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  • 1.
    Andersson, Sofia
    et al.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Granat, Lisa
    Brännström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Sandgren, Anna
    Translation, Cultural Adaptation, and Content Validation of the Palliative Care Self-Efficacy Scale for Use in the Swedish Context2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 3, artikkel-id 1143Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Palliative Care Self-Efficacy Scale (PCSE) is a valid instrument in English for assessing healthcare professionals’ self-efficacy in providing palliative care; it has not been translated into Swedish. The aim of this study was to describe the translation, cultural adaptation, and contentvalidation process of the PCSE scale. In this study, forward and backward translations, pre-testingincluding an expert panel (n = 7), and cognitive interviewing with possible healthcare professionals (physicians, nurses, and assistant nurses) (n = 10) were performed. Experts in palliative care rateditems on a Likert scale based on their understandability, clarity, sensitivity, and relevance. The item-level content validity index (I-CVI) and modified kappa statistics were calculated. Healthcareprofessionals were interviewed using the think-aloud method. The translation and validation process resulted in the final version of the PCSE scale. The average I-CVI for sensitivity was evaluated andapproved. Most of the items were approved for clarity, some items lacked understandability, but a majority of the items were considered relevant. The healthcare professionals agreed that the items in the questionnaire evoked emotions, but were relevant for healthcare professionals. Thus, the Palliative Care Self-Efficacy scale is relevant for assessing healthcare professionals’ self-efficacy inpalliative care in a Swedish care context. Further research using psychometric tests is required.

    Fulltekst (pdf)
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  • 2.
    Baxter, Rebecca
    et al.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Fromme, Erik K.
    Ariadne Labs, Boston, USA; Harvard Medical School, Boston, USA.
    Sandgren, Anna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Patient identification for serious illness conversations: A scoping review2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 7, artikkel-id 4162Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Serious illness conversations aim to align medical care and treatment with patients' values, goals, priorities, and preferences. Timely and accurate identification of patients for serious illness conversations is essential; however, existent methods for patient identification in different settings and population groups have not been compared and contrasted. This study aimed to examine the current literature regarding patient identification for serious illness conversations within the context of the Serious Illness Care Program and/or the Serious Illness Conversation Guide. A scoping review was conducted using the Joanna Briggs Institute guidelines. A comprehensive search was undertaken in four databases for literature published between January 2014 and September 2021. In total, 39 articles met the criteria for inclusion. This review found that patients were primarily identified for serious illness conversations using clinical/diagnostic triggers, the 'surprise question', or a combination of methods. A diverse assortment of clinicians and non-clinical resources were described in the identification process, including physicians, nurses, allied health staff, administrative staff, and automated algorithms. Facilitators and barriers to patient identification are elucidated. Future research should test the efficacy of adapted identification methods and explore how clinicians inform judgements surrounding patient identification.

    Fulltekst (pdf)
    fulltext
  • 3.
    Baxter, Rebecca
    et al.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjo, Sweden.
    Pusa, Susanna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjo, Sweden.
    Andersson, Sofia
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjo, Sweden.
    Fromme, Erik K.
    Ariadne Labs, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
    Paladino, Joanna
    Ariadne Labs, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA.
    Sandgren, Anna
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Core elements of serious illness conversations: an integrative systematic review2023Inngår i: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Ariadne Labs' Serious Illness Care Program (SICP), inclusive of the Serious Illness Conversation Guide (SICG), has been adapted for use in a variety of settings and among diverse population groups. Explicating the core elements of serious illness conversations could support the inclusion or exclusion of certain components in future iterations of the programme and the guide.

    Aim: This integrative systematic review aimed to identify and describe core elements of serious illness conversations in relation to the SICP and/or SICG.

    Design: Literature published between 1 January 2014 and 20 March 2023 was searched in MEDLINE, PsycINFO, CINAHL and PubMed. All articles were evaluated using the Joanna Briggs Institute Critical Appraisal Guidelines. Data were analysed with thematic synthesis.

    Results: A total of 64 articles met the inclusion criteria. Three themes were revealed: (1) serious illness conversations serve different functions that are reflected in how they are conveyed; (2) serious illness conversations endeavour to discover what matters to patients and (3) serious illness conversations seek to align what patients want in their life and care.

    Conclusions: Core elements of serious illness conversations included explicating the intention, framing, expectations and directions for the conversation. This encompassed discussing current and possible trajectories with a view towards uncovering matters of importance to the patient as a person. Preferences and priorities could be used to inform future preparation and recommendations. Serious illness conversation elements could be adapted and altered depending on the intended purpose of the conversation.

    Fulltekst (pdf)
    fulltext
  • 4.
    Baxter, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden.
    Pusa, Susanna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden.
    Andersson, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden.
    Perils and payoffs for patients in serious illness conversations as described by physicians: a qualitative study2024Inngår i: BMJ Open Quality, E-ISSN 2399-6641, Vol. 13, nr 2, artikkel-id e002734Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The Serious Illness Care Programme was developed to promote more, better and earlier serious illness conversations. Conversations about goals and values are associated with improved experiences and outcomes for seriously ill patients. Clinicians’ attitudes and beliefs are thought to influence the uptake and performance of serious illness conversations, yet little is known about how clinicians perceive the impact of these conversations on patients. This study aimed to explore physicians’ perceptions regarding the impact of serious illness conversations for patients.

