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Mijwel, S., Backman, M., Bolam, K. A., Jervaeus, A., Sundberg, C. J., Margolin, S., . . . Wengström, Y. (2018). Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial. Breast Cancer Research and Treatment, 168(1), 79-93
Open this publication in new window or tab >>Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial
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2018 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 168, no 1, p. 79-93Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Exercise training is an effective and safe way to counteract cancer-related fatigue (CRF) and to improve health-related quality of life (HRQoL). High-intensity interval training has proven beneficial for the health of clinical populations. The aim of this randomized controlled trial was to compare the effects of resistance and high-intensity interval training (RT-HIIT), and moderate-intensity aerobic and high-intensity interval training (AT-HIIT) to usual care (UC) in women with breast cancer undergoing chemotherapy. The primary endpoint was CRF and the secondary endpoints were HRQoL and cancer treatment-related symptoms.

METHODS: Two hundred and forty women planned to undergo chemotherapy were randomized to supervised RT-HIIT, AT-HIIT, or UC. Measurements were performed at baseline and at 16 weeks. Questionnaires included Piper Fatigue Scale, EORTC-QLQ-C30, and Memorial Symptom Assessment Scale.

RESULTS: The RT-HIIT group was superior to UC for CRF: total CRF (p = 0.02), behavior/daily life (p = 0.01), and sensory/physical (p = 0.03) CRF. Role functioning significantly improved while cognitive functioning was unchanged for RT-HIIT compared to declines shown in the UC group (p = 0.04). AT-HIIT significantly improved emotional functioning versus UC (p = 0.01) and was superior to UC for pain symptoms (p = 0.03). RT-HIIT reported a reduced symptom burden, while AT-HIIT remained stable compared to deteriorations shown by UC (p < 0.01). Only RT-HIIT was superior to UC for total symptoms (p < 0.01).

CONCLUSIONS: 16 weeks of resistance and HIIT was effective in preventing increases in CRF and in reducing symptom burden for patients during chemotherapy for breast cancer. These findings add to a growing body of evidence supporting the inclusion of structured exercise prescriptions, including HIIT, as a vital component of cancer rehabilitation.

TRIAL REGISTRATION: Clinicaltrials.gov Registration Number: NCT02522260.

Place, publisher, year, edition, pages
Springer, 2018
Keyword
Breast cancer, Chemotherapy, Concurrent training, Health-related quality of life, High-intensity interval training, Symptom burden
National Category
Clinical Medicine
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
urn:nbn:se:his:diva-14988 (URN)10.1007/s10549-017-4571-3 (DOI)000425747200009 ()29139007 (PubMedID)2-s2.0-85033731943 (Scopus ID)
Available from: 2018-03-29 Created: 2018-03-29 Last updated: 2018-03-29Bibliographically approved
Muntlin Athlin, Å., Browall, M., Wengström, Y., Conroy, T. & Kitson, A. L. (2018). Descriptions of Fundamental Care needs in cancer care - an exploratory study. Journal of Clinical Nursing
Open this publication in new window or tab >>Descriptions of Fundamental Care needs in cancer care - an exploratory study
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2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS AND OBJECTIVES: To explore the experiences of the fundamentals of care for people with a cancer diagnosis, from diagnosis to after adjuvant treatment.

BACKGROUND: More focus is needed on the experience of people living with cancer, as current cancer care more emphasises on independence and resilience without fully acknowledging that there will be moments in the cancer journey where patients will need 'basic nursing care' to manage their symptoms and care pathways.

DESIGN: Secondary analysis of qualitative data.

METHOD: Secondary thematic analysis of interview data from 30 people with a diagnosis of breast (n=10), colorectal (n=10) or prostate (n=10) cancer was undertaken.

RESULTS: The findings revealed vivid descriptions of the fundamentals of care (i.e. basic needs) and participants described physical, psychosocial and relational aspects of the delivery of care. Both positive (e.g. supportive and kind) and negative (e.g. humiliating) experiences related to the relationship with the healthcare professionals were re-counted and affected the participants' experiences of the fundamentals of care. Participants' accounts of their fundamental care needs were provided without them identifying who, within the health care system, was responsible for providing these needs. Specific nursing interventions were seldom described.

