BACKGROUND: Postponing childbirth is becoming increasingly common in Western countries, especially among women with higher education. OBJECTIVE: The aim of the present study was to investigate female and male postgraduate students' attitudes toward parenthood, their intentions to have children, perceived obstacles to having or raising children during postgraduate studies, and their awareness of fertility issues. METHODS: A 52-question survey was mailed to randomly selected postgraduate students attending a Swedish university. The questionnaire was developed based on earlier research by, and the professional experience of, the authors. Three pilot studies were conducted to test the questionnaire's reliability and validity. The t, x2, and Mann-Whitney U tests were used, as appropriate, to analyze responses. RESULTS: Two hundred female and 200 male postgraduate students aged
PURPOSE: To compare attitudes towards gamete donation between IVF doctors in the Nordic countries, and to determine whether attitudes are in correspondence with national legislation. MATERIALS AND METHODS: A study-specific questionnaire was used to study attitudes of 108 IVF doctors (92% response). Participants constituted 78% of all IVF doctors in Sweden, Denmark and Norway and 15% of IVF doctors in Finland. RESULTS: Despite similar legislation regarding offspring right to learn his/her donor's identity, IVF doctors from Norway reported significantly more negative attitudes towards disclosure than did Swedish physicians. A majority from all countries demonstrated positive attitudes towards embryo donation and allowing sperm donation for lesbian couples. Physicians reported strong support for anonymous donation but less support for 'known' donation. CONCLUSION: There are discrepancies between IVF doctors' attitudes towards gamete donation and national legislation in four Nordic countries. Negative attitudes towards disclosure to offspring may counteract legislative intentions.
The aim of the present cross-sectional study was to investigate psychological distress, changes in life, adherence to surveillance programs and satisfaction with cancer genetic counseling based on Swedish participants' self-reported data. A total of 218 probands (72% response rate) affected by breast, breast/ovarian or colorectal cancer and/or a family history of cancer were surveyed 3-7 years after receiving cancer genetic counseling. Participants reported a relatively high level of anxiety and a low level of depression. Probands affected by colorectal cancer reported a higher level of depression than did non-affected individuals with a family history of colorectal cancer. Overall, the participants reported moderate changes in family relations, priorities and appreciation of daily life activities. The majority of at-risk probands reportedly adhered to recommended surveillance programs. The mean level of satisfaction with cancer genetic counseling was high. About half of the participants would have accepted additional counseling sessions, contact with a psychologist or further help concerning informing family members. The present results indicate no adverse effects of genetic counseling, but they do suggest that typical counseling procedures could be improved by provision of additional psychosocial support.
Purpose/Objectives: To investigate nurses' planning and implementation of individualized patient care in relation to patients' emotional distress as assessed by nurses and whether nurses and patients perceived the implemented care in a similar manner.Design: Prospective, comparative.Setting: Five oncologic-hematologic wards in Sweden.Sample: 90 individual nurse-patient pairs were recruited and 81 were intact after three consecutive days. Each pair consisted of a patient with cancer and a nurse responsible for that patient's care.Methods: Nurse-patient pairs were followed using questionnaires. Outcome measures were nurses' identification of patients' emotional distress, care planning, and nursepatient ratings of implemented care.Main Research Variables: Patients' emotional distress and nurses' implemented care.Findings: Nurses identified a variety of emotional issues among patients and planned individual nursing interventions. Nurse and patient perceptions of implemented care demonstrated weak correlations for individually planned interventions and nurses' general caring behavior. With one exception, nurse self-reports did not indicate any differences in nurses' caring behavior directed to more and less distressed patients. Nurses reported providing comfort more frequently to patients with high levels of emotional distress, but this was not substantiated in patients' ratings.Conclusions: Nurses showed an intention to provide individualized care. However, with one exception, nurses did not report providing more care to patients with cancer with high levels of emotional distress than to less distressed patients.Implications for Nursing: To ensure individualized care, nurses in cancer care should closely validate the accuracy of their interpretation of patients' needs and their planning of care in collaboration with the patients.
OBJECTIVES: As highly educated women tend to postpone childbearing, the purpose was to explore female university students' attitudes to future motherhood and their understanding about fertility. METHODS: Female students (n = 300), visiting a Student Health Centre in Sweden, answered a questionnaire with mainly multiple choice questions and verbal rating scales. RESULTS: The women wanted to have two to three children at the age of 29 for the first birth and 35 for the last. Only 2.7% did not plan to have any children. Six out of 10 would consider having an abortion if confronted with an unplanned pregnancy 'right now'. The most important circumstances for women's decision to have children were to be sufficiently mature, have a stable partner to share parenthood with, have completed studies and have a good economy. Having children before they got 'too old' was only ranked as very important by 18% of women. The women had an acceptable understanding about fertility. CONCLUSIONS: It appears that female university students are not very concerned about having children before they get 'too old'. Therefore, it is important that caregivers, working with contraceptive counselling also include information about fertility, especially to women who intend to postpone their motherhood.
