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  • 1.
    Backman, Malin
    et al.
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Sundberg, Carl Johan
    Department of Physiology & Pharmacology and Unit for Bioentrepreneurship, Karolinska Institutet, Sweden / Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
    Wengström, Yvonne
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Experiencing health - Physical activity during adjuvant chemotherapy treatment for women with breast cancer2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 21, p. 160-167Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to explore how women with breast cancer experience physical activity (PA) during adjuvant chemotherapy treatment.

    METHODS: This study included sixteen women diagnosed with breast cancer who had participated in a supervised 16-week PA intervention during adjuvant chemotherapy treatment. The qualitative approach included semi-structured individual and focus group interviews. Data were analyzed inductively with content analysis.

    RESULT: The content analysis resulted in a description of experiencing health during chemotherapy treatment covered by five categories: Solidarity with others and being good to oneself; Experiencing functional improvement and social support; Empowerment and motivation to focus on health; Barriers to adherence to PA during illness and treatment; and Enabling health and independence. A core category was identified; PA a tool for maintenance and recovery of physical, mental and social health. The women reported that PA had a positive impact on both physical function and mental wellbeing. Participating in the PA intervention also increased their feeling of social support, which was reported to be important to motivate adherence to PA when the side effects became more severe. Symptom burden, time and lack of motivation were reported as barriers to continue PA during treatment.

    CONCLUSION: The women in this study reported that PA had a positive impact on their perceived health and that it was possible to exercise despite increasing symptom burden from treatment. PA was perceived as a tool that supported health processes and gave the women a feeling of getting respite from the illness.

  • 2.
    Blomberg, Karin
    et al.
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Wengström, Yvonne
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden / Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Sundberg, Kay
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Isaksson, Ann-Kristin
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nyman, Maria Hälleberg
    Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Langius-Eklöf, Ann
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer - Scoping the perspectives of patients, professionals and literature2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 21, p. 139-145Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.

    METHODS: The study combines data from interviews with patients (n = 8) and health care professionals (n = 10) and a scoping review of the literature (n = 26) focusing on the period during and up to 6 months after radiotherapy.

    RESULTS: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.

    CONCLUSIONS: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.

  • 3.
    Browall, Maria
    et al.
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden / Department of Oncology, Division of Selected Clinical Specialties, Sahlgrenska University Hospital, Göteborg, Sweden.
    Ahlberg, Karin
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    Karlsson, Per
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden / Department of Oncology, Southern Älvsborg Hospital, Borås, Sweden.
    Danielson, Ella
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden / Department of Health Science, Mid Sweden University, Östersund, Sweden.
    Persson, Lars-Olof
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    Gaston-Johansson, Fannie
    School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
    Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women2008In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 12, no 3, p. 180-189Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was twofold: first, to describe changes of Health-Related Quality of Life (HRQoL) during the adjuvant treatment among postmenopausal women with breast cancer; second, in the same population to identify the best predictors of Overall Quality of Life (QoL) after treatment, from perceived functioning, symptoms, emotional distress and clinical/demographic variables measured at baseline. The study group was 150 women (>= 55 years of age) scheduled for adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75). They were examined before (baseline), during and after completing the treatment. Data about QoL, perceived functioning, symptoms and emotional distress were collected with the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, BR23 and Hospital Anxiety and Depression Scale (HADS) questionnaires. The general finding was that the adjuvant treatments were associated with decrease in overall QoL, physical and role functioning, anxiety and body image, as well as with increase in fatigue, dyspnoea, pain, nausea/vomiting, constipation and systemic therapy side effects measured over time. For women receiving CT, better emotional functioning and less pain at baseline predicted better overall QoL at the end of the treatment. For women receiving RT, better physical and emotional functioning, less breast symptoms and lower tumour stage at baseline predicted better overall QoL at the end of the treatment. (c) 2008 Elsevier Ltd. All rights reserved.

  • 4.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Brandberg, Yvonne
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Nasic, Salmir
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Rydberg, Per
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Bergh, Jonas
    Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
    Rydén, Andreas
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Xie, Hanjing
    Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
    Eriksson, Irene
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Wengström, Yvonne
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden / Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
    A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment2017In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 25, no 5, p. 1423-1429Article in journal (Refereed)
    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.

  • 5.
    Browall, Maria
    et al.
    Department of Oncology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.
    Carlsson, Maria
    Department of Public Health and Caring Sciences, Döbelnsgatan 2, Uppsala 752 37, Sweden.
    Horvath, György
    Department of Oncology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.
    Information needs of women with recently diagnosed ovarian cancer - A longitudinal study2004In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 8, no 3, p. 200-207Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the information needs among patients with ovarian cancer and whether these information needs change over time. The information needs were evaluated three times, through structured interviews, and were based on the paired comparison approach developed by Degner and colleagues. A consecutive sample of patients (n=82) with recently diagnosed ovarian cancer was asked to participate.Sixty-four patients (78%) chose to participate. The three different measurements of participants' information needs revealed only small changes in these needs. The three most important information needs, in all measurements, were information about the likelihood of cure, information about the stage and spreading of the disease, and information about different treatment options. Information regarding sexual attractiveness was the lowest ranked item in all measurements. Regarding subgroups (age, education) the only significant difference throughout all measurements was that younger patients rated issues of sexual attractiveness higher than older patients (p=0.005).In this longitudinal study patients with ovarian cancer ranked information about the disease and its treatment (i.e. likelihood of cure, stage of disease, and treatment options) highest, and information about psychosocial aspects and self-care lowest. These findings are in accordance with the results from studies of women diagnosed with other types of cancer, which used the same methodology. © 2004 Elsevier Ltd. All rights reserved.