CONCLUSION: Some people with a cancer diagnosis have to strive for help and support from the nursing staff to manage to regain control over their recovery. Nurses in cancer care need to focus on the patients' fundamental care needs to optimise their patients' recovery. This article is protected by copyright. All rights reserved.

Keyword
Cancer care, fundamentals of care, nursing care, person-centred care, qualitative study, secondary analysis
National Category
Nursing
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
urn:nbn:se:his:diva-14616 (URN)10.1111/jocn.14251 (DOI)29292542 (PubMedID)
Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2018-01-03Bibliographically approved
Ek, K., Browall, M., Eriksson, M. & Eriksson, I. (2018). Healthcare providers’ experiences of assessing and performing oral care in older adults. International Journal of Older People Nursing
Open this publication in new window or tab >>Healthcare providers’ experiences of assessing and performing oral care in older adults
2018 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed) Epub ahead of print
Keyword
ethics, experiences, focus-group interviews, healthcare providers, older adults, oral health
National Category
Clinical Medicine Dentistry Geriatrics Health Sciences Nursing
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
urn:nbn:se:his:diva-15030 (URN)10.1111/opn.12189 (DOI)29512291 (PubMedID)
Available from: 2018-04-11 Created: 2018-04-11 Last updated: 2018-04-12Bibliographically approved
Browall, M., Mijwel, S., Rundqvist, H. & Wengstrom, Y. (2018). Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences. Integrative Cancer Therapies, 17(1), 16-30
Open this publication in new window or tab >>Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences
2018 (English)In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 17, no 1, p. 16-30Article, review/survey (Refereed) Published
Abstract [en]

Background: In oncology, physical activity (PA) is recognized to improve psychological and physiological functions. Motivating women with breast cancer to sustain a physically active lifestyle is important for promoting positive health after diagnosis. To review and synthesize what is known about how women with breast cancer experience supervised and unsupervised PA during and after adjuvant treatment. PubMed, PsycINFO, and CINAHL were searched, yielding 994 citations. The final review included 17 articles published between 2004 and 2014 in English. The CASP (Critical Appraisal Skills Programme) instrument was used to appraise quality. Results: Exercise is experienced as a positive element with multiple benefits. However, maintaining a physically active lifestyle during and after chemotherapy is sometimes challenging. Reported benefits of PA include feeling empowered, and improving and reclaiming health. Facilitators to PA comprised exercising with peers and skilled instructors. Barriers included social factors and lack of information. Conclusions: Findings highlight the importance of incorporating PA programs from a patient experience perspective as routine treatment. Health care professionals play a crucial gateway role in providing information on implementation and benefits of PA. Providing support and educated advice about how to safely start or continue regular PA to minimize symptoms, reduce morbidity, and increase well-being during or after treatment is vital for women with breast cancer. Implications for Practice: Health care professionals need increased knowledge of the breast cancer patients' perspectives on facilitators and barriers to PA during and after treatment, in order to provide sufficient support for women to stay physically active during a breast cancer illness.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keyword
breast cancer, physical exercise, physical activities, qualitative research, supervised exercise, nonsupervised exercise
National Category
Nursing
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
urn:nbn:se:his:diva-14948 (URN)10.1177/1534735416683807 (DOI)000425156600003 ()28008778 (PubMedID)2-s2.0-85034572010 (Scopus ID)
Available from: 2018-03-08 Created: 2018-03-08 Last updated: 2018-03-09Bibliographically approved
Browall, M., Brandberg, Y., Nasic, S., Rydberg, P., Bergh, J., Rydén, A., . . . Wengström, Y. (2017). A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment. Supportive Care in Cancer, 25(5), 1423-1429
Open this publication in new window or tab >>A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment
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2017 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 25, no 5, p. 1423-1429Article in journal (Refereed) Published
Abstract [en]

Purpose

The aim was to prospectively map symptom clusters in patients with stage I–IIIa breast cancer during standard chemotherapy treatment in a randomised study.

Methods

Participants completed the Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined.

Results

The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48–79%), difficulty sleeping (54–78%), difficulty concentrating (53–74%), worrying (54–74%) and pain (29–67%).

