO-CTCAE platform. Results One hundred forty-six melanoma patients were randomized. In this study, we did not detect a difference between the two groups in the number of grade 3 or 4 AEs (P = 0.983), in the overall number of AEs (P = 0.560) or in the time the patients in the two groups experienced grade 2 or higher toxicity (0.516). The number of phone contacts was significantly higher in the intervention group (P = 0.009) and there was a tendency towards patients in the intervention group having more extra visits (P = 0.156). Conclusion It has been examined if the number of severe AEs for melanoma patients receiving immunotherapy could be reduced by involving the patients in the reporting of symptoms. The results do not justify the expansion of the pilot study into a regular phase III study with this particular set-up. However, a significant difference in the number of phone contacts was found as patients in the intervention group called more frequently, indicating that their attention to AEs was increased. Even though the use of an electronic PRO tool could not reduce the number of severe AEs in this melanoma population, a positive impact on other endpoints such as QoL, communication, or treatment-planning, cannot be excluded. Trial registration Clinicaltrials.gov NCT03073031 Registered 8 March 2017, Retrospectively registered.
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Affiliation(s)
- Lærke K Tolstrup
- Department of Oncology, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Nyborg, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
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18
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Kristensen MB, Wessel I, Ustrup KS, Dieperink KB, Zwisler AD, Beck AM. Nutrition screening and assessment tools for patients with cancer and survivors of cancer: a systematic review protocol. BMJ Open 2020; 10:e037844. [PMID: 33004394 PMCID: PMC7534678 DOI: 10.1136/bmjopen-2020-037844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Nutritional challenges are common consequences of cancer, and they do not only occur in the hospital setting. They are also frequent after completion of treatment, and nutritional interventions in community-based post-treatment rehabilitation services are important. The first step towards initiating any nutritional intervention is to identify the individual in need hereof, but evidence is limited on the applicability of different nutrition screening and assessment tools in the post-treatment rehabilitation services. The aim is to systematically review and identify nutrition screening and assessment tools appropriate for use in patients with cancer and survivors of cancer in hospital or community-based healthcare settings. METHODS AND ANALYSIS In this systematic review, the electronic databases PubMed, CINAHL Complete and Embase were searched systematically using comprehensive search strategies. Primary searches were carried out in August 2018 with updated searches performed in November 2019. Clinicaltrials.gov and PROSPERO International Prospective Register of Systematic Reviews will be searched for additional relevant studies. Studies will be included if they validate a nutrition screening or assessment tool in adult patients with cancer or survivors of cancer. No restriction on publication date will be applied, and full-text articles in English, Danish, Norwegian and Swedish are eligible for inclusion. Two reviewers will independently conduct screening of search results, study selection, data extraction and quality assessment. Data will be synthesised narratively. ETHICS AND DISSEMINATION No ethical approval is required. Results will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and published in an international peer-reviewed journal. Furthermore, results will be presented in relevant research and clinical fora to facilitate transfer of results to clinical practice in benefit of patients. PROSPERO REGISTRATION NUMBER CRD42018096678.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Kim Skov Ustrup
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Karin B Dieperink
- Research Unit of Oncology, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Herlev, Denmark
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19
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Kristensen MB, Wessel I, Beck AM, Dieperink KB, Mikkelsen TB, Møller JJK, Zwisler AD. Effects of a Multidisciplinary Residential Nutritional Rehabilitation Program in Head and Neck Cancer Survivors-Results from the NUTRI-HAB Randomized Controlled Trial. Nutrients 2020; 12:nu12072117. [PMID: 32708864 PMCID: PMC7400860 DOI: 10.3390/nu12072117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer survivors frequently experience nutritional challenges, and proper rehabilitation should be offered. The trial objective was to test the effect of a multidisciplinary residential nutritional rehabilitation programme addressing physical, psychological, and social aspects of eating problems after treatment. In a randomized controlled trial, 71 head and neck cancer survivors recruited through a nationwide survey were randomized to the program or a wait-list control group. Inclusion was based on self-reported interest in participation. The primary outcome was change in body weight. Secondary outcomes included physical function, quality of life, and symptoms of anxiety and depression. Differences between groups at the 3-month follow-up were tested. No significant differences were seen in body weight change, but there were overall trends towards greater improvements in physical function (hand grip strength: p = 0.042; maximal mouth opening: p = 0.072) and quality of life ("Role functioning": p = 0.041; "Speech problems": p = 0.040; "Pain": p = 0.048) in the intervention group. To conclude, a multidisciplinary residential nutritional rehabilitation program had no effect on body weight in head and neck cancer survivors with self-reported interest in participation, but it may have effect on physical function and quality of life. Further research on relevant outcomes, inclusion criteria, and the program's effect in different subgroups is needed.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
- Correspondence: ; Tel.: +45-2429-6329
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark;
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 50, 4. 2730 Herlev, Denmark
| | - Karin B. Dieperink
- Research Unit of Oncology, Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark;
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000 Odense C, Denmark
| | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
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20
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Nielsen DS, Dieperink KB. Cultural Perspectives and Nurses Reactions on the Corona Pandemic: A Critical View From Denmark. J Transcult Nurs 2020; 31:333-336. [DOI: 10.1177/1043659620924118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dorthe S. Nielsen
- University of Southern Denmark, Odense, Denmark
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark
