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Purpose: Support after cancer treatment can improve health-related quality of life for cancer survivors. Contact nurses play a key role in patient care following cancer treatment. The contact nurse is responsible for providing support, encouraging patient participation in care, and assessing and managing individual needs throughout the cancer trajectory. This study aims to explore contact nurses' perceptions of how organisational conditions influence patient care provision after cancer treatment.

Methods: A descriptive qualitative study design was used. Semi-structured individual interviews were conducted with 12 contact nurses from seven hospitals in northern Sweden, between February 2022 and January 2024. Data was analysed using qualitative content analysis.

Results: Contact nurses perceive that they are: working around resource limitations, navigating unclear responsibilities, pursuing inter-professional collaboration and envisioning integrative follow-up. The results highlight the challenges that contact nurses face when maneuvering between the formal and informal boundaries they perceived within the organisation. They struggled to work according to their job descriptions and felt hindered by existing structures.

Conclusion: Contact nurses experienced that organisational prerequisites hindered their ability to fulfil their role when providing care to patients after cancer treatment. They strived to adopt a person-centred approach and improve patient support, but felt hindered by unclear structures within the organisation. By addressing these challenges, organisational conditions for contact nurses may be enhanced to improve patient care after cancer treatment.Keywords: Cancer care navigator; Cancer survivors; Contact nurse; Curative treatment; Experience; Nursing; Oncology care coordinator; Organisation; Qualitative research; Support.

Introduction: Teledermoscopy (TD), introduced in Västerbotten, northern Sweden in 2014, enables dermatological consultation in primary care via high-resolution images. As skin cancer incidence increases in Sweden, TD offers potential for diagnostic efficiency and resource optimisation. Despite increasing referrals, TD remains unevaluated. This study examines TD's impact on equitable access to dermatological assessment for skin tumours in this region.

Methods: This descriptive study analysed 67,137 TD referrals submitted between 2014 and 2024, excluding 2,384 due to incomplete data. Variables included age, diagnosis (benign vs malignant), and referral origin (public/private; urban/rural). A survey examined TD routines across primary care centres (PCCs), staff roles, training, and frequency of internal TD discussions.

Results: Over the 11-year period, mean age increased from 50 (2014) to 61 years (2024) (P < 0.001). The proportion of benign referrals decreased from 80% to 69% (P < 0.001). Private PCCs referred 78% benign lesions versus 75% from public PCCs (P < 0.001); urban PCCs referred 77% versus 73% PCCs in remote areas (P < 0.001). Assessment by a nurse was associated with higher benign referral rates (odds ratio (OR) 1.132, 95% confidence interval (CI) 1.052–1.219), whereas internal TD discussions (OR 0.714, 95% CI 0.669–0.763) and lack of dermoscopy training (OR 0.893, 95% CI 0.882–0.971) were associated with lower benign referral rates.

Discussion: TD has enhanced access to dermatological evaluation for suspected skin tumours in Västerbotten. The increasing age of referred patients and higher proportion of tumour diagnoses imply improved targeting of high-risk groups. Local routines influenced referral quality, underscoring the need for structured TD implementation.

Introduction: Self-conscious emotions, such as shame and guilt, can lead to negative health behaviors in people with chronic obstructive pulmonary disease (COPD). The aim was to investigate which factors – sociodemographic, lifestyle, burden of disease, and healthcare interventions – are associated with self-conscious emotions in people with COPD.

Methods; People with COPD answered a questionnaire with questions about self-conscious emotions, sociodemographic factors, lifestyle, disease burden, and previous healthcare interventions. The relationship between self-conscious emotions and the other variables were analyzed.

Results: A total of 136 participants (68% women, 73.5 ± 7.87 years, FEV1% 53.1 ± 19.3) were included. Emotions of shame were significantly associated with being a woman (p=0.020), reporting physical activity below recommended levels (p=0.029), being a smoker (p=0.018), more severe symptoms (p=0.035), and more exacerbations (p=0.013). Meanwhile, emotions of guilt, worry and grief were significantly associated with reporting physical activity below recommended levels (p<0.001), worse lung function (p=0.018), more symptoms (p<0.001), more breathlessness (p=0.005), more comorbidities (p=0.007), and worse subjective health (p<0.001). No significant associations were found between self-conscious emotions and previous healthcare interventions.

