Two questions were investigated: whether cancer patients (n = 32) and staff (n = 30) have different cognitive representations of the concepts 'caring' (Swedish: 'omvårdnad') and 'clinical care' (Swedish: 'vård'), and whether results differ between forced vs. free choice response formats. Two Swedish versions of the CARE-Q instrument were used: (i) a CARE-Q sorting (forced format) and (ii) a CARE-Questionnaire (free format). Four groups of patients and 4 groups of staff completed (i) the forced format/caring, (ii) the forced format/clinical care, (iii) the free format/caring and (iv) the free format/clinical care versions, respectively. Participants were asked to rank the importance of 50 CARE-Q behaviours for the specific method/concept combination. Results demonstrated that neither patients nor staff, to any great extent, valued CARE-Q subscales differently when regarded as examples of 'caring' vs. 'clinical care'. Further, the free vs. forced choice format did not influence patient and staff perceptions of the importance of CARE-Q subscales, except that both groups gave higher values to all subscales in the free choice response format. The assumptions that different cognitive representations of the concepts or the response formats had affected previous CARE-Q results were not substantiated.
INTRODUCTION: Danish cancer patients generally have a poorer survival than Swedish cancer patients. The difference is most pronounced for certain tumour types, e.g. common types such as lung, breast, colorectal, and prostate cancer. The reasons are not clear. The present article examines if differences in the diagnostic workup and treatment can explain some of this variation. MATERIAL AND METHODS: Aspects of the diagnostic workup and treatment of the above mentioned four cancer types are examined using data from cancer registry analyses and official reports. These data are seen in the context of counts of trained personnel and equipment in cancer diagnostics and treatment in the two countries. RESULTS: With regard to lung and breast cancer, the data seem to indicate that Danish patients are diagnosed later, and that Denmark lags behind in treatment capacity. With regard to rectal cancer, the data seem to indicate that concentrating operations in fewer hospitals, and improvements in operation technique have been introduced earlier in Sweden than in Denmark. With regard to prostate cancer, however, the data seem to indicate that many more indolent cases that do not need treatment are diagnosed in Sweden than in Denmark. The total capacity for oncologic treatment, both in terms of trained personnel and equipment, seen in relation to the size of the population, is considerably larger in Southern Sweden than in Eastern Denmark. DISCUSSION: The data for some of the common cancer types seem to indicate that problems in the areas of sufficient capacity for diagnostic workup and treatment may explain some of the difference in survival between Danish and Swedish cancer patients.
A well-functioning care pathway for oesophageal cancer patients is particularly important in view of the need for a multidisciplinary approach and of the complex diagnostic procedures, extensive treatment, increasing volume of patients at fewer centres, and poor prognosis. Nevertheless, the literature regarding organization of care pathways for cancer patients is sparse. We therefore present our newly developed care pathway for oesophageal cancer patients, created to optimize the organization, coordination and supportive care. Based on scientific evidence, the pathway includes all relevant diagnostic examinations and therapeutic options, multidisciplinary team meetings, programmes for follow-up, rehabilitation and after-hospital care, and organized supportive care throughout the pathway, all led by a specialist nurse. The specialist nurse maintains continuous contacts with the patient and family throughout the care pathway. The experience and evaluation of our care pathway indicate that it works well in clinical practice, and that the role of the specialist nurse seems to be the key to the success, from the colleagues', hospital's and patients' point of view. This pathway has therefore been established at our hospital, and we can recommend well-organized and nurse-led care pathways for oesophageal cancer patients.
Author Affiliations: Department of Global Public Health and Primary Care (Ms Blytt and Drs Drageset, Natvig, and Husebo) and Centre for Elderly and Nursing Home Medicine (Ms Blytt and Dr Husebo), University of Bergen; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen (Ms Blytt); Faculty of Medicine, University of Oslo; Ageing and Health, Norwegian Centre for Research, Education and Service Development, Vestfold Hospital Trust, Tonsberg; and Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad (Dr Selbæk); Faculty for Health and Social Sciences, Bergen University College (Dr Drageset); and the Municipality of Bergen (Dr Husebo), Norway.
Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored.
The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer.
This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored.
Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P
BACKGROUND: The gap between nursing research and practice is readily acknowledged in literature, with a variety of strategies suggested for reducing this gap. It is necessary not only to address problems of research implementation in practice, but also to find strategies that strengthen the influence of practitioners on research agendas through more collaborative relationships in order to have an impact on care of patients. A multi-centre research project was therefore initiated by two universities and three health care facilities, aiming to improve quality of care for patients with advanced cancer through a knowledge-exchange programme between nurse researchers, practitioners and students. AIM: The aim of this article is to explore how clinical staff reason about care provision for patients with advanced cancer, through analysis of 20 focus group discussions conducted with staff in three different health care facilities in two Swedish cities. An initial analysis based on grounded theory was complemented with consideration of the interactive process in the focus group discussions, and carried out by a team consisting of senior nurse researchers, clinical experts and nursing instructors. FINDINGS: The findings of the focus group discussions emphasize the complexity of caregiving for patients with advanced cancer. The tension between caregiving ideals and limits imposed by the realities of caregiving in today's health system were striking. Practitioners discussed the organization of care, different constellations of relationships between patients, family members and professionals, and theoretical and experiential knowledge as equally important aspects in dealing with all concrete situations in daily practice. The importance of reflective practice, use of self and ethical reasoning also permeated the focus group discussions. CONCLUSIONS: These findings highlight an integrated need both to influence organizational structures and working relationships, along with increasing knowledge, if sustainable change is to be effected.