- Familiy Focused Healthcare Research Center FaCe, University of Southern Denmark
| | - Karin B. Dieperink
- University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Familiy Focused Healthcare Research Center FaCe, University of Southern Denmark
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21
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Konradsen H, Brødsgaard A, Østergaard B, Svavarsdóttir E, Dieperink KB, Imhof L, Luttik ML, Mahrer-Imhof R, García-Vivar C. Health practices in Europe towards families of older patients with cancer: a scoping review. Scand J Caring Sci 2020; 35:375-389. [PMID: 32291782 DOI: 10.1111/scs.12855] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION In Europe, cancer is one of the predominant causes of mortality and morbidity among older people aged over 65. A diagnosis of cancer can imply a negative impact on the quality of life of the older patients and their families. Despite research examining the impact of cancer on the family, it is unclear what kind of information is available about the types of clinical practice towards older patients with cancer and their families. The aim is to determine the extent, range and variety of research in Europe describing health practices towards families of older patients with cancer and to identify any existing gaps in knowledge. METHODS Scoping review. RESULTS A total of 12 articles were included, showing that family interventions are generally based on end-of-life care. Most studies used a qualitative approach and involved different types of family member as participants. Most studies were conducted in the UK. CONCLUSIONS Review findings revealed limited knowledge about health practices in Europe towards families with an older patient with cancer. This review indicates a need to increase family-focused research that examines health practices that meet the needs of families of older patients with cancer. Seeing cancer as a chronic disease, there is an urgent need for the implementation of family-focused interventions.
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Affiliation(s)
- Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Solna, Sweden
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark.,Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erla Svavarsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology and Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Lorenz Imhof
- Community-Based Care, Nursing Science & Care Ltd, Winterthur, Switzerland
| | - Marie Louise Luttik
- Family Care, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Romy Mahrer-Imhof
- Community-Based Care, Nursing Science & Care Ltd, Winterthur, Switzerland
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Tolstrup LK, Pappot H, Bastholt L, Zwisler AD, Dieperink KB. Patient-Reported Outcomes During Immunotherapy for Metastatic Melanoma: Mixed Methods Study of Patients' and Clinicians' Experiences. J Med Internet Res 2020; 22:e14896. [PMID: 32271150 PMCID: PMC7180512 DOI: 10.2196/14896] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/16/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background The benefits of electronic patient reported outcomes (PRO) questionnaires have been demonstrated in many settings, including in hospitals and patient homes. However, it remains to be investigated how melanoma patients and their treating clinicians experience the electronic self-reporting of side effects and the derived communication. Objective The primary objective of this study was to examine patients’ and clinicians’ experiences with an eHealth intervention for weekly monitoring of side effects during treatment with immunotherapy. Methods An eHealth intervention based on questions from the PRO-Common Terminology Criteria for Adverse Events (CTCAE) library was used and tested in a randomized clinical trial with patients receiving immunotherapy for malignant melanoma and clinicians at a university hospital in Denmark. On a weekly basis, patients reported their symptoms from home during the treatment via a provided tablet. The electronic patient reports were available to clinicians in the outpatient clinic. A mixed methods approach was applied to investigate the patients’ and clinicians’ experiences with the intervention. Data from patient experiences were collected in a short survey, the Patient Feedback Form. Moreover, a subset of the patients participating in the survey was interviewed about their experience. Furthermore, one focus group interview with clinicians was carried out to elucidate their views. Results A total of 57 patients completed the Patient Feedback Form, and 14 patients were interviewed. The focus group interview included 5 clinicians. Overall, patients and clinicians were satisfied with the tool. They believed it enhanced patients’ awareness of side effects and increased their feeling of involvement. The patients reported that it was easy to fill out the questionnaire and that it made sense to do so. However, a minority of the patients expressed in the interviews that they did not believe that the health care professionals had seen their reports when they came to the clinic, and that the reporting did not lead to increased contact with the department. Conclusions Overall, satisfaction with the eHealth intervention was high among patients and their treating clinicians. The tool was easy to use and contributed to greater symptom awareness and patient involvement. Thus, in terms of patient and clinician satisfaction with the tool, it makes sense to continue using the tool beyond the project period. Trial Registration ClinicalTrials.gov NCT03073031; https://tinyurl.com/tjx3gtu
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Affiliation(s)
- Lærke K Tolstrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Bastholt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
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23
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Abstract
PURPOSE To investigate caregivers' experiences and level of involvement with video-based patient rounds. PARTICIPANTS & SETTING 17 caregivers of patients with cancer at Odense University Hospitals in Denmark. METHODOLOGIC APPROACH Field observation and semistructured interviews were employed. Interpretative phenomenologic analysis was used for data analysis. 17 interviews with caregivers and 190 hours of observations were conducted. FINDINGS Video-based patient rounds made it possible for caregivers to attend without being physically present at the hospital. This allowed flexibility in caregivers' daily lives. However, caregivers also noted limitations in the use of video, particularly when conversations with healthcare professionals included serious messages. In that context, physical presence was preferred. IMPLICATIONS FOR NURSING This study highlights the importance caregivers place on involvement and how video-based patient rounds allow caregivers to participate without being physically present at the hospital. The structure of video-based patient rounds and the topic of conversation should be considered.