Conclusions: This study reveals significant differences in how people with COPD experience self-conscious emotions, with specific subgroups exhibiting distinct emotional profiles. These emotions may stem from dominant norms in society and can contribute to negative health behaviors. Healthcare professionals need to acknowledge self-conscious emotions and tailor their healthcare interventions accordingly. Because of the small sample size, the findings need to be considered with caution and more comprehensive studies about COPD-related self-conscious emotions are needed.

Aim and Objectives: To explore how chronic illness transforms the self when living with and managing chronic illness and what this means for their self and identity. We also discuss how people with chronic conditions could be supported by healthcare professionals to manage illness in daily life.

Background: Self-management recommendations from health care are commonly based on a biomedical understanding of the disease. People's experiences of how a condition affects them and adequate support are crucial for their outcomes in daily self-management.

Design: A narrative review.

Methods: A systematic search was undertaken during January 2021 across the databases MEDLINE, CINAHL, PsycINFO, Soc INDEX and Philosopher's Index. A quality appraisal of articles was performed. Our analysis was inspired by qualitative content analysis. The PRISMA Checklist 2020/EQUATOR guidelines was used to report the study.

Results: Twenty-eight peer-reviewed qualitative empirical articles focusing on self in a variety of chronic illnesses with relevance to nursing published from January 2010 to December 2020 were included. The main theme, Developing from an uncertain existence to meaning and wholeness, was built up by the five themes: Walking on an unstable ground; Being stalemated; Being involved with others for better or worse; Searching for meaning; and lastly, Modifying self and integrating a new way of living.

Conclusions: The results illuminate experiences that seldom are prioritized but need to be addressed by health professionals. Such experiences are oriented more towards the existential self rather than medical issues, why it is important to go beyond the medical lens.

Relevance to Clinical Practice: This is important knowledge for nurses aiming to support people with chronic illnesses. Nurses supporting people in self-management need to be aware that by teaching and encouraging people to revise their daily habits, they also work on the boundaries of their self-concept.

Patient or Public Contribution: No patient or public contribution.

Purpose: Cancer rehabilitation guidelines emphasise the importance of providing individualised support to meet each patient's unique needs. Contact nurses have an essential role in providing such support. This study aims to explore contact nurses' experiences of supporting patients after cancer treatment.

Method: This descriptive qualitative study was undertaken between February 2022 and January 2024. Semi-structured individual interviews were conducted with 12 contact nurses who were purposively recruited from seven hospitals in northern Sweden. Data were analysed using qualitative content analysis with an inductive approach.

Results: Three themes were revealed. Providing a sense of stability was achieved through creating order despite chaos, always being reachable and giving information to reassure patients. Creating trustful relationships involved being a confidant who assisted patients to cope and acknowledged their challenged existence. Navigating within limitations meant that contact nurses provided support while dealing with the unknown and facing their own inadequacy. The results highlight the ways that contact nurses support patients' self-management and well-being after curative cancer treatment.

Conclusion: Contact nurses experienced that patients had multifaceted physical, psychosocial and relational needs following cancer treatment. They described their role as inherently solitary and struggled to uphold care ideals while lacking support themselves. It was challenging to provide person-centred support when patient needs were not clearly identified or expressed, or when the required support was beyond the contact nurses' scope of practice. The contact nurse role was extensive but lacked clarity regarding how it could be optimised to best support patients following cancer treatment.

Chronic obstructive pulmonary disease (COPD) represents a public health challenge and self-management support is crucial to prevent deterioration of health. The Self-Management Assessment Scale was developed to screen for prerequisites for self-management but has not been tested on people with COPD. The study aimed to evaluate the psychometric properties and internal structure of the 20-item Self-Management Assessment Scale in a Swedish COPD population. The 20-item Self-Management Assessment Scale was tested in a sample of 173 participants with a verified COPD diagnosis. Data collection was performed between September 2021 and September 2022. Assessment of content validity by an expert group, confirmatory factor analysis, and test-retest reliability were performed. The scale content validity index (S-CVI) was 0.87, and the number of missing items was low. A moderate to good goodness-of-fit of a five-factor solution was shown. The five factors, Knowledge, Goals for the future, Daily routines, Wellbeing, and Social Support, had correlations within the range of 0.59 to 0.89, with the strongest correlation between Wellbeing and Daily routines. The internal reliability was high for the instrument (0.93) and for each factor (0.73–0.85). Test-retest reliability was good, with no significant difference between scale or factor scores. Good validity and reliability were shown for the Self-Management Assessment Scale and its five key domains. The low number of missing items indicates that the instrument is easy and quick for people to complete. The Self-Management Assessment Scale is, therefore, considered a valuable tool in clinical practice.