  • 6.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Forsberg, Christina
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden / Karolinska University Hospital, Breast and Sarcoma Unit, Radiumhemmet, Sweden.
    Assessing patient outcomes and cost effectiveness of nurse-led follow-up for women with breast cancer: have relevant and sensitive evaluation measures been used?2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 13-14, p. 1770-1786Article, review/survey (Refereed)
    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.

  • 7.
    Browall, Maria
    et al.
    Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg, Sweden / Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, SE 405 30 Göteborg, Sweden.
    Gaston-Johansson, Fannie
    Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg, Sweden / Johns Hopkins University, School of Nursing, Baltimore, MD, United States.
    Danielson, Ella
    Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg, Sweden.
    Postmenopausal women with breast cancer: Their experiences of the chemotherapy treatment period2006In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 29, no 1, p. 34-42Article in journal (Refereed)
    Abstract [en]

    This article illustrates the experience of 20 postmenopausal women with breast cancer who had received chemotherapy treatment. The interviews were of narrative nature and analyzed with content analysis. Four themes, including 12 subthemes, described these women's life during treatment as a journey from the negative experiences of fear of the unknown, affects on body and mind, to the more positive to get by, and a transformed life. The treatment was compared with an assault on the body, and the loss of their hair was experienced more negatively than the loss of a breast. The women described a feeling of imbalance in their relationships due to lack of support from those close to them. The support from healthcare professionals was experienced both positively and negatively, and many of the women revealed variation in the professional's attitude, knowledge, and empathy. The women who chose not to work during the treatment felt pressure from society and healthcare professionals to get back to work as soon as possible. For many, especially those in a leading position, this was experienced as very difficult. The women expressed a feeling of not being afraid of dying but wanted more time to prepare themselves.

  • 8.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Henoch, Ingela
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Göteborg, Sweden / University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden.
    Melin-Johansson, Christina
    Mid Sweden University, Department of Nursing, Östersund, Sweden.
    Strang, Susann
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Göteborg, Sweden.
    Danielson, Ella
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Göteborg, Sweden / Mid Sweden University, Department of Nursing, Östersund, Sweden.
    Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 636-644Article in journal (Refereed)
    Abstract [en]

    Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress. Aim: The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer. Methods and sample: Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured. Results: Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live. Conclusions: This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs. (C) 2014 Elsevier Ltd. All rights reserved.

  • 9.
    Browall, Maria
    et al.
    University of Skövde, School of Life Sciences. Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden / Johns Hopkins University, Baltimore, Maryland, USA.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA.
    Nasic, Salmir
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
    Validity and Reliability of the Swedish Version of the Memorial Symptom Assessment Scale (MSAS): An Instrument for the Evaluation of Symptom Prevalence, Characteristics, and Distress2013In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 46, no 1, p. 131-141Article in journal (Refereed)
  • 10.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Persson, Lars-Olof
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
    Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer2016In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 2, p. 324-333Article in journal (Refereed)
  • 11.
    Browall, Maria
    et al.
    University of Skövde, School of Life Sciences. Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Koinberg, Ingalill
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Falk, Hanna
    Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wijk, Helle
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Institution of Caring Science, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Patients' experience of important factors in the healthcare environment in oncology care2013In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, no 1, article id 20870Article in journal (Refereed)
    Abstract [en]

    Background and objective. The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design. A qualitative design was adopted using focus group interviews. Setting and participants. The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results. Analysis of the patients' perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients' primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions. This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment. © 2013 M. Browall et al.

  • 12.
    Browall, Maria M.
    et al.
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    Ahlberg, Karin M.
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden / Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Persson, Lars-Olof G.
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    Karlsson, Per O.
    Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden / Department of Oncology, Southern Älvsborg Hospital, Borås, Sweden.
    Danielson, Ella B.
    The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    The impact of age on Health-Related Quality of Life (HRQoL) and symptoms among postmenopausal women with breast cancer receiving adjuvant chemotherapy2008In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 47, no 2, p. 207-215Article in journal (Refereed)
    Abstract [en]

    Background and purpose. Elderly women with breast cancer are often not given adjuvant chemotherapy (CT). One reason for this is that older women are believed to have more problems in tolerating side-effects of CT. The purpose of this study was to analyze the impact of age on health related quality of life (HRQoL) and symptoms in postmenopausal women with breast cancer undergoing adjuvant CT. Patients and methods. Eighty consecutive postmenopausal patients planned for CT were invited. Seventy-five agreed to participate (age 55-77 years). The patients completed two cancer-specific HRQoL questionnaires, The European Organisation for Research and Treatment of cancer (EORTC) EORTC-QLQ-C30, the EORTC-QLQ-BR23, and the Hospital Anxiety and Depression Scale (HADS) before, during, and 4 months after completion of treatment. The design was descriptional and longitudinal. Correlations were examined between age and change in HRQoL variables. Results. No significant correlations were found between age and any of the assessed HRQoL domains or symptom scales, except for dyspnoea and sexual functioning. Age was inversely correlated to change in dyspnoea from baseline through follow-up, whereas older women perceived their sexual functioning significantly lower at baseline. Conclusion: The results indicate that among postmenopausal patients in the age range 55-77 years consecutively selected for adjuvant CT age was not a predictor of decreased HRQoL. This supports the argument that age should not be used in isolation in decisions about adjuvant CT for breast cancer in elderly women.