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24
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Kristensen MB, Wessel I, Beck AM, Dieperink KB, Mikkelsen TB, Møller JJK, Zwisler AD. Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial). Nutr J 2020; 19:21. [PMID: 32183835 PMCID: PMC7079410 DOI: 10.1186/s12937-020-00539-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background Eating problems frequently affect quality of life and physical, psychological and social function in patients treated for head and neck cancer (HNC). Residential rehabilitation programmes may ameliorate these adverse effects but are not indicated for all individuals. Systematic assessment of rehabilitation needs may optimise the use of resources while ensuring referral to rehabilitation for those in need. Yet, evidence lacks on which nutrition screening and assessment tools to use. The trial objectives are: 1) To test the effect of a multidisciplinary residential nutritional rehabilitation programme compared to standard care on the primary outcome body weight and secondary outcomes health-related quality of life, physical function and symptoms of anxiety and depression in patients curatively treated for HNC and 2) To test for correlations between participants’ development in outcome scores during their participation in the programme and their baseline scores in Nutritional Risk Screening 2002 (NRS 2002), the Scored Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and M. D. Anderson Dysphagia Inventory (MDADI) and to assess sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores. Methods In a randomised controlled trial, 72 patients treated for HNC recruited through a nationwide survey will be randomised to a multidisciplinary residential nutritional rehabilitation programme or to a wait-list control group. Data are collected at baseline, three and six months. Primary outcome is change in body weight, and secondary outcomes include changes in quality of life, physical function and symptoms of anxiety and depression. Potential correlations between intervention effect and baseline scores in NRS 2002, PG-SGA-SF and MDADI will be tested, and sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores will be assessed. Discussion This is the first randomised controlled trial to test the effect of a multidisciplinary residential nutritional rehabilitation programme in patients treated for HNC. Recruitment through a nationwide survey gives a unique possibility to describe the trial population and to identify potential selection bias. As the trial will explore the potential of different nutrition screening and assessment tools in the assessment of rehabilitation needs in patients treated for HNC, the trial will create knowledge about how selection and prioritisation of nutritional rehabilitation aimed at patients treated for HNC should be offered. The results may contribute to a better organisation and use of existing resources in benefit of patients treated for HNC. Trial registration The trial is registered by The Danish Data Protection Agency (registration 2012-58-0018, approval number 18/14847) and the Regional Committees on Health Research Ethics for Southern Denmark (journal number 20182000–165). ClinicalTrials.gov Identifier: NCT03909256. Registered April 9, 2019.
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Affiliation(s)
- Marianne Boll Kristensen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark. .,Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, J.B. Winsløws Vej 9A, DK-5000, Odense C, Denmark.
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark.,Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 50, 4, DK- 2730, Herlev, Denmark
| | - Karin B Dieperink
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark.,Research Unit of Oncology, Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000, Odense C, Denmark
| | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark
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25
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Østergaard B, Clausen AM, Agerskov H, Brødsgaard A, Dieperink KB, Funderskov KF, Nielsen D, Sorknaes AD, Voltelen B, Konradsen H. Nurses' attitudes regarding the importance of families in nursing care: A cross-sectional study. J Clin Nurs 2020; 29:1290-1301. [PMID: 31971287 DOI: 10.1111/jocn.15196] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/05/2020] [Accepted: 01/10/2020] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To investigate attitudes towards family involvement in care among a broad sample of Danish nurses from all sectors and healthcare settings. BACKGROUND Evidence suggests that nurses hold both supportive and less supportive attitudes about involvement of family members in the care of patients, and the existing findings are limited to specific healthcare contexts. DESIGN A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology for reporting observational studies. METHODS Using snowball sampling, the Families' Importance in Nursing Care-Nurses' Attitudes questionnaire was initially administered to a broad, convenience sample of Danish registered nurses through social media: Facebook interest groups and the homepage of the Danish Family Nursing Association. These nurses were encouraged to send the invitation to participate in their network of nursing colleagues. Complete data sets from 1,720 nurses were available for analysis. RESULTS In general, the nurses considered the family as important in patient care. Nurses who held master's and doctorate degrees scored significantly higher than nurses with a basic nursing education. Nurses who had had experience with illness within their own families tended to score higher on the family as a conversational partner subscale than those without this experience. Nurses with the longest engagement within hospital settings scored significantly lower than those with the longest engagement within primary health care and/or psychiatry. CONCLUSIONS Families are considered important in nursing care. Younger nurses with a basic education, short-term engagement at a hospital and no experiences with illness within their own families were predictors of less supportive attitudes towards including the family in nursing care. RELEVANCE TO CLINICAL PRACTICE Clinical leaders and managers should promote education on the importance of active family involvement in patient care in clinical practice and undergraduate education. More focus on collaboration with families in the hospital setting is needed.
