Health literacy in cancer care: A systematic review.

PURPOSE: Health literacy (HL) is a set of knowledge and skills that enables individuals to interpret and act upon health information, which is essential for health equity. There is a growing body of evidence in the field of HL in cancer care but there is, to our knowledge, no systematic review that explores the association between sociodemographic factors and HL among patients with cancer. The aim of this study was therefore to conduct a systematic review of the existing literature that assesses HL levels and the relationship between HL and sociodemographic factors in an adult cancer population. METHODS: This is a systematic review and its protocol was registered in PROSPERO (ID: CRD42021164071). The study was conducted in accordance with the PRISMA statement. The literature search, from December 2009 to September 2023, was made in six databases, AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science Core Collection. RESULTS: Fifteen studies were included in the review. The included studies used nine different measurement tools for assessing HL. In the included studies between 11.9 % and 86 % had limited HL. We identified a relationship between limited HL and annual income, education level, ethnicity, living in rural areas and multiple comorbidities. CONCLUSION: The results indicate that limited HL is prevalent in the cancer population and should be acknowledge in everyday practice to meet health equity. Our awareness about sociodemographic factors and its association with HL, may enhance adherence to cancer treatment and quality of life, and lower physical and emotional distress.

Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial.

BACKGROUND: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores. METHODS: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14. RESULTS: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound. CONCLUSIONS: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care. CLINICAL TRIAL REGISTRATION: NCT02492191.

Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial.

BACKGROUND: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphone-based application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care. METHODS: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use. RESULTS: The mean cost for health-care consumption during 2 weeks after surgery was estimated at €37.29 for the intervention group and €60.96 for the control group. The mean difference was €23.66 (99% confidence interval -46.57 to - 0.76; P=0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of €4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P=0.75). The probability of the intervention being cost-effective was 71%. CONCLUSIONS: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective tool in providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery. CLINICAL TRIAL REGISTRATION: NCT02492191.

RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies.

INTRODUCTION: Day surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life. METHODS AND ANALYSIS: This study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either e-assessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery.The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A-C) at 1 and 2 weeks and (D) at 1 and 4 months. TRIAL REGISTRATION NUMBER: NCT02492191; Pre-results.

Swedish midwives' care of women who are at high obstetric risk or who have obstetric complications.

OBJECTIVE: to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood. DESIGN: a qualitative approach using a phenomenological method. PARTICIPANTS: 10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals. FINDINGS: the essence of midwifery when caring for women at high obstetric risk or with a manifested complication was defined as 'a struggle for the natural process'. Women's transition, physically as well as emotionally, during pregnancy, childbirth and early parenthood, was described as a genuinely natural process. The midwives' struggle consisted of encouraging and preserving this process within each woman. It was based on embodied knowledge and included a balancing between the medical and natural perspectives. Prerequisites, and therefore part of the struggle for the natural process, were sensitivity to the spontaneous, mutual interaction with the woman and enduring presence. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: the midwives' responsibility is to promote the natural process during pregnancy, childbirth and puerperium within every woman at high obstetric risk or with obstetric complications. The findings could serve as a basis for reflection on the professional role of midwives, and on the organisation of modern maternity care.

A meaningful relief from suffering experiences of massage in cancer care.

The experience of massage in an oncology ward was the focus of this study. Eight female cancer patients were given massage for 10 consecutive days and then interviewed using phenomenology as a theoretical framework. The essential meaning of getting massage as part of the daily care for female cancer patients was described as getting a meaningful relief from suffering. The findings identified five themes: the relief is meaningful because it offers the patient an experience of being "special." The massage contributes to the development of a positive relationship with the personnel, to feeling strong, and to a balance between autonomy and dependence. The massage also brings about a meaningful relief from suffering because it just "feels good." The findings of this study can be of use to health care professionals as it shows that the relatively short period of massage can result in physical and emotional benefits for cancer patients.

Pre-understanding and openness - a relationship without hope?

Pre-understanding and openness - a relationship without hope? In all research, quantitative as well as qualitative, we have to deal with our presuppositions in order to remain open throughout the whole process of inquiry. If we fail to do so the findings might be little more than a reflected image of something already existing in our understanding. The question dealt with in this paper is: how can we gain increased openness by being more aware of our presuppositions. The aim was to investigate the intentional structure of pre-understanding and its effects upon data-collection as well as data-analysis and conclusions in research. The question of pre-understanding is central in Gadamer's philosophy, even if he is not the first one to discuss this concept. Gadamer further developed the philosophy of understanding. According to him pre- understanding is an intentional structure of feelings and thoughts, which is activated when we regard something as something. By studying the structure of pre-understanding we became more aware of its effect upon understanding. In this paper, theoretical frameworks within cognitive and social psychology as well as psychoanalytic object-relation-theory were compared with Gadamer's philosophy concerning the conditions of human understanding. Finally the possibility of increased openness in the process of research was discussed. (Such openness is related to knowledge about the structure of pre-understanding.)