  • 13.
    Browall, Maria
    et al.
    Sahlgrenska University Hospital, Department of Oncology, Clinical Trial Unit, Gothenburg, Sweden.
    Melin-Johansson, Christina
    Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Strang, Susann
    The Sahlgrenska Academy, University of Gothenburg, Department of Clinical Neuroscience and Rehabilitation and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Danielson, Ella
    Mid Sweden University, Department of Health Sciences, Östersund, Sweden / The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Henoch, Ingela
    Bräcke Diakoni Foundation, Research Unit, Gothenburg, Sweden / Karolinska Institutet, Institution of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden.
    Health care staff's opinions about existential issues among patients with cancer2010In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 8, no 1, p. 59-68Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to explore health care staff's opinions about what existential issues are important to patients with cancer and staff's responsibility when existential issues are raised by patients. Method: Four focus group interviews were conducted with health care staff (N = 23) at an in-patient hospice, on an oncology ward, on a surgical ward, and with a palliative home health care team. The focus group interviews focused on two questions, first, about health care staff's opinions about patients' important existential questions and, second, about health care staff's responsibility when existential issues are raised by the patient. The interviews were taperecorded, transcribed verbatim, and analyzed by qualitative content analysis into subcategories and categories. Results: Four categories and 11 subcategories emerged from the first question. The first category, "life and death," was based on joy of living and thoughts of dying. The second category "meaning," consisted of acceptance, reevaluation, hope, and faith. The third category, "freedom of choice," consisted of responsibility and integrity, and the fourth and last category, "relationships and solitude," consisted of alleviation, dependency, and loss. One category emerged from the second question about the health care staff's responsibility, "to achieve an encounter," which was based on the subcategories time and space, attitudes, and invitation and confirmation. Significance of results: One strength of this study was that the findings were fairly congruent in different settings and in different geographical areas. Health care staff were aware of the importance of existential issues to patients. The existential issues, mentioned by health care staff, are similar to findings from studies conducted among patients, which is another strength of the present study. Health care staff are also confident about how to act when these issues are raised by the patients. The challenge for the future is to implement the findings from this study among health care staff in different settings.

  • 14.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Huddinge, Sweden.
    Mijwel, Sara
    Karolinska Institutet, Stockholm, Sweden.
    Rundqvist, Helen
    Karolinska Institutet, Stockholm, Sweden.
    Wengstrom, Yvonne
    Karolinska Institutet, Huddinge, Sweden / Karolinska University Hospital, Stockholm, Sweden.
    Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences2018In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 17, no 1, p. 16-30Article, review/survey (Refereed)
    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.

  • 15.
    Browall, Maria
    et al.
    University of Skövde, School of Life Sciences. Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Östlund, Ulrika
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden / Umeå University, Department of Nursing, Umeå, Sweden.
    Henoch, Ingela
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    The course of health related quality of life in postmenopausal women with breast cancer from breast surgery and up to five years post-treatment2013In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 22, no 5, p. 952-957Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies include too few patients over 70 years to be able to assess treatment effects on Health Related Quality Of Life (HRQOL) in the older age group. We aimed to follow HRQOL in postmenopausal women (55-80 years) with breast cancer receiving adjuvant treatment, until five years post-treatment, and compare with a general population. Patients and methods: The patient sample included 150 women (adjuvant CT n=75 and RT n=75) and two reference samples from the Swedish SF-36 norm database. Results: Data from baseline showed significantly higher levels of physical functioning and general health among the patients compared to the reference sample, and significantly lower levels of bodily pain, emotional role functioning and mental health. Longitudinal analyses showed significant changes in all scales, and three different patterns (a decrease-stable, a decrease-increase, and a stable- increase pattern) were identified. Conclusion: Postmenopausal women seem to successfully manage the effects of adjuvant treatment on HRQOL. © 2013 Elsevier Ltd.

  • 16.
    Ek, Kristina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Eriksson, Monika
    Skaraborg Hospital, Skövde, Sweden.
    Eriksson, Irene
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Healthcare providers’ experiences of assessing and performing oral care in older adults2018In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed)
  • 17.
    Feo, Rebecca
    et al.
    Adelaide Nursing School, University of Adelaide, Australia.
    Conroy, Tiffany
    Adelaide Nursing School, University of Adelaide, Australia.
    Jangland, Eva
    Department of Surgical Sciences, Uppsala University, Sweden / Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Muntlin Athlin, Åsa
    Department of Medical Sciences Uppsala University, Uppsala University Hospital, Sweden / Department of Public Health and Caring Sciences, Uppsala University, Sweden / Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Parr, Jenny
    Auckland University of Technology, New Zealand / Counties Manukau Health District Health Board, Middlemore Hospital, Auckland, New Zealand.
    Blomberg, Karin
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kitson, Alison
    College of Nursing and Health Sciences, Flinders University, Australia / Adelaide Nursing School, University of Adelaide, Australia.
    Towards a standardised definition for fundamental care: a modified Delphi study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    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.

  • 18.
    Gaston-Johansson, Fannie
    et al.
    Johns Hopkins University, Department of Acute and Chronic Care, School of Nursing, Baltimore, MD, USA.
    Fall-Dickson, Jane M.
    National Institute of Health, Symptom Management Branch, National Institute of Nursing, Research, Bethesda, MD, USA.
    Nanda, Joy P.
    Johns Hopkins Medical Institutions, Baltimore, MD, USA.
    Kenne Sarenmalm, Elisabeth
    Skaraborg Hospital, Department of Research and Development Centre, Skövde, Sweden.
    Browall, Maria
    University of Skövde, School of Life Sciences.
    Goldstein, Nancy
    Johns Hopkins University, Department of Acute and Chronic Care, School of Nursing, Baltimore, MD, USA.
    Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy2012In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 3, p. 530-539Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program (CCSP) on quality of life (QOL) among breast cancer patients 1 year after treatment.