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Affiliation(s)
- Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne M Clausen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Section for Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Karen F Funderskov
- Department of Clinical Physiology, Danish Center for Sleep Medicine - Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Nielsen
- Migrant Health Clinic, Department of Infectious diseases, Odense University Hospital, Odense, Denmark.,Department of Nursing/Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Anne D Sorknaes
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Medical Department, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | - Barbara Voltelen
- Department of Nursing/Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte University Hospital, Hellerup, Denmark.,Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Instituttet, Solna, Sweden.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Bauer EH, Bollig G, Dieperink KB. District nurses' views on and experiences with a telemedicine educational programme in palliative care. Scand J Caring Sci 2020; 34:1083-1093. [PMID: 31943328 PMCID: PMC7754273 DOI: 10.1111/scs.12818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/30/2019] [Indexed: 12/26/2022]
Abstract
Background Medical advancements, limited resources and shifting demographics have increased the number of patients with palliative care needs in primary care. To address educational needs, the specialised palliative care team of South Jutland, Denmark, created a telemedicine educational programme in palliative care to empower district nurses. Aim The study aimed to explore district nurses’ views on and experiences with a telemedicine educational programme in palliative care. Research methods A qualitative explorative study based on interpretive description was conducted. Data collection consisted of four focus group interviews with district nurses from three municipalities, supplemented by participant observations and a focus group interview with teachers from the specialised palliative care team. Data were analysed using predominately inductive thematic analysis. Results District nurses (n = 15) who participated in the programme and members of the specialised palliative care team (n = 6) who taught the programme were included. Analysis revealed the following advantages: reaffirming and updating existing knowledge, reduced professional isolation and creation of a forum to promote knowledge dissemination. A disadvantage was limited interaction between teachers and district nurses, questioning suitability for teaching complex palliative care. Initial technical problems affected motivation to participate. Organisational support differed between participating municipalities resulting in varying degrees of programme integration. Despite advantages of IT‐expert‐led sessions, key‐nurse‐led sessions in smaller groups proved more beneficial, suggesting a combination of IT support and key‐nurse management to maximise benefits. Conclusion The use of an inter‐professional telemedicine educational programme to teach palliative care to district nurses is beneficial. However, programmes should be designed for interactivity and address varying educational needs. Key‐nurse roles require managerial and IT support to optimise knowledge dissemination. Further research on implementation of telemedicine education in palliative care is needed.
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Affiliation(s)
- Eithne Hayes Bauer
- Medical Department, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Georg Bollig
- Medical Department, University Hospital of Southern Jutland, Aabenraa, Denmark.,IRS-centre South Jutland, University of Southern Denmark, Palliative Team and Department for Palliative Care, Medical Department, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND There is extensive need for palliative care worldwide, but access to care remains inadequate, especially for non-cancer patients. Video consultations are a promising tool in the provision of home-based palliative care, but an overview of evidence solely on video consultations in palliative care is lacking. AIM To review and synthesize current evidence regarding the use of video consultations in general and specialized palliative care to various patient groups. DESIGN A systematic integrative review with a narrative synthesis was undertaken in accordance with PRISMA (2009) guidelines. PROSPERO #: CRD42018095383. DATA SOURCES PubMed, Embase, CINAHL, and PsychINFO were searched for primary research articles published between 2005 and 2018. In addition, reference lists of included articles were hand searched. RESULTS The search resulted in 813 articles; 39 articles were included in the review, consisting of mixed methods (n = 14), qualitative (n = 10), quantitative (n = 10), and case studies (n = 5). The studies mainly focused on specialized palliative care to adult patients with cancer in high income countries. Through data analysis, six themes addressing advantages/disadvantages and facilitators/barriers were identified: (1) Redesign of care, (2) Communication, (3) User perceptions, (4) Technology, (5) Privacy issues, and (6) Economic implications. CONCLUSION Using video technology in palliative care has both advantages and disadvantages. However, evidence beyond the focus on specialized palliative care and patients with cancer is limited. Future research should focus on how and when video consultations might replace in-person specialized palliative care and video consultations in general palliative care, in low and middle income countries; and involve patients with a non-cancer diagnosis.