Aim: This study aimed to explore the experiences of being a clinical research nurse (CRN), in Sweden.

Design: A qualitative study analysing individual interview data.

Methods: Interviews with 10 participants were conducted in April 2017 and repeated with five participants in May 2022. A semi-structured interview guide was used to cover topics such as experiences of working in a new role and professional challenges related to the role. The transcribed interviews were analysed inductively using qualitative content analysis.

Results: The main theme revealed that the CRNs experienced their work role as being like a hub in a wheel, using an ethical compass, but without real power. The six themes identified showed that CRNs worked independently and relied on clinical experiences as nurses but needed more education. They not only had a sense of duty but also too large responsibilities. Furthermore, they viewed their work as valuable and important. However, they needed an accentuated ethical compass and were also affected by power relations that negatively impacted work.

Conclusion: Working as a CRN means being in a central position and working independently, which requires diverse skills and competencies. CRNs, however, face and manage complex ethical and practical challenges without real power. They experience huge responsibilities but need education and acknowledgement, indicating a need for improvement. This is an important message to stakeholders and managers about the necessity of taking adequate action to support CRNs who are crucial resources in clinical research.

Patient or Public Contribution: No patient or public contribution.

Background: Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy. Objective: This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors. Methods: This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses. Results: As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8-3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2-3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2-3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2-3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2-3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95% CI 1-1.05; P=.03); digital technology use (OR 1.05, 95% CI 1.02-1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95% CI 1-1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one. Conclusions: Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users' individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible.

Objectives: Hereditary cancer risks can be effectively managed if at-risk relatives enroll in surveillance and preventive care. Family-mediated risk disclosure has internationally been shown to be incomplete, selective and leave over a third of eligible at-risk individuals without access to genetic counseling. We explored patients handling of cancer risk information in practice. 

Methods: We conducted twelve semi-structured interviews with patients who had completed their genetic counseling and been asked to disclose risk information to relatives. Questions were designed to investigate lived experiences of communicating hereditary risk and focused on disclosure strategies, intrafamilial interactions and emotional responses. 

Results: Qualitative content analysis yielded five categories. These span personal fears, shared responsibilities, feeling of empowerment, innovative solutions and unmet needs. Patients put high value on collaboration with their genetic healthcare professionals but also solicited better overview of the counseling process and more personalized, case-tailored information. 

Conclusions: Our results add novel insights about the practical strategies employed by genetic counselees and their motivations behind disclosing hereditary risk information to relatives. 

Practice implications: A patient-centered cancer genetics care would clarify roles and responsibilities around risk disclosure, inform counselees about the process upfront and tailor information to offer case-specific data with the family’s inheritance pattern explained.

Assessment of self-conscious emotions is important to develop tailored interventions for people with chronic obstructive pulmonary disease (COPD). Previous instruments have largely been developed for mental health populations. The Self-Conscious Emotions in COPD Questionnaire was the first instrument to assess self-conscious emotions in people with COPD, but it was only available in English.

The aim was to translate the Self-Conscious Emotions in COPD Questionnaire into Swedish and to evaluate its psychometric properties and internal structure in a Swedish context.

The translation process included forward and backward translation, a multidisciplinary meeting, assessment of content validity, and cognitive interviews. The translated instrument was tested in a sample of 173 people with COPD between September 2021 and September 2022. Parallel analysis (PA), exploratory factor analysis (EFA), and test-retest reliability was performed.

The content validity index (CVI) for the instrument was 0.88. Based on the PA, an EFA with a two-factor solution was conducted, with a high Cronbach's alpha (0.786-0.821), and one item about self-blame was excluded. The two factors were labelled: The burden of living with a disability and The desire to hide vulnerability. Test-retest reliability showed no difference between scale scores on factor or item level, except for one item.

The Swedish Self-Conscious Emotions in COPD showed good validity and reliability. One item was excluded from the two subscales, indicating that the instrument needs to be further developed to cover the concept of self-blame. The instrument is expected to be a valuable tool for assessing self-conscious emotions in people with COPD.