    METHODS: Patients (n = 110) with stage II, III, or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were randomized to either CCSP treatment or control group. The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge. The CCSP components included educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery. Instruments administered at baseline included the following: Quality of Life Index-Cancer Version (QOLI-CV), State-Trait Anxiety Inventory, Beck Depression Inventory, and Coping Strategies Questionnaire. At 1-year follow-up, patients (n = 73) completed and returned the follow-up QOLI-CV.

    RESULTS: Patients were mainly ≥40 years of age, married, Caucasian, and diagnosed with advanced breast cancer. A model measuring effectiveness of CCSP on QOL (total and subscale) at 1-year follow-up showed that the CCSP group (n = 38) had significant improvement in overall QOL (p < 0.01), health and functioning (p < 0.05), and socioeconomic (p < 0.05) and psychological/spiritual well-being (p < 0.01) compared with the control group (n = 35). The CCSP patients frequently used the CCSP to manage psychological (51%) and sleep problems (60%).

    CONCLUSIONS: The CCSP improved QOL for patients at 1-year follow-up. Patients overwhelmingly reported that CCSP was beneficial. The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors.

  • 19.
    Gustavell, Tina
    et al.
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden / Karolinska University Hospital, Gastrocentrum, Stockholm, Sweden.
    Sundberg, Kay
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Frank, Catharina
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden / Karolinska University Hospital, Breast and Sarcoma Unit, Radiumhemmet, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Segersvärd, Ralf
    Karolinska University Hospital, Gastrocentrum, Stockholm, Sweden / Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Surgery, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Symptoms and self-care following pancreaticoduodenectomy: Perspectives from patients and healthcare professionals - Foundation for an interactive ICT application2017In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 26, p. 36-41Article in journal (Refereed)
    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.

  • 20.
    Göransson, Carina
    et al.
    School of Health and Welfare, Halmstad University, Halmstad, Sweden / Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Irene
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ziegert, Kristina
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Wengström, Yvonne
    Cancer Theme, Karolinska University Hospital, Stockholm, Sweden / Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Brovall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kihlgren, Annica
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Blomberg, Karin
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Testing an app for reporting health concerns-Experiences from older people and home care nurses2017In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed)
    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.

  • 21.
    Hagelin, Carina Lundh
    et al.
    Sophiahemmet University, Stockholm, Sweden / Stockholms Sjukhem Foundation, Stockholm, Sweden / Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Melin-Johansson, Christina
    Department of Nursing, Mid Sweden University, Östersund, Sweden / Institute of Caring Sciences and Health, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Henoch, Ingela
    Institute of Caring Sciences and Health, The Sahlgrenska Academy, University of Gothenburg, Sweden / Angered's Local Hospital, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Prahl, Charlotte
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Strang, Susann
    Institute of Caring Sciences and Health, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Westin, Lars
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Österlind, Jane
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Factors influencing attitude toward care of dying patients in first-year nursing students2016In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 22, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    AIM: To describe Swedish first-year undergraduate nursing students' attitudes toward care of dying patients. Possible influences such as age, earlier care experiences, care education, experiences of meeting dying patients and place of birth were investigated.

    METHOD: The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) was used in six universities. Descriptive statistics and regression analysis were used.

    RESULTS: Some 371 students (67.3%) reported overall positive attitude toward caring for dying patients (total mean FATCOD 119.5, SD 10.6) early in their first semester. Older students, students with both earlier care experience and earlier education, those with experience of meeting a dying person, and students born in Sweden reported the highest scores, a more positive attitude.

    CONCLUSION: Age, earlier care experience and education, experiences of meeting a dying person and place of birth seems to affect students' attitudes toward care of the dying and need to be considered among nursing educators.

  • 22.
    Henoch, I.
    et al.
    Sahlgrenska Academy at Göteborg University, Institute of Health and Caring Sciences, Göteborg, Sweden.
    Danielson, E.
    Sahlgrenska Academy at Göteborg University, Institute of Health and Caring Sciences, Göteborg, Sweden.
    Strang, S.
    Sahlgrenska Academy at Göteborg University, Institute of Health and Caring Sciences, Göteborg, Sweden.
    Browall, Maria
    University of Skövde, School of Life Sciences.
    Melin-Johansson, C.
    Mid Sweden University, Östersund, Sweden.
    Patients', family members', and healthcare staffs' opinions about existential issues as a base for an educational intervention2011In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 1, no 1, p. 84-Article in journal (Refereed)
    Abstract [en]

    Objective: To explore patients', family members' and healthcare staff's opinions about existential issues important to patients with cancer and their relatives.                                

    Methods: Two integrative literature reviews were conducted about existential issues among cancer patients and relatives, and interventions to meet these issues. Four focus groups were conducted with healthcare staff working with cancer patients at different stages about patients' existential issues, and staff's responsibility when existential issues are raised.

    Results: In the patient review, existential issues were divided into two themes: struggle to maintain self-identity and threats to self-identity. Relatives' existential issues concerned living both in and beyond the presence of death, with reminders of death, compelling them to respond to life close to death and seek support. Few interventions directed to patients or relatives applicable to everyday healthcare practice were found. Focus groups with staff revealed four categories of patients' existential issues, life and death, meaning, freedom of choice, relationships and solitude. According to staff, their responsibility concerned achieving an encounter with the patient.                                

    Conclusion: Results from three studies are congruent in that, patients, relatives and staff agree, although in different ways, about the importance of existential issues to patients and relatives. Healthcare staff was aware of the importance of existential issues and are to some extent confident about how to act when these issues are raised by the patients.                    