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Affiliation(s)
- Mia Jess
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Helle Timm
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Karin B Dieperink
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,2 Department of Oncology, Odense University Hospital, Odense, Denmark
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28
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Funderskov KF, Boe Danbjørg D, Jess M, Munk L, Olsen Zwisler A, Dieperink KB. Telemedicine in specialised palliative care: Healthcare professionals' and their perspectives on video consultations—A qualitative study. J Clin Nurs 2019; 28:3966-3976. [DOI: 10.1111/jocn.15004] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | - Dorthe Boe Danbjørg
- Centre of Innovative Medical Technology University of Southern Denmark Odense Denmark
- Department of Haematology, Clinical Research Unit Odense University Hospital Odense Denmark
| | - Mia Jess
- REHPA—Danish Knowledge Centre for Rehabilitation and Palliative Care University of Southern Denmark Odense Denmark
| | - Lene Munk
- Department of Oncology, Palliative Care Team Odense University Hospital Odense Denmark
| | - Ann‐Dorthe Olsen Zwisler
- REHPA—Danish Knowledge Centre for Rehabilitation and Palliative Care University of Southern Denmark Odense Denmark
| | - Karin B. Dieperink
- Department of Oncology, REHPA—Danish Knowledge Centre for Rehabilitation and Palliative Care Odense University Hospital Odense Denmark
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29
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Tolstrup LK, Bastholt L, Zwisler AD, Dieperink KB, Pappot H. Selection of patient reported outcomes questions reflecting symptoms for patients with metastatic melanoma receiving immunotherapy. J Patient Rep Outcomes 2019; 3:19. [PMID: 30900035 PMCID: PMC6515745 DOI: 10.1186/s41687-019-0111-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/15/2019] [Indexed: 12/12/2022] Open
Abstract
Context Toxicity-monitoring plays an important role in all cancer treatment,
however, early recognition is vital for detecting and treating immune-related
symptoms. Preparing a Patient Reported Outcomes tool and including melanoma
patients receiving immunotherapy in the reporting of symptoms, may optimize
toxicity-monitoring. Objectives The objective of this study was to identify the symptoms and their
equivalent questions to include from the Patient-Reported Outcomes Common
Terminology Criteria for Adverse Events (PRO-CTCAE) library for melanoma patients,
receiving immunotherapy and, further, to evaluate if all relevant symptoms are
covered by this tool. Methods To establish the relevant symptoms, three measures were taken.
First, a literature search was carried out in three databases. Second, a chart
audit was performed including medical records from melanoma patients receiving
immunotherapy. Finally, the product information for the relevant immunotherapies
was studied. Results Ten articles were included as a result of the literature search. As
for the chart audit, a total of 37 patients (48 treatments with immunotherapy)
were included. Overall, the reported symptoms from the literature review aligned
with those identified in the chart audit. The examination of the product
information supported the findings from review and chart audit, revealing only one
additional symptom. In total, 28 PRO-CTCAE symptoms were selected comprising of 56
PRO-questions plus an additional question on blood in stool. Conclusion When preparing a Patient Reported Outcomes tool it is important that
the preparatory work of selecting questions is done properly. By going through the
literature, performing a chart audit, and examining the product information, the
most important and relevant symptoms have been uncovered, facilitating the design
of a PROquestionnaire, based on PRO-CTCAE, that fits the patient population under
investigation.
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Affiliation(s)
- Lærke K Tolstrup
- Department of Oncology, Odense University Hospital, Odense, Denmark. .,REHPA -The Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark. .,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Oncology, Odense University Hospital, Odense, Denmark.,REHPA -The Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark.,REHPA -The Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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30
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Kristensen MB, Dieperink KB, Rossau HK, Egholm CL, Viggers L, Bertelsen BM, Zwisler AD. Dietary interventions in cardiac rehabilitation - The gap between guidelines and clinical practice. Clin Nutr ESPEN 2018; 27:120-126. [PMID: 30144884 DOI: 10.1016/j.clnesp.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS An unhealthy diet is a risk factor for ischemic heart disease (IHD) and therefore cardiac rehabilitation (CR) should include dietary interventions. In 2007, CR became a shared responsibility between Danish hospitals and municipalities. Later, a national clinical guideline including recommendations on dietary interventions was developed to facilitate implementation of CR. The aim of the present study is: 1) To describe provision of dietary interventions in CR for IHD patients in Denmark in 2013 and 2015 emphasizing differences between hospitals and municipalities, and 2) To evaluate the implementation of the national clinical guideline in clinical practice. METHODS A repeated nationwide cross-sectional electronic survey was carried out in 2013 and 2015. Participation was mandatory for all Danish hospital departments offering CR (n = 36), but voluntary for municipalities (n = 98) reaching response rates of 82% and 89% in 2013 and 2015, respectively. The electronic survey covered the core components of dietary interventions in CR as described in the national clinical guideline. RESULTS In 2015, 72% of municipalities provided dietary interventions. This proportion was significantly higher in hospitals (94%, p = 0.007). 26% and 38% of hospitals screened systematically for dietary intervention needs in 2013 and 2015, respectively. Corresponding results from municipalities were 26% and 29%. No significant differences were seen in clinical practice over time. CONCLUSIONS The results of this study identified a major gap between recommendations in the national clinical guideline and actual clinical practice on dietary interventions in CR in Danish hospitals and municipalities. The study confirmed that implementation of guidelines in clinical practice takes time and requires an intensive effort.
