Marianne Kirstine Thygesen

Gynecological cancer patients' differentiated use of help from a nurse navigator: a qualitative study

BackgroundFragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context.MethodsA longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels.ResultsPrior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help.ConclusionsNot everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients’ guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients’ trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.

The self-efficacy in patient-centeredness questionnaire – a new measure of medical student and physician confidence in exhibiting patient-centered behaviors

BackgroundPatient-centered communication is a core competency in modern health care and associated with higher levels of patient satisfaction, improved patient health outcomes, and lower levels of burnout among physicians. The objective of the present study was to develop a questionnaire assessing medical student and physician self-efficacy in patient-centeredness (SEPCQ) and explore its psychometric properties.MethodsA preliminary 88-item questionnaire (SEPCQ-88) was developed based on a review of the literature and medical student portfolios and completed by 448 medical students from Aarhus University. Exploratory Principal Component analysis resulted in a 27-item version (SEPCQ-27) with three underlying self-efficacy factors: 1) Exploring the patient perspective, 2) Sharing information and power, and 3) Dealing with communicative challenges. The SEPCQ-27 was completed by an independent sample of 291 medical students from 2 medical schools and 101 hospital physicians.ResultsInternal consistencies of total and subscales were acceptable for both students and physicians (Cronbach’s alpha (range): 0.74–0.95). There were no overall indications of gender-related differential item function (DIF), and a Confirmatory Factor Analysis (CFA) indicated good fit (CFI = 0.98; NNFI = 0.98; RMSEA = 0.05; SRMR = 0.07). Responsiveness was indicated by increases in SEPCQ scores after a course in communication and peer-supervision (Cohen’s d (range): 0.21 to 0.73; p: 0.053 to 0.001). Furthermore, positive associations were found between increases in SEPCQ-scores and course-related motivation to learn (medical students) and between SEPCQ scores and years of clinical experience (physicians).ConclusionsThe final SEPCQ-27 showed satisfactory psychometric properties, and preliminary support was found for its construct validity, indicating that the SEPCQ-27 may be a valuable measure in future patient centered communication training and research.

Nurse navigation is helpful for cancer patients, but with some restrictions.

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Video-, audio-, and computer-mediated education of patients and relatives in gynecologic cancer care: A systematic review

see front matter Copyright 2013 ECCO the European CanCer Organisation. All rights reserved. http://dx.doi.org/10.1016/j.ejcsup.2013.07.053 * Corresponding author at: Department of Gynecology and Obstetrics, Odense University Hospital and Institute of Clinical Res Boulevard 29, 5000 Odense C, Denmark. Tel.: +45 6541846. E-mail address: Marianne.thygesen@rsyd.dk (M.K. Thygesen). M.K. Thygesen *, B.D. Pedersen , J. Kragstrup , L. Wagner , O. Mogensen a,d

Case management used to optimize cancer care pathways: A systematic Review

Background: Cancer patients can often experience emotional distress, and gynecologic cancer patients may be among the most distressed. As hospital stays become shorter, nurses are challenged to educate patients and relatives adequately. The use of computer-based technologies may alleviate the situation. Objective: This article aims to review the literature related to the use of audio-, visual-, or computer-based technologies to support healthcare professional training of adult female patients and their close relatives in gynecologic cancer care. We describe to what extent these technologies were found to be effective and evaluate clinical implications. Methods: PubMed, EMBASE and PsycINFO via Ovid, CINAHL via EBSCO, and the Cochrane Library were searched, and 4177 unique references were examined. All studies evaluating healthcare professional training of women with gynecologic cancer and/or their relatives via audio-, visual-, or computer-based technologies were included. Results: We found scarce and conflicting evidence of benefits to gynecologic patients of healthcare professional use of video- or computer-based patient education. These interventions might be best suited to the highest educated with coping skills beyond the average. No studies were found to include relatives or found to test audio-based patient education. Conclusion: More rigorously produced and reported studies of healthcare professional training initiatives for gynecologic cancer patients and their relatives are recommended. Measures used to capture the perceived benefits to patients might be reconsidered. Implication for Practice: Precautions should be taken before recommending technologies that are unevaluated in own context. Attention must be on both what is provided when and to whom.