Lip rejuvenation.

BACKGROUND: The management of the senile lip remains a dilemma. Allogenic fillers often feel unnatural, lip resurfacing is not adequate, and fat transfers may disappear. OBJECTIVE: To develop a more reliable step-by-step approach to lip augmentation. METHOD: Lips were divided into types: (1) the simple senile lip that had lost its fullness-treated with fat augmentation; (2) the lip with rhagades-treated with fat augmentation and laser resurfacing; and (3) the duckbill lip-treated with lip advancement, fat augmentation, and laser resurfacing. Tattooing to increase the degree of redness was performed on all types of lips. RESULT: If there had been a previously full lip, it was possible to rejuvenate the lip by simple augmentation with autologous fat transfer. The average number of fat transfer sessions to generate this pleasing lip was two to three. The lip with rhagades required fat filling, with laser resurfacing to achieve a new contour. The duckbill lip required a lip advancement along with lipofilling and laser resurfacing. All types benefited from lip tattooing. CONCLUSIONS: It was possible with fat augmentation and/or laser resurfacing to generate a pleasing lip in type 1 and 2 lips. Lip type 3 required a lip advancement along with fat augmentation and laser resurfacing. Lip tattooing accentuated all the lip types.

Context and methodological decontextualization in nursing research with examples from phenomenography.

In both human science and nursing research the concept of context is important. However, context can be understood in different ways. The aim of this article is to elucidate, discuss and problematize context, decontextualization and recontextualization in some health care-related phenomenographical studies. A further aim is to problematize the concept of context in a wider perspective of human science, in order to gain a better understanding of phenomenographical research related to nursing care. Our analysis indicates that the complex phenomena which characterize nursing research demand a broad contextual understanding. Both the local or immediate context and the global or mediated context must be considered, as they are dialectically related. This includes the informants' experiences of the phenomenon of interest as well as the socio-cultural discourse. A balance between openness and pliability to the phenomenon is suggested. Reflection is considered an important tool in this process. Within phenomenography, the interest is directed towards conceptions of certain aspects of the world. Thus, context in a wider sense is given a subordinate role. Accordingly, phenomenography is considered to have limited applicability in nursing research when complex phenomena are to be studied.

Encountering violence and aggression in mental health nursing: a phenomenological study of tacit caring knowledge.

Violence is a growing psychosocial problem in the health care working environment. Literature shows that nurses are physically assaulted, threatened, and verbally abused more often than other professionals. However, some nurses are able to relate to clients in a way that produces positive resolution. This study explored the phenomenon of positive encounters with aggressive and violent clients. Guided by a phenomenological method, data were analyzed within a lifeworld perspective. The essential meaning of the phenomenon of caregivers' experiences of encountering violent clients is described as an "embodied moment," which is explicated by seven themes of meaning, "respecting one's fear and respecting the client," "touch," "dialogue," "situated knowledge," "stability," "mutual regard," and "pliability." The authors discuss the meaning of the outcome and propose both theory and praxis-oriented activities toward decreasing aggression and violence in health care.

Neck rejuvenation by combining Jessner/TCA peel, dermasanding, and CO2 laser resurfacing.

BACKGROUND: One of the greatest challenges facing facial cosmetic surgeons today is the simultaneous rejuvenation of the neck and face. Laser resurfacing of the face using the carbon dioxide (CO2) laser or the erbium:yttrium-aluminum-garnet (Er:YAG) laser has enjoyed widespread popularity, but the neck and chest are often avoided. It would be quite helpful to rejuvenate the neck at the same time the face is being resurfaced. This would diminish lines of demarcation and help reduce the signs of aging of the neck. There would be a better match between the new skin of the neck and face. OBJECTIVE: To develop a safe and effective method to rejuvenate the neck. METHOD: A step-by-step skin care program was instituted. The patients preconditioned their face and neck skin with vitamin A/glycolic skin conditioning lotions for 6-8 weeks prior to surgery. Following this the chest and neck area was treated with the Jessner-trichloroacetic acid (TCA) peel. Then the middle section of the neck was sanded with 150 grit sandscreen. Finally, the central area was resurfaced with the UltraPulse CO2 laser using reduced power settings. Usually two passes was adequate to shrink the skin of this central section of the neck. A petrolatum-based ointment was applied during the initial 7-day postoperative period. After reepithelialization a sunscreen-moisturizer was used during the day and hydrocortisone moisturizer was applied at night. RESULTS: The neck skin was able to tolerate this step-by-step skin rejuvenation. The blending from the décolleté area to the hairline produced a rejuvenation without a line of demarcation. There were no examples of scarring in the 12 cases that were evaluated for 6 months. Two cases developed persistent erythema that responded to silicone gel sheeting. Although no patients complained of hypopigmentation, a decrease in pigment was found using special UV photography. CONCLUSION: It is possible with this gradient, step-by-step method to produce a rejuvenation of the neck. An improved texture of the neck developed without visible scarring.