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Affiliation(s)
- Marianne Boll Kristensen
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark; Bachelor's Degree Programme in Nutrition and Health, University College Copenhagen, Sigurdsgade 26, DK-2200 Copenhagen N, Denmark.
| | - Karin B Dieperink
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark; Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
| | - Henriette Knold Rossau
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark.
| | - Cecilie Lindström Egholm
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark; Department of Medicine, Holbæk University Hospital, Region Zealand, Smedelundsgade 60, DK-4300, Holbæk, Denmark.
| | - Lone Viggers
- Department of Nutrition, Regional Hospital West Jutland, Lægårdvej 12, DK-7500, Holstebro, Denmark; The Danish Dietetic Association, Skt. Annæ Plads 6, DK-1250, Copenhagen K, Denmark.
| | - Birgitte Møllegaard Bertelsen
- Department of Medicine, Hospital South West Jutland, Finsensgade 35, DK-6700, Esbjerg, Denmark; The Danish Dietetic Association, Skt. Annæ Plads 6, DK-1250, Copenhagen K, Denmark.
| | - Ann-Dorthe Zwisler
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark.
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Tolstrup LK, Pappot H, Zangger G, Bastholt L, Zwisler AD, Dieperink KB. Danish translation, cultural adaption and initial psychometric evaluation of the patient feedback form. Health Qual Life Outcomes 2018; 16:77. [PMID: 29703191 PMCID: PMC5921302 DOI: 10.1186/s12955-018-0900-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/16/2018] [Indexed: 01/05/2023] Open
Abstract
AIM No suitable Danish questionnaire exists to evaluate patient satisfaction with various patient reported outcome measures. Thus, the aim of this research project was to conduct a study on the translation and cultural adaption of an American patient reported experience measures questionnaire, "Patient Feedback Form", among Danish patients, and to examine selected psychometric properties within reliability. MATERIAL AND METHODS In the first phase of the study, the Patient Feedback Form was forward and backward translated following the methodology of existing guidelines. Subsequently, cognitive interviewing was performed with seven cancer patients and seven healthy persons (19-86 years old/6 men and 8 women) to ensure that questions were easy to understand and made sense to Danish interviewees. In the second phase, phone interviews were carried out with 95 prostate cancer patients after they had responded to the same Patient Feedback Form. Missing data was imputed using the Expectation-Maximization technique. To examine the structure of the questionnaire, an exploratory factor analysis was conducted. Cronbach's alpha was calculated to investigate internal consistency. RESULTS There were only minor disagreements in the translation process, and the reconciliation went smoothly (phase 1). With regard to one item, however, it was difficult to reach a consensus. Through the qualitative validation process, the right solution was found. The results from the psychometric testing (phase 2) showed that four factors had an Eigen value > 1, but only one factor was extracted as the Scree plot had a clear "elbow", showing a one factor structure that explained 46.1% of the variance. The internal consistency was high as Cronbach's alpha was 0.89. CONCLUSION The translated, culturally adapted, and validated version of the Patient Feedback Form seems to be suitable for measuring satisfaction with patient reported outcome measures in a Danish setting. While the results should be treated with caution due to the small sample size, psychometric testing indicates that the questionnaire is a valid instrument. However, additional psychometric testing such as hypotheses testing, responsiveness, and test-retest on a larger and more diverse sample size is required to further verify the validity of the instrument.
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Affiliation(s)
- Lærke K Tolstrup
- Department of Oncology, Odense University Hospital, Odense, Denmark. .,University of Southern Denmark, Odense, Denmark.
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Graziella Zangger
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark.,The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
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Dieperink KB, Sigaard L, Larsen HM, Mikkelsen TB. Rehabilitation targeted late adverse effects after radiotherapy for cervical cancer – Different gains in different settings. ACTA ACUST UNITED AC 2017. [DOI: 10.5430/cns.v6n2p9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many cervical cancer survivors experience late adverse effects, and rehabilitation may alleviate symptoms. This study describes participants’ experiences with late adverse effects in daily living and with experiences of perceived rehabilitation in hospital, municipal, and a residential setting. Twenty-one cervical cancer survivors aged 40-72 years, curatively treated with concomitant radio-chemotherapy, with moderate/severe incontinence and sexual problems, participated in a 5-day residential rehabilitation intervention. Three focus group interviews were conducted and analyzed. Late adverse effects like incontinence, sexual problems, tinnitus and pain severely restricted everyday life. The participants described rehabilitation in hospital settings as fragmented, but several of the participants benefitted from the physical rehabilitation in municipal settings; however, no participants were offered sexual rehabilitation. In the residential setting, they gained a sense of connectedness and confidence in association with peers. More time to reflect and the anonymity gave opportunity to work with sensitive issues e.g. sexuality. Increased knowledge about late adverse effects and tools to alleviate these made the participants prepared to regain command of their lives. In conclusion, incontinence and tinnitus had especially impact on social life and every day activities. The participants benefitted especially from rehabilitation in two settings (municipal and residential). Intensively psychosocial interventions allowed participants to work with underlying problems. Women with sexual and/or incontinence problems favored the residential rehabilitation due to anonymity.