    Ongoing studies: The project group now continues implementing findings from these studies in an educational intervention to healthcare staff in different settings, and planning interventions to patients and relatives.                                

  • 23.
    Henoch, Ingela
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Melin-Johansson, Christina
    Department of Health Sciences, Mid Sweden University, Östersund.
    Danielson, Ella
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg / Department of Health Sciences, Mid Sweden University, Östersund.
    Udo, Camilla
    Department of Health Sciences, Mid Sweden University, Östersund.
    Johansson Sundler, Annelie
    University of Skövde, School of Health and Education.
    Björk, Maria
    University of Skövde, School of Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education.
    Bergh, Ingrid
    University of Skövde, School of Health and Education.
    Strang, Susann
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg / Angered Local Hospital, Gothenburg, Sweden.
    The Swedish version of the Frommelt attitude toward care of the dying scale: Aspects of validity and factors influencing nurses' and nursing students' attitudes2014In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 37, no 1, p. E1-E11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language. OBJECTIVES: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients. METHODS: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used. RESULTS: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients. CONCLUSIONS: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients. IMPLICATION FOR PRACTICE: Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

  • 24.
    Henoch, Ingela
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Danielson, Ella
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
    Strang, Susann
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Browall, Maria
    University of Skövde, School of Life Sciences. Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden.
    Melin-Johansson, Christina
    Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
    Training Intervention for Health Care Staff in the Provision of Existential Support to Patients With Cancer: A Randomized, Controlled Study2013In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 46, no 6, p. 785-794Article in journal (Refereed)
    Abstract [en]

    Context: When a patient receives a cancer diagnosis, existential issues become more compelling. Throughout the illness trajectory, patients with cancer are cared for in oncology wards, by home care teams or in hospices. Nurses working with these patients are sometimes aware of the patients' existential needs but do not feel confident when discussing these issues. Objectives: To determine the effects of a training intervention, where the focus is on existential issues and nurses' perceived confidence in communication and their attitude toward caring for dying patients. Methods: This was a randomized, controlled trial with a training intervention comprising theoretical training in existential issues combined with individual and group reflection. In total, 102 nurses in oncology and hospice wards and in palliative home care teams were randomized to a training or non-training group. Primary outcomes, confidence in communication, and attitude toward the care of dying patients were measured at baseline, immediately after the training, and five to six months later. Results: Confidence in communication improved significantly in the training group from baseline (before the training) to both the first and second follow-up, that is, immediately after the training and five months later. The attitude toward caring for the dying did not improve in the training group. Conclusion: This study shows that short-term training with reflection improves the confidence of health care staff when communicating, which is important for health care managers with limited resources. Further studies are needed to explore how patients experience the communication skills of health care staff after such training. © 2013 U.S. Cancer Pain Relief Committee.

  • 25.
    Henoch, Ingela
    et al.
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden / Angered Local Hospital, Gothenburg, Sweden.
    Melin-Johansson, Christina
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden / Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Strang, Susann
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden / Angered Local Hospital, Gothenburg, Sweden.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lundh Hagelin, Carina
    Sophiahemmet University, Stockholm, Sweden / Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden / Stockholms Sjukhem Foundation, Stockholm, Sweden.
    Westin, Lars
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Österlind, Jane
    Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Nursing, Stockholm, Sweden.
    Undergraduate nursing students' attitudes and preparedness toward caring for dying persons: A longitudinal study2017In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 26, p. 12-20, article id S1471-5953(17)30384-0Article in journal (Refereed)
    Abstract [en]

    Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.

  • 26.
    Henoch, Ingela
    et al.
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden.
    Strang, Susann
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Angered Local Hospital, Gothenburg, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Nursing, Solna, Sweden.
    Danielson, Ella
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Melin-Johansson, Christina
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Development of an existential support training program for healthcare professionals2015In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 13, no 6, p. 1701-1709Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Our aim was to describe the developmental process of a training program for nurses to communicate existential issues with severely ill patients.

    METHOD: The Medical Research Council (MRC) framework for the development and evaluation of complex interventions was used to develop a training program for nurses to communicate about existential issues with their patients. The steps in the framework were employed to describe the development of the training intervention, and the development, feasibility and piloting, evaluation, and implementation phases. The development and feasibility phases are described in the Methods section. The evaluation and implementation phases are described in the Results section.

    RESULTS: In the evaluation phase, the effectiveness of the intervention was shown as nurses' confidence in communication increased after training. The understanding of the change process was considered to be that the nurses could describe their way of communicating in terms of prerequisites, process, and content. Some efforts have been made to implement the training intervention, but these require further elaboration.

    SIGNIFICANCE OF RESULTS: Existential and spiritual issues are very important to severely ill patients, and healthcare professionals need to be attentive to such questions. It is important that professionals be properly prepared when patients need this communication. An evidence-based training intervention could provide such preparation. Healthcare staff were able to identify situations where existential issues were apparent, and they reported that their confidence in communication about existential issues increased after attending a short-term training program that included reflection. In order to design a program that should be permanently implemented, more knowledge is needed of patients' perceptions of the quality of the healthcare staff's existential support.

  • 27.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Johns Hopkins University, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer2014In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 47, no 4, p. 731-741Article in journal (Refereed)
    Abstract [en]

    Context: Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. Objectives: To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. Methods: In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups. Results: Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden. Conclusion: This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients. © 2013 U.S. Cancer Pain Relief Committee.