Disappointing results following resurfacing of facial skin with CO2 lasers for prophylaxis of keratoses and cancers.

BACKGROUND: With the development of the short-pulse CO2 laser it was hoped that this resurfacing would prevent recurrent actinic keratoses and basal cell cancers similar to resurfacing with dermabrasion, laser abrasion, and deep chemical peel. However, we have begun to see patients that are developing keratoses and cancers within months following laser resurfacing. OBJECTIVE: To document the problems of recurrent keratoses and basal cell cancers in patients following CO2 laser resurfacing. METHODS: Thirty-five patients with extreme sun damage were seen at 3, 6, and 12 months following CO2 laser resurfacing for repeat color and ultraviolet photography and clinical examination to look for erythematous dyskeratotic lesions or papules with pearly borders. RESULTS: Five of our patients (14.3%) who had undergone recent CO2 resurfacing developed actinic keratoses and basal cell cancers. CONCLUSION: CO2 laser resurfacing is not as effective as dermabrasion, chemabrasion, and deep chemical peel for the prophylaxis of actinic keratoses and basal cell cancers, especially in Fitzpatrick type I and II patients.

A phenomenological study of women's experiences of complicated childbirth.

OBJECTIVE: To describe women's experiences of a complicated childbirth. DESIGN: A qualitative study using a phenomenological approach. Data were collected by tape-recorded interviews. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden in 1995. PARTICIPANTS: 10 women, eight primiparous and two multiparous, who were interviewed two to five days post delivery. KEY FINDINGS: The essential meaning of women's experiences of complicated childbirth is the desire to be recognised and affirmed as a genuine subject. If this happens they feel accepted as childbearing women and as mothers-to-be, even if obstetric interventions are necessary and high technology is used. IMPLICATIONS FOR PRACTICE: By understanding and respecting every women as an individual the caregivers support women giving birth and make them feel accepted, thus paving the way for them to gain control over the situation. Through a true dialogue resulting in a trustful relationship, the women can manage even emergency situations. Separation of the mother and her baby should be avoided if possible.

Women's experience of pain during childbirth.

OBJECTIVE: To describe women's experience of pain during childbirth. DESIGN: A qualitative study using a phenomenological approach. Data were collected by tape-recorded interviews. SETTING: An Alternative Birth Care Centre at a university hospital in Sweden in 1995. PARTICIPANTS: Nine women, four primiparous and five multiparous who were two to four days post delivery. KEY FINDINGS: Four themes were identified in the meanings of experience: (1) pain is hard to describe and is contradictory; (2) trust in oneself and one's body; (3) trust in the midwife and husband; and (4) transition to motherhood. The essential structure of the studied phenomenon was described as 'being one's body', which includes a non-objectifying view of the body, a presence in the delivery process, and a meaning connected to the transition to motherhood. IMPLICATIONS FOR PRACTICE: The women felt that pain was a natural part of the delivery process, and that the strength and power to cope with it came from within the women. A conclusion is that midwives can help birthing women to find their own ability to cope, and should interfere only if the woman asks or if the natural process is disturbed, e.g. by complications. The experience of pain during childbirth, together with the experience of strength during childbirth, gives meaning to the transition to motherhood.

A lifeworld paradigm for nursing research.

This article is a companion to an earlier article entitled "Challenging a Reductionistic Paradigm as a Foundation for Nursing," which appeared in the December 1995 issue of the Journal of Holistic Nursing. The authors discuss how five concepts-encounter, openness, immediacy, uniqueness, and meaning-which constitute their philosophy for nursing practice, also comprise a foundation for human sciences research. In the first article, encounter was presented as the core concept for practice. In the present work, openness is the central idea in a lifeworld research paradigm, with encounter, immediacy, uniqueness, and meaning as supporting concepts. Openness is explicated with the notions of open-mindedness, open-heartedness, phenomenological questioning, and preunderstanding. A lifeworld paradigm for research is based on phenomenological philosophy and the understanding that the conduct of research is guided by the researcher's openness to the phenomena of the everyday world.

Population dynamics and global change: the need for new conceptual maps.

The author criticizes current approaches to the study of global population problems as typified by the discussions at the International Conference on Population and Development, held in Cairo, Egypt, in 1994. "Current approaches to population: (1) focus too much on humans and not on their interactions over time with populations of other species; (2) focus too much on the number of humans and not on their differential resource use and environmental impact; (3) accept uncritically the assumptions and concepts of industrial society regarding the nature of progress and the neutrality of technologies, markets, and trade. Broader and more integrated approaches are needed to address current international and global realities and trends." Some conceptual datasets that would illustrate a more effective approach to population problems are introduced.