Conclusion

In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.

Keyword
Breast cancer, Chemotherapy, Patient reported outcome measures, Symptom, Symptom cluster
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:his:diva-13243 (URN)10.1007/s00520-016-3527-1 (DOI)000399153200009 ()27981366 (PubMedID)2-s2.0-85006138053 (Scopus ID)
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2017-12-08Bibliographically approved
Browall, M., Forsberg, C. & Wengström, Y. (2017). Assessing patient outcomes and cost effectiveness of nurse-led follow-up for women with breast cancer: have relevant and sensitive evaluation measures been used?. Journal of Clinical Nursing, 26(13-14), 1770-1786
Open this publication in new window or tab >>Assessing patient outcomes and cost effectiveness of nurse-led follow-up for women with breast cancer: have relevant and sensitive evaluation measures been used?
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 13-14, p. 1770-1786Article, review/survey (Refereed) Published
Abstract [en]

Aim

To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost effectiveness.

Background

As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients’ satisfaction with the model of physician-led follow-up.

Design

Systematic review.

Method

Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005 and 2013. The quality of appraisal assessment was inspired by the GRADE system.

Results

The results show that there are many different instruments used when evaluating nurse-led follow up which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses and the results are hard to interpret.

Conclusions

Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients’ information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keyword
quality of life, symptoms, psychosocial support, cost effectiveness, nurse-led follow-up, breast cancer
National Category
Nursing
Research subject
Age and Ageing
Identifiers
urn:nbn:se:his:diva-13188 (URN)10.1111/jocn.13496 (DOI)000405323200003 ()27487478 (PubMedID)2-s2.0-85016488234 (Scopus ID)
Available from: 2016-12-05 Created: 2016-12-05 Last updated: 2017-11-27Bibliographically approved
Wengström, Y., Bolam, K. A., Mijwel, S., Sundberg, C. J., Backman, M., Browall, M., . . . Rundqvist, H. (2017). Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy. BMC Cancer, 17, Article ID 100.
Open this publication in new window or tab >>Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy
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2017 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 17, article id 100Article in journal (Refereed) Published
Abstract [en]

Background: Women with breast cancer undergoing chemotherapy suffer from a range of detrimental disease and treatment related side-effects. Exercise has shown to be able to counter some of these side-effects and improve physical function as well as quality of life. The primary aim of the study is to investigate and compare the effects of two different exercise regimens on the primary outcome cancer-related fatigue and the secondary outcomes muscle strength, function and structure, cardiovascular fitness, systemic inflammation, skeletal muscle gene activity, health related quality of life, pain, disease and treatment-related symptoms in women with breast cancer receiving chemotherapy. The second aim is to examine if any effects are sustained 1, 2, and 5 years following the completion of the intervention and to monitor return to work, recurrence and survival. The third aim of the study is to examine the effect of attendance and adherence rates on the effects of the exercise programme. Methods: This study is a randomised controlled trial including 240 women with breast cancer receiving chemotherapy in Stockholm, Sweden. The participants are randomly allocated to either: group 1: Aerobic training, group 2: Combined resistance and aerobic training, or group 3: usual care (control group). During the 5-year follow-up period, participants in the exercise groups will receive a physical activity prescription. Measurements for endpoints will take place at baseline, after 16 weeks (end of intervention) as well as after 1, 2 and 5 years. Discussion: This randomised controlled trial will generate substantial information regarding the effects of different types of exercise on the health of patients with breast cancer undergoing chemotherapy. We expect that dissemination of the knowledge gained from this study will contribute to developing effective long term strategies to improve the physical and psychosocial health of breast cancer survivors.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keyword
Patients with breast cancer, Exercise intervention, Chemotherapy, Fatigue, Inflammation, Skeletal muscle
National Category
Medical and Health Sciences Cancer and Oncology
Research subject
Age and Ageing
Identifiers
urn:nbn:se:his:diva-13437 (URN)10.1186/s12885-017-3079-x (DOI)000393841600001 ()28166765 (PubMedID)2-s2.0-85011659401 (Scopus ID)
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2017-11-29Bibliographically approved
Gustavell, T., Sundberg, K., Frank, C., Wengström, Y., Browall, M., Segersvärd, R. & Langius-Eklöf, A. (2017). Symptoms and self-care following pancreaticoduodenectomy: Perspectives from patients and healthcare professionals - Foundation for an interactive ICT application. European Journal of Oncology Nursing, 26, 36-41
Open this publication in new window or tab >>Symptoms and self-care following pancreaticoduodenectomy: Perspectives from patients and healthcare professionals - Foundation for an interactive ICT application
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2017 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 26, p. 36-41Article in journal (Refereed) Published
Abstract [en]