  • 28.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Browall, Maria
    University of Skövde, School of Life Sciences. Johns Hopkins School of Nursing, Baltimore, MD, USA / Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Persson, L.-O.
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Fall-Dickson, Jane M.
    National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
    Gaston-Johansson, Fanny
    Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Relationship of sense of coherence to stressful events, coping strategies, health status, and quality of life in women with breast cancer2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Objective: To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) predicts stressful events, coping strategies, health status, and quality of life (QoL) in a cohort of postmenopausal women (n = 131) with newly diagnosed primary or recurrent breast cancer.

    Methods: Regression analyses of longitudinal data at baseline through 6 months following breast cancer diagnosis examined the relationships between SOC (13-item version), daily assessment of coping with stressful events, health status, and QoL (EORTC QLQ-30).

    Results: The findings support Antonovsky's concept of SOC. Women with strong SOC reported fewer stressful events and more days without stressful events. They used more coping strategies and more frequently used distraction, situation redefinition, direct action, and relaxation, but seldom religion, to cope with stressful events, and reported better health status and QoL. Women with weak SOC experienced more distress and used fewer coping strategies, and they more frequently used coping strategies such as catharsis and seeking social and spiritual support, but seldom acceptance of the situation. They reported worse health status and QoL, regardless of disease stage or treatment. The relationships between SOC and health status and QoL were linear.

    Conclusions: Sense of coherence significantly predicts distress, number and type of coping strategies such as direct action and relaxation, health status, and QoL in women with breast cancer. Our data suggest that the SOC scale may be a useful screening tool to identify individuals particularly vulnerable to distress and unable to cope adequately. Assessing SOC strength may assist health care providers to provide individualized patient interventions.

  • 29.
    Melin-Johansson, Christina
    et al.
    Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Henoch, Ingela
    Bräcke Diakoni Foundation, Research Unit, Gothenburg, Sweden / Karolinska Institutet, Institution of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden / The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Sweden.
    Strang, Susann
    Angered Local Hospital, Gothenburg, Sweden / The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Sweden.
    Browall, Maria
    University of Skövde, School of Life Sciences. Sahlgrenska University Hospital, Department of Oncology, Clinical Trial Unit. Gothenburg, Sweden / The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Sweden.
    Living in the Presence of Death: An Integrative Literature Review of Relatives' Important Existential Concerns when Caring for a Severely Ill Family Member2012In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 6, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore relatives’ existential concerns when caring for a seriously ill family member as well as to describe interventions that meet these concerns.

    Methods: In this integrative literature review we assessed and classified 17 papers, 12 qualitative and 5 quantitative. Literature was sought in the databases Cinahl, PubMed, Psykinfo and Web of Science in September 2009 and in March 2010. Search terms used in different combinations were: family, family caregiver, next of kin, relatives, palliative, palliative care, end-of-life care, existential, spirit*. Data were redrawn from the papers results/findings, and synthesized into a new descriptive content.

    Results: The results were categorized from 13 papers exploring relatives’ important existential concerns and 4 papers describing interventions aimed to support them in the existential area. A majority of the reviewed papers had been written in Sweden and concerned relatives of patients with cancer. One overarching theme, living in the presence of death, and three categories: responses to life close to death; support when death is near; and beyond the presence of death were created.

    Conclusion: There is an urgent demand for large-scale studies using accurate methodology, as well as a need to design qualified investigations regarding the effects of various interventions, and to determine which interventions are the most effective in supporting relatives who experience existential distress manifested physically and/or psychologically. There is also a considerable demand for educational interventions among professionals in various healthcare settings to increase their knowledge regarding existential concerns among relatives.

  • 30.
    Mijwel, Sara
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden / Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Backman, Malin
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden / Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
    Bolam, Kate A.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden / School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
    Jervaeus, Anna
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Sundberg, Carl Johan
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden / Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Margolin, Sara
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden / Department of Oncology, Stockholm South General Hospital, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Rundqvist, Helene
    Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden / Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
    Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial2018In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 168, no 1, p. 79-93Article in journal (Refereed)
    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.

  • 31.
    Molassiotis, A.
    et al.
    School of Nursing, University of Manchester, United Kingdom.
    Browall, Maria
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Milovics, L.
    Department of Education, Institute for Oncology and Radiology, Belgrade, Serbia.
    Panteli, V.
    Greek Oncology Nursing Society, Athens, Greece.
    Patiraki, E.
    Greek Oncology Nursing Society, Athens, Greece.
    Fernandez-Ortega, P.
    Institut Català Oncologia ICO, Barcelona, Spain.
    Complementary and alternative medicine use in patients with gynecological cancers in Europe2006In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 16, no Suppl. 1, p. 219-224Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to assess the use of complementary and alternative medicine (CAM) specifically in women with gynecological cancer. The design of the study was of a descriptive cross-sectional survey using a 27-item questionnaire. The study was conducted in 11 countries in Europe as part of a larger project. Data were available from 72 gynecological cancer patients. Among the participants, 40.3% used CAM after the diagnosis with cancer. The most popular CAM modalities used were herbal medicine (34.5%), relaxation techniques (21.4%), and vitamins/minerals (20.7%). A very high level of satisfaction with CAM use was reported. Patients used CAM to increase the body's ability to fight the cancer or to improve physical and emotional well-being. The main sources of information about CAM were informal (friends/ family or the media). It is important to discuss CAM use with gynecological cancer patients, as they frequently use it and such use may have implications for clinical practice.