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Dieperink KB, Coyne E, Creedy DK, Østergaard B. Family functioning and perceived support from nurses during cancer treatment among Danish and Australian patients and their families. J Clin Nurs 2017; 27:e154-e161. [DOI: 10.1111/jocn.13894] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Karin B. Dieperink
- Department of Oncology and Danish Knowledge Centre of Rehabilitation and Palliation (REHPA); Odense University Hospital; Odense C Denmark
| | - Elisabeth Coyne
- School of Nursing and Midwifery; Menzies Health Institute; Griffith University; Meadowbrook Logan QLD Australia
| | - Debra K. Creedy
- School of Nursing and Midwifery; Menzies Health Institute; Griffith University; Meadowbrook Logan QLD Australia
| | - Birte Østergaard
- Department of Clinical Research; University of Southern Denmark; Odense C Denmark
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Dieperink KB, Johansen C, Hansen S, Wagner L, K. Andersen K, Minet LR, Hansen O. Male coping through a long-term cancer trajectory. Secondary outcomes from a RTC examining the effect of a multidisciplinary rehabilitation program (RePCa) among radiated men with prostate cancer. Acta Oncol 2017; 56:254-261. [PMID: 28093012 DOI: 10.1080/0284186x.2016.1267395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The objective of this study was to examine if rehabilitation influenced self-reported male coping styles during and up to three years after treatment with radiotherapy for prostate cancer. MATERIALS AND METHODS In a single-center oncology unit in Odense, Denmark, 161 prostate cancer patients treated with radiotherapy and androgen deprivation therapy were included in a randomized controlled trial from 2010 to 2012. The trial examined the effect of a multidisciplinary rehabilitation program within six months of treatment consisting of two nursing counseling sessions and two instructive sessions with a physical therapist (n = 79), or standard care (n = 82). As secondary outcomes coping was measured before radiotherapy, one month after radiotherapy (baseline), six month post-intervention (assessment) and three years after radiotherapy (follow-up) by the Mini-mental adjustment to cancer scale (Mini-MAC). The male coping styles towards the illness are expressed in five mental adjustment styles: Fighting Spirit, Helplessness-Hopelessness, Anxious Preoccupation, Fatalism and Cognitive Avoidance. Descriptive analysis and multiple linear regression analysis adjusting for the longitudinal design were conducted. RESULTS Most coping styles remained stable during the patient trajectory but Anxious Preoccupation declined from before radiotherapy to follow-up in both intervention and control groups. After six months the intervention group retained Fighting Spirit significantly (p = 0.025) compared with controls, but after three years this difference evened out. After three years the intervention group had lower Cognitive Avoidance (p = 0.044) than the controls. Factors as educational level, and depression influenced the use of coping styles after three years. CONCLUSION Multidisciplinary rehabilitation in irradiated prostate cancer patients retained the adjustment style Fighting Spirit stable after six months of radiotherapy, and in the long term reduced Cognitive Avoidance. Thus, the rehabilitation program supported the patient's active coping style and played down the passive coping style.
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Affiliation(s)
| | | | - Steinbjørn Hansen
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | | | - Klaus K. Andersen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lisbeth R. Minet
- Department of Rehabilitation, Odense University Hospital, Odense C, Denmark
- Health Sciences Research Centre, University College Lillebaelt, Denmark
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense C, Denmark
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Mikkelsen TB, Sørensen B, Dieperink KB. Prediction of rehabilitation needs after treatment of cervical cancer: what do late adverse effects tell us? Support Care Cancer 2016; 25:823-831. [PMID: 27834003 DOI: 10.1007/s00520-016-3466-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/26/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE Women treated for cervical cancer with radiotherapy and chemotherapy have reported serious bowel, vaginal, and sexual late effects. The purpose of this study was to describe late adverse effects, health-related quality of life, and self-efficacy in a representative Danish cervical cancer population in order to describe rehabilitation needs. METHODS Women, mean age 55 years, treated for cervical cancer from January 2010 to July 2013, who were alive and without known relapse/metastases were included in this cross-sectional study. EORTC QLQ C30 and CX24 and self-efficacy questionnaires were sent to all participants. RESULTS The participation rate was 85/107 (79%). Participants below 45 years had significantly more menopausal symptoms and lower body image scores compared to elderly women. The frequency of participants with menopausal symptoms decreased with time since diagnosis. Symptom experience was significantly higher in participants with locally advanced disease than in those with local disease. Self-efficacy was significantly lower in participants with locally advanced disease. The incidence of lymphedema was significantly higher among participants who were obese. Multiple analyses showed impaired quality of life, e.g., a lower body image and self-efficacy score, correlated with increasing BMI. Women who had surgery had greater risk of lymphedema, and women who received chemotherapy during treatment had a lower quality of life. All but one received radiotherapy. CONCLUSION This study found that young, obese survivors with locally advanced cervical cancer and survivors who received chemotherapy may have a serious risk of developing late adverse effects; thus, rehabilitation should target these needs.