PurposePoor prognosis and a problematic recovery period after pancreaticoduodenectomy means that patients may benefit from early detection of symptoms and support for self-management. Interactive Information and Communication Technology tools can be used for this purpose, but the content needs to be relevant to patients as well as healthcare professionals. To facilitate development of the content of an application for this purpose, the aim of this study was to explore common symptoms and self-care in the first six months after pancreaticoduodenectomy, as identified by patients and healthcare professionals.

MethodData were collected through individual interviews with patients (n = 14), along with two focus group interviews and one individual interview with healthcare professionals (n = 10). Data were analysed using qualitative content analysis.

ResultsCommon symptoms after surgery were those related to eating, bowel function and emotional wellbeing, along with fatigue and pain. Some self-care activities and advice were mentioned in the interviews. The patients often experienced a lack of advice on self-care at discharge.

ConclusionsThe results render knowledge of the symptoms it is important to be aware of and to assess regularly after pancreaticoduodenectomy. The results also contribute to knowledge about specific self-care related to these symptoms, even though it was not extensively described, and further research is needed to define evidence-based self-care advice.

Keyword
Pancreatic neoplasms, Pancreatic surgery; Pancreaticoduodenectomy, Symptoms, Self-care; advice, ICT, Smartphone application
National Category
Medical and Health Sciences Nursing
Research subject
Medical sciences
Identifiers
urn:nbn:se:his:diva-13229 (URN)10.1016/j.ejon.2016.12.002 (DOI)000392887400005 ()2-s2.0-85004028289 (Scopus ID)
Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2017-11-29Bibliographically approved
Göransson, C., Eriksson, I., Ziegert, K., Wengström, Y., Langius-Eklöf, A., Brovall, M., . . . Blomberg, K. (2017). Testing an app for reporting health concerns-Experiences from older people and home care nurses. International Journal of Older People Nursing
Open this publication in new window or tab >>Testing an app for reporting health concerns-Experiences from older people and home care nurses
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2017 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS AND OBJECTIVES: To explore the experiences of using an app among older people with home-based health care and their nurses.

BACKGROUND: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed.

DESIGN: Explorative qualitative design.

METHODS: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis.

RESULTS: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement.

CONCLUSIONS: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future.

IMPLICATIONS FOR PRACTICE: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.

Keyword
app, health concerns, older people, security, self-confidence, thematic analysis
National Category
Nursing
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
urn:nbn:se:his:diva-14595 (URN)10.1111/opn.12181 (DOI)29210218 (PubMedID)
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-02-16Bibliographically approved
Feo, R., Conroy, T., Jangland, E., Muntlin Athlin, Å., Browall, M., Parr, J., . . . Kitson, A. (2017). Towards a standardised definition for fundamental care: a modified Delphi study. Journal of Clinical Nursing
Open this publication in new window or tab >>Towards a standardised definition for fundamental care: a modified Delphi study
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.

BACKGROUND: There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.

DESIGN: Modified Delphi study.

METHODS: Three phases: (1) engaging stakeholders via an interactive workshop; (2) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (3) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n=38; Round 2 n=28).

RESULTS: Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.

CONCLUSIONS: This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users. This article is protected by copyright. All rights reserved.

Keyword
Delphi study, Fundamental care, basic nursing care, definition, fundamentals of care
National Category
Nursing
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
urn:nbn:se:his:diva-14614 (URN)10.1111/jocn.14247 (DOI)29278437 (PubMedID)
Available from: 2018-01-02 Created: 2018-01-02 Last updated: 2018-01-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0976-531X

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