  • 32.
    Molassiotis, A.
    et al.
    School of Nursing, University of Manchester, Manchester, United Kingdom.
    Fernandez-Ortega, P.
    Institut Català Oncologia ICO, Barcelona, Spain.
    Pud, D.
    Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
    Ozden, G.
    Gazi University Hospital, Ankara, Turkey.
    Scott, J. A.
    Department of Nursing and Midwifery, University of Stirling, Stirling, United Kingdom.
    Pantelil, V.
    Greek Oncology Nursing Society, Ag. Anargiri Hospital, Athens, Greece.
    Margulies, A.
    Zurich University Hospital, Poliklinik Onkologie, Zurich, Switzerland.
    Browall, Maria
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Magri, M.
    Università degli Studi di Milano, Istituto Nazionale Tumori, Milan, Italy.
    Selvekerova, S.
    Masaryk Memorial Cancer Institute, Brno, Czech Republic.
    Madsen, E.
    Oncology Department, Aarhus University Hospital, Aarhus, Denmark.
    Milovics, L.
    Department of Education, Institute for Oncology and Radiology, Belgrade, Serbia.
    Bruyns, I.
    Belgian Society of Oncology Nursing, Brussels, Belgium.
    Gudmundsdottir, G.
    Department of Oncology, Lanspitali, Reykjavik, Iceland.
    Hummerston, S.
    Department of Oncology, City Hospital, Nottingham, United Kingdom.
    Ahmad, A. M. A.
    School of Nursing, University of Manchester, Manchester, United Kingdom.
    Platin, N.
    School of Health Sciences, Koc University, Istanbul, Turkey.
    Kearney, N.
    Department of Nursing and Midwifery, University of Stirling, Stirling, United Kingdom.
    Patiraki, E.
    Greek Oncology Nursing Society, Department of Nursing, University of Athens, Athens, Greece.
    Use of complementary and alternative medicine in cancer patients: a European survey2005In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 16, no 4, p. 655-663Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries. Methods: A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients. Results: Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient. Conclusions: It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

  • 33.
    Molassiotis, A.
    et al.
    School of Nursing, University of Manchester, Manchester, United Kingdom.
    Ozden, G.
    Gazi University Hospital, Ankara, Turkey.
    Platin, N.
    School of Health Sciences, Koc University, Istanbul, Turkey.
    Scott, J. A.
    Department of Nursing and Midwifery, University of Stirling, Stirling, United Kingdom.
    Pud, D.
    Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
    Fernandez-Ortega, P.
    Institut Català Oncologia ICO, Barcelona, Spain.
    Milovics, L.
    Department of Education, Institute for Oncology and Radiology, Belgrade, Serbia.
    Panteli, V.
    Greek Oncology Nursing Society, Athens, Greece.
    Gudmundsdottir, G.
    Department of Oncology, Landspitali, Reykjavik, Iceland.
    Browall, Maria
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Madsen, E.
    Oncology Department, Aarhus University Hospital, Aarhus, Denmark.
    Patiraki, E.
    Greek Oncology Nursing Society, Athens, Greece.
    Kearney, N.
    Department of Nursing and Midwifery, University of Stirling, Stirling, United Kingdom.
    Complementary and alternative medicine use in patients with head and neck cancers in Europe2006In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 15, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to examine the patterns of complementary and alternative medicine (CAM) use in a sample of head and neck cancer patients, forming part of a larger study. A cross-sectional survey design was used collecting data through a descriptive 27-item questionnaire in nine countries in Europe. The participants were 75 patients with head and neck cancers. The prevalence rate of CAM use was 22.7%. The most common therapies used were herbal medicine (47%), medicinal teas (23.5%), use of vitamins/minerals (11.8%) and visualization (11.8%). Use of CAM dramatically increased after the diagnosis with cancer (i.e. eightfold increase in the use of herbs). A profile of CAM users was not evident in this sample. Patients used CAM for a variety of reasons together, with counteracting the ill effects from cancer and its treatment being the most common one. Information about CAM was obtained mostly from friends and family. As one in five head and neck cancer patients use CAM it is important that clinicians explore practices with their patients, improve communication about CAM with them and assist those who want to use CAM in using appropriate and safe therapies.

  • 34.
    Molassiotis, Alexander
    et al.
    School of Nursing, University of Manchester, Manchester, United Kingdom.
    Margulies, Anita
    University Hospital Zürich, Klinik und Poliklinik für Onkologie, Zürich, Switzerland.
    Fernandez-Ortega, Paz
    Institut Català Oncologia ICO, Barcelona, Spain.
    Pud, Dorit
    Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
    Panteli, Vassiliki
    Greek Oncology Nursing Society, Athens, Greece.
    Bruyns, Ingrid
    Belgian Society of Oncology Nursing, Brussels, Belgium.
    Scott, Julia A.
    Department of Nursing and Midwifery, University of Stirling, Stirling, Scotland.
    Gudmundsdottir, Gudbjorg
    Department of Oncology, Landspitali, Reykjavik, Iceland.
    Browall, Maria
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Madsen, Elin
    Oncology Department, Aarhus University Hospital, Aarhus, Denmark.
    Ozden, Gulten
    Gazi University Hospital, Ankara, Turkey.
    Magri, Miriam
    Università degli Studi di Milano-Istituto Nazionale Tumori, Milan, Italy.
    Selvekerova, Sarka
    Masaryk Memorial Cancer Institute, Brno, Czech Republic.
    Platin, Nurgun
    School of Health Sciences, Koc University, Istanbul, Turkey.
    Kearney, Nora
    Department of Nursing and Midwifery, University of Stirling, Stirling, Scotland.
    Patiraki, Elisabeth
    Greek Oncology Nursing Society, Athens, Greece.
    Complementary and alternative medicine use in patients with haematological malignancies in Europe2005In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 11, no 2, p. 105-110Article in journal (Refereed)
    Abstract [en]