    Methods: The Serious Illness Care Programme was implemented as a quality improvement project in two hospitals in Southern Sweden. Focus group evaluation discussions were conducted with 14 physicians and inductive thematic analysis was undertaken.

    Results: The results revealed that physicians considered potential perils and optimised potential payoffs for patients when engaging in serious illness conversations. Potential perils encompassed inappropriate timing, damaging emotions and shattering hopes. Potential payoffs included reflection time, secure space, and united understandings.

    Conclusions: Physicians depicted a balance in evaluating the perils and payoffs of serious illness conversations for patients and recognised the interrelation of these possibilities through continual assessment and adjustment.

    Fulltekst (pdf)
    fulltext
  • 5.
    Granat, Lisa
    et al.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Andersson, Sofia
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Hadziabdic, Emina
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Brännström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandgren, Anna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings2022Inngår i: BMC Palliative Care, E-ISSN 1472-684X, Vol. 21, nr 1, artikkel-id 48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context.

    Methods: This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method.

    Results: Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant.

    Conclusions: The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.

    Fulltekst (pdf)
    fulltext
  • 6.
    Granat, Lisa
    et al.
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Andersson, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Åberg, Daniel
    Region Kronoberg, Växjö, Sweden.
    Hadziabdic, Emina
    Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Evaluation of the swedish self‐efficacy in palliative care scale and exploration of nurses' and physicians' self‐efficacy in swedish hospitals: a cross‐sectional study2024Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous research found that healthcare professionals had low preparedness for palliative care. Thus, it is necessary to explore healthcare professionals' self-efficacy. The Swedish Self-Efficacy in Palliative Care Scale (SEPC-SE) evaluates readiness in communication, patient management and multidisciplinary teamwork; however, it should be tested on a larger population. Furthermore, the constructs of the SEPC-SE should be compared to that of the original SEPC.

    Aim: This study aimed to evaluate the consensus between the construct validity and reliability of the SEPC and the translated and adapted SEPC-SE. Furthermore, it aimed to describe and compare the self-efficacy of nurses and physicians in hospitals and explore the associated factors.

    Methods: The nurses (n = 288) and physicians (n = 104) completed the SEPC-SE. Factor analysis with Cronbach's alpha evaluated validity and reliability, and an analysis using the Mann-Whitney U test compared self-efficacy and multiple linear regression-associated factors.

    Results: The SEPC-SE revealed three factors with high reliability. Education or experience in specialised palliative care was minor, especially for nurses. Self-efficacy was highest in patient management (nurses, median [md] = 74.57, physicians md = 81.71, p = 0.010) and communication (nurses md = 69.88, physicians md = 77.00, p = 0.141) and lowest in multidisciplinary teamwork (nurses md = 52.44, physicians md = 62.88, p = 0.001). The strongest associations with self-efficacy were education at work and advanced homecare experiences. In addition, there were significant associations between years in the profession, male sex, physicians and university education.

    Conclusion: The SEPC-SE is valid and reliable for measuring self-efficacy. Nurses had lower self-efficacy than physicians. Physicians were associated with higher self-efficacy and had more education and experience in palliative care settings, which may explain their levels of self-efficacy.

    Fulltekst (pdf)
    fulltext
  • 7.
    Pusa, Susanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Baxter, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Andersson, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Fromme, Erik K.
    Ariadne Labs, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
    Paladino, Joanna
    Ariadne Labs, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA.
    Sandgren, Anna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Core competencies for serious illness conversations: an integrative systematic review2024Inngår i: Journal of Palliative Care, ISSN 0825-8597Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The Serious Illness Care Program was developed to support goals and values discussions between seriously ill patients and their clinicians. The core competencies, that is, the essential clinical conversation skills that are described as requisite for effective serious illness conversations (SICs) in practice, have not yet been explicated. This integrative systematic review aimed to identify core competencies for SICs in the context of the Serious Illness Care Program. 

    Methods: Articles published between January 2014 and March 2023 were identified in MEDLINE, PsycINFO, CINAHL, and PubMed databases. In total, 313 records underwent title and abstract screening, and 96 full-text articles were assessed for eligibility. The articles were critically appraised using the Joanna Briggs Institute Critical Appraisal Guidelines, and data were analyzed using thematic synthesis.

    Results: In total, 53 articles were included. Clinicians' core competencies for SICs were described in 3 themes: conversation resources, intrapersonal capabilities, and interpersonal capabilities. Conversation resources included using the conversation guide as a tool, together with applying appropriate communication skills to support better communication. Intrapersonal capabilities included calibrating one's own attitudes and mindset as well as confidence and self-assurance to engage in SICs. Interpersonal capabilities focused on the clinician's ability to interact with patients and family members to foster a mutually trusting relationship, including empathetic communication with attention and adherence to patient and family members views, goals, needs, and preferences.

    Conclusions: Clinicians need to efficiently combine conversation resources with intrapersonal and interpersonal skills to successfully conduct and interact in SICs.

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