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Affiliation(s)
- Tina Broby Mikkelsen
- Knowledge Centre for Rehabilitation and Palliative Care, Vestergade 17, 5800, Nyborg, Denmark.
| | - Bente Sørensen
- Department of Oncology, Lillebaelt Hospital Vejle, Kabbeltoft 25, 7100, Vejle, Denmark
| | - Karin B Dieperink
- Knowledge Centre for Rehabilitation and Palliative Care, Vestergade 17, 5800, Nyborg, Denmark.,Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, Indgang 99, 2. Sal, 5000, Odense C, Denmark
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Brødsgaard A, Dieperink KB, Konradsen H, Lund A, Sorknaes AD, Voltelen B, Østergaard B. Report of the 12th International Family Nursing Conference: Improving Family Health Globally Through Research, Education, and Practice, Odense, Denmark, 2015. J Fam Nurs 2016; 22:139-147. [PMID: 27165752 DOI: 10.1177/1074840716646311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Affiliation(s)
- Karin B. Dieperink
- Rehabilitation Centre Dallund; Odense University Hospital, Department of Oncology; Southern Boulevard 29 DK-5000 Odense C Denmark
| | - Karen Mark
- Rehabilitation Centre Dallund; Odense University Hospital, Department of Oncology; Southern Boulevard 29 DK-5000 Odense C Denmark
| | - Tina Broby Mikkelsen
- PAVI - Centre of Rehabilitation and Palliation; University of Southern Denmark; Øster Farimagsgade 5A 1353 København K Denmark
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Dieperink KB, Johansen C, Hansen S, Wagner L, Andersen KK, Minet LR, Hansen O. The effects of multidisciplinary rehabilitation: RePCa-a randomised study among primary prostate cancer patients. Br J Cancer 2013; 109:3005-13. [PMID: 24169342 PMCID: PMC3859951 DOI: 10.1038/bjc.2013.679] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 10/06/2013] [Accepted: 10/08/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects after completed radiotherapy in patients with prostate cancer (PCa). METHODS In a single-centre oncology unit in Odense, Denmark, 161 PCa patients treated with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79) or to usual care (n=82). Primary outcome was Expanded Prostate Cancer Index Composite (EPIC-26) urinary irritative sum-score. Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported disease-specific quality of life (QoL; EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (Short-form-12, SF-12), pelvic floor muscle strength (Modified Oxford Scale), and pelvic floor electromyography. Intension-to-treat analyses were made with adjusted linear regression. RESULTS The intervention improved, as compared with controls, urinary irritative sum-score 5.8 point (Cohen's d=0.40; P=0.011), urinary sum-score (d=0.34; P=0.023), hormonal sum-score (d=0.19; P=0.018), and the SF-12 Physical Component Summary, d=0.35; P=0.002. Patients with more severe impairment gained most. Pelvic floor muscle strength measured by electromyography declined in both groups, P=0.0001. CONCLUSION Multidisciplinary rehabilitation in irradiated PCa patients improved urinary and hormonal symptoms, and SF-12 physical QoL.
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Affiliation(s)
- K B Dieperink
- Department of Oncology, Odense University Hospital, Southern Boulevard 29, DK-5000 Odense C, Denmark
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Dieperink KB, Hansen S, Wagner L, Johansen C, Andersen KK, Hansen O. Living alone, obesity and smoking: important factors for quality of life after radiotherapy and androgen deprivation therapy for prostate cancer. Acta Oncol 2012; 51:722-9. [PMID: 22793038 DOI: 10.3109/0284186x.2012.682627] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND While effective treatment of prostate cancer with radiotherapy and hormones increase survival, adverse effects may reduce quality of life (QoL). The aim of this study was to investigate frequency and severity of self-assessed late adverse effects, and identify the patients most exposed. MATERIAL AND METHODS QoL of 317 cancer survivors with primary stage T1-T3 prostate cancer treated with conformal radiotherapy (70-78 Gy) and androgen deprivation therapy was analyzed by using SF-12 and EPIC-26 questionnaires. Patients were stratified into three groups, filling out the questionnaires 1-2, 2-3, and 3-4 years after radiotherapy. Differences between groups were tested with ANOVA and the χ(2) test. The influence of marital status, severe obesity, smoking, stage of disease, and applied dose of radiotherapy on QoL was evaluated with multiple linear and logistic regression analyses. RESULTS Of 337 patients, 317 (94%) answered the questionnaire. The sexual and hormonal summary scores in the EPIC significantly improved during time since radiotherapy (p < 0.001). Current smoking had a negative effect on SF-12 Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores, on EPIC bowel overall bother (OR 7.8; p = 0.003), on EPIC mean urinary incontinence scores, and on the sexual domain. Severe obesity had a negative influence on SF-12 PCS and vitality. Severe obesity also was a negative predictor for moderate-to-severe problems in the EPIC urinary incontinence, and in the hormonal domain. Living alone was associated with lower SF-12 PCS, MCS scores, and SF-12 general health, social functioning, and the EPIC hormonal domain. The stage of disease or the radiation dose had no statistically significant impact on QoL. CONCLUSION Results showed significant negative associations between smoking, severe obesity and living alone on self-assessed late adverse effects after radiotherapy for prostate cancer. This information may guide rehabilitation.
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