    This study reports upon a descriptive cross-sectional survey assessing the use of complementary and alternative medicine (CAM) in patients with haematological cancers. Twelve European countries contributed data from patients with haematological cancers, as part of a larger study. Sixty-eight patients with haematological cancer participated. Among the participants, 26.5% used some form of CAM after the cancer diagnosis. The most common therapies used were homeopathy (38.9%), herbal medicine (22.2%) various psychic therapies, such as use of mediums, healers, rebirthing or past life regression therapy (22.2%). A particular profile of a CAM user was not evident in the sample. Moderate levels of satisfaction with CAM were reported. Patients commonly used CAM to increase the ability of their body to fight cancer and to improve physical and emotional well-being. Information about CAM was received mainly from friends or family. As CAM use in patients with haematological malignancies is common, clinicians should assist patients who want to use CAM to make an appropriate decision, and improve communication with them about CAM use in an open and non-judgemental dialogue. © 2005 Elsevier Ltd. All rights reserved.

  • 35.
    Molassiotis, Alexander
    et al.
    a School of Nursing, University of Manchester, Manchester, United Kingdom.
    Panteli, Vassiliki
    Greek Oncology Nursing Society, Athens, Greece.
    Patiraki, Elisabeth
    Greek Oncology Nursing Society, Athens, Greece.
    Ozden, Gulten
    Gazi University Hospital, Ankara, Turkey.
    Platin, Nurgun
    School of Health Sciences, Koc University, Istanbul, Turkey.
    Madsen, Elin
    Oncology Department, Aarhus University Hospital, Aarhus, Denmark.
    Browall, Maria
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fernandez-Ortega, Paz
    Institut Català Oncologia ICO, Barcelona, Spain.
    Pud, Dorit
    Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
    Margulies, Anita
    University Hospital Zürich, Klinik und Poliklinik für Onkologie, Zürich, Switzerland.
    Complementary and alternative medicine use in lung cancer patients in eight European countries2006In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 12, no 1, p. 34-39Article in journal (Refereed)
    Abstract [en]

    This paper presents findings from a cross-sectional survey about the use of complementary and alternative medicine (CAM) in patients with lung cancer, forming part of a larger study. Data from 111 lung cancer patients in 8 countries in Europe were collected through a descriptive 27-item questionnaire. The data suggest that 23.6% of the lung cancer patients used CAM after the diagnosis with cancer. The most popular CAM modalities were herbal medicine (48.1%), medicinal teas (11.5%), homeopathy (11.5%), use of animal extracts (11.5%) and spiritual therapies (11.5%). Herbal use increased by three times after the diagnosis of cancer. Patients seemed quite satisfied with the CAM used. They were also spending on average about 142 Euros monthly on CAM therapies or remedies. The most common motivation to use CAM was to increase the body's ability to fight the cancer. Main sources of information about CAM were friends and family. As CAM is increasingly used by patients with lung cancer, it is important to be able to assist patients make an appropriate decision by discussing the issue of CAM openly, providing reassurance and communicating safe and appropriate information to patients. © 2005 Elsevier Ltd. All rights reserved.

  • 36.
    Muntlin Athlin, Åsa
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden / Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden / Adelaide Nursing School, University of Adelaide, SA, Australia / Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Huddinge, Sweden & Karolinska University Hospital, Radiumhemmet, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Huddinge, Sweden & Karolinska University Hospital, Radiumhemmet, Stockholm, Sweden.
    Conroy, Tiffany
    Adelaide Nursing School, University of Adelaide, SA, Australia / Centre for Evidence based Practice South Australia, Adelaide Nursing School, Faculty of Health Sciences, The University of Adelaide, SA, Australia.
    Kitson, Alison L
    Adelaide Nursing School, University of Adelaide, SA, Australia / College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
    Descriptions of Fundamental Care needs in cancer care - an exploratory study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    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.

  • 37.
    Strang, Susann
    et al.
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Henoch, Ingela
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Danielson, Ella
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden / Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute, Solna, Sweden.
    Melin-Johansson, Christina
    Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
    Communication about existential issues with patients close to death—nurses' reflections on content, process and meaning2014In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, no 5, p. 562-568Article in journal (Refereed)
    Abstract [en]

    Objective: Encountering dying patients with implicit existential questions requires the nurses to have positive and comfortable attitude to talking about existential issues. This paper describes the nurses' reflections on existential issues in their communication with patients close to death. Methods: Nurses (n=98) were recruited from a hospital, hospices and homecare teams. Each nurse participated in five group reflection sessions that were recorded, transcribed and analysed using qualitative content analysis. Results: Three domains and nine themes emerged. The content domain of the existential conversation covered living, dying and relationships. The process domain dealt with using conversation techniques to open up conversations, being present and confirming. The third domain was about the meaning of existential conversation for nurses. The group reflections revealed a distinct awareness of the value of sensitivity and supportive conversations. Conclusion: This study supports the assertion that experience of talking about existential issues and supporting environment make nurses comfortable when counselling patients close to death. It was obvious from this study that having the courage to be present and confirming, having time and not trying to 'solve' every existential problem were the most important factors in conversations with the patients close to death. © 2013 John Wiley & Sons, Ltd.

  • 38.
    Wengström, Y.
    et al.
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden / Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Bolam, K. A.
    Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden / School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
    Mijwel, S.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Sundberg, C. J.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden / Unit for Bioentrepreneurship, Karolinska Institutet, Solna, Sweden.
    Backman, M.
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden / Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Norrbom, J.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Rundqvist, H.
    Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
    Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy2017In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 17, article id 100Article in journal (Refereed)
    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.

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