BACKGROUND: The aim was to investigate HRQoL and psychosocial function among patients with carcinoid tumours, longitudinally and prospectively, and to compare HRQoL among patients with carcinoid tumours to that of the Swedish general population. The aim was also to investigate the prevalence of distress during the first year after diagnosis. METHODS: At four assessments during the first year after diagnosis, HRQoL was measured by the EORTC QLQ-C30 3.0, anxiety and depression by the HADS, and prevalence, and worst aspects of distress by an interview guide. ANOVA was performed in order to study changes over time with regard to HRQoL, anxiety and depression. Comparisons regarding HRQoL between patients and the Swedish population were made by the use of one-sample t-tests and changes over time regarding the prevalence of distress was investigated by means of Cochran's Q. RESULTS: High levels of physical-, emotional-, cognitive-, and social function and somewhat lower levels of role function and global quality of life were reported at all assessments. Role- and emotional function increased over time. Patients reported lower role function and global quality of life and more problems with fatigue and diarrhoea than the Swedish general population, at all assessments. Fatigue, limitations to work and pursue daily activities, and worry that the illness will get worse were among the most prevalent aspects at all assessments. At all assessments the majority reported worrying about the family's situation, the ability to care for the family, and worrying before the check-up. CONCLUSION: It is concluded that HRQoL and psychosocial function among patients with carcinoid tumours remains stable during the first year, that the patients report a lower HRQoL than the Swedish general population, and that a majority of the patients report a number of aspects of emotional distress. In the clinical care, it should be considered that the majority of patients report not only fatigue and diarrhoea but also worries about their prognosis, their families, tests, and examinations. Efforts to reduce these worries should be made.
The aim of this study was to investigate (i) whether specific aspects of the initial consultation (IC) and/or patients' satisfaction with doctors' care are related to health-related quality of life (HRQoL), anxiety and depression among patients with carcinoid tumours and (ii) whether patients' satisfaction with doctors' care changes over time. The study has a longitudinal design. The HRQoL and psychosocial function among patients who met the doctors showing good ability to identify patients' worry and wish for information were compared with those patients who met doctors showing less good ability. Patients' HRQoL, anxiety, depression and satisfaction with doctors' care were assessed longitudinally, shortly after each of the first four admissions to specialist care. Patients who met doctors showing good ability to identify their wish for information at the IC reported higher levels of cognitive function. Higher satisfaction with doctors' care was related to higher emotional and cognitive function, to higher global QoL, and to lower levels of problems with diarrhoea, financial difficulties, constipation, anxiety and depression shortly after each of the first three admissions, although not after the fourth admission to the specialist care. Although most patients with carcinoid tumours report high satisfaction with care, it is important to be aware of the fact that some patients may be less satisfied. Doctors should provide patients with information which matches the individual patients' needs and preferences as patients' satisfaction with doctors' provision of information is related to patients' HRQoL, anxiety and depression.
The aim was to describe the patient attitudes, behaviours, and other factors, considered by doctors when estimating cancer patients' worry about how the disease may develop and the desire for information about the disease and its treatment. Data was gathered through semi-structured interviews with 19 doctors regarding 29 patients within endocrine oncology and haematology care, and the data were analysed by content analysis. The doctors considered the patients' verbal expressions, verbal behaviours, questions, body language, and facial expressions together with their own professional knowledge and experience, when estimating the patients' worry and desire for information. The doctors also considered contextual factors, patients' demographical factors, and medical situation when estimating the patients' worry, and also when estimating the patients' desire for information. The findings illustrate that estimating patients' worry and desire for information is a multifaceted and complex task, and that doctors consider not only the patients' verbal and nonverbal cues, but also factors, such as their own professional knowledge and experience, contextual factors, and patients' demographical variables. The findings should be communicated to doctors who meet cancer patients in medical consultations in order to illuminate the complexity of the medical consultation. The awareness of potentially important patient cues and other factors may aid doctors in their efforts to gain insight about their patients' emotions and informational needs.
The aim of the study was to describe how young adults who have survived childhood cancer consider their present life to be influenced by the cancer experience. A cohort of 246 long-term survivors were approached a median of 16 years after diagnosis. Semi-structured telephone interviews were conducted based on the Swedish version of the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW). Interviews were analysed using content analyses. When asked if cancer negatively or positively currently affected their lives, 68% reported at least one negative consequence and 53% at least one positive consequence. The most frequently reported negative consequences include a variety of physical impairments and limitations in participating in activities; positive consequences describe a more positive view of life and of self. Women more often than men reported negative psychological impact, a changed body appearance and positive interaction with others. CNS tumours and combined treatment were somewhat associated to a higher extent of negative consequences. Overall, the results indicate that long-term survivors of childhood cancer are getting along quite well despite shortcomings.