Persistent pain associated with socioeconomic and personal factors in a Sami and Non-Sami population in Norway: an analysis of SAMINOR 2 survey data.

In international studies, higher prevalence of persistent pain has been reported in indigenous populations compared to majority populations. The present study aimed to determine the prevalence of persistent pain within a Sami and a non-Sami population in northern Norway, with adjustment for the confounding factors of age, sex, marital status, education, income, mental health, smoking status and ethnic background. Using SAMINOR 2 survey data including Sami and non-Sami populations, we analysed 5,546 responses, from individuals aged 40-79 years, to questions concerning persistent pain (≥ 3 months). In total, 2,426 (43.7%) participants reported persistent pain with differences between Sami women and non-Sami women (44.1% versus 51.1%, respectively), but none between Sami men and non-Sami men (38.7% versus 38.2%, respectively). Elderly Sami women were less likely to report persistent pain than were elderly non-Sami women. In men, no ethnic differences in pain were observed according to age-group. Marital status, education levels, household income, psychological distress, and smoking status did not influence the association between ethnicity and pain. Pain severity and location did not differ between Sami and non-Sami participants. In this study, we found only minor ethnic differences in persistent pain. Similar living conditions and cultural features may explain these findings.

Supporting doctor-patient communication: Providing a question prompt list and audio recording of the consultation as communication aids to outpatients in a cancer clinic.

OBJECTIVE: To document the effect of a cancer specific question prompt list (QPL) on patients question asking and shared decision-making (SDM), and to evaluate the combined effect of the QPL and consultation audio recording (CAR) on patient outcomes. METHOD: This exploratory study compared two groups of patients receiving either a QPL or combined QPL/CAR, to a control group. Measurements included number/types of questions asked, and physician SDM behavior (OPTION score). Questionnaire data included anxiety/depression and quality of life (QoL). RESULTS: A total of 93 patients participated (31 Control, 30 QPL and 32 Combined). Patients in the intervention groups asked more questions concerning prognosis (p < .0001), the disease (p = .006) and quality of treatment (p < .001) than patients in the control group, but no impact was found on the OPTION score. An increase in mean consultation length was observed in the intervention groups compared to the control group (44 vs. 36 min; p = .028). Patients rated both interventions positively. CONCLUSION: Provision of the QPL facilitates patients to ask a broader range of questions, but does not increase physician SDM behavior. PRACTICAL IMPLEMENTATION: The combination of QPL and CAR seems feasible and should be tested in an implementation study following the disease trajectory.

Is patient behavior during consultation associated with shared decision-making? A study of patients' questions, cues and concerns in relation to observed shared decision-making in a cancer outpatient clinic.

OBJECTIVES: To explore how cancer patients actively participate in consultations by asking questions and expressing emotional cues/concerns and to what extent this is associated with physician shared decision making (SDM) behavior. METHODS: This observational study included audio recordings of 31 primary consultation with patients at the Oncology Outpatient Clinic at the University Hospital of North Norway. The content (topics) and frequency of health related questions from patients/caregivers were registered along with emotional cues and concerns (VR-CoDES) and observed shared decision-making (OPTION). Patient reported outcomes were measured before and one week after the consultation. RESULTS: On average, 17 (SD 15) questions were asked, and 1.9 (SD 1.9) emotional cues and concerns were expressed by patients per consultation. The questions mainly pertained to treatment and practical issues. The mean OPTION score was 12 (SD 7.9) and was neither associated with questions nor emotional cues and concerns from patients. CONCLUSION: Although patients were active by asking questions, observed physician SDM behavior measured by OPTION was low and not associated with patient behavior during consultation. PRACTICE IMPLICATIONS: Further research on patients influence on physician SDM behavior is needed.

Adapting an Australian question prompt list in oncology to a Norwegian setting-a combined method approach.

PURPOSE: A question prompt list (QPL) is an inexpensive communication aid that has been proved effective in encouraging patients to ask questions during medical consultations. The aim of this project was to develop a QPL for Norwegian cancer patients. METHODS: A multimethod approach was chosen combining literature review, focus groups, and a survey in the process of culturally adjusting an Australian QPL for the Norwegian setting. Participants were recruited from the University Hospital of North Norway. They were asked to review and comment on iterative drafts of the QPL. RESULTS: Eighteen patients, mean age 54, participated in the focus groups, and 31 patients, mean age 55, participated in the survey. Focus groups suggested that topics related to accompanying relatives, children as next of kin, and rehabilitation were important and should be added to the original QPL. The survey revealed that most questions from the original QPL were considered both useful and understandable. Although half of the patients found some questions about prognosis unpleasant, the vast majority considered the same questions useful. Questions regarding clinical studies, multidisciplinary teams, and public versus private hospitals had lower ratings of usefulness. CONCLUSION: QPLs require some adjustment to the local cultural context, and a mixed method approach may provide a useful model for future cultural adaptation of QPLs. The present QPL has been adjusted to the needs of oncology patients in the Norwegian health care setting.

Cancer survivors' experiences of humour while navigating through challenging landscapes--a socio-narrative approach.

AIM: Humour is seen as a health-promoting coping strategy when dealing with life stress. The aim is to elucidate how adult cancer survivors experience and evaluate the significance of humour in daily life, from diagnosis through their entire illness trajectory, and to gain a broader understanding of humour as part of stress-coping processes during the experience of cancer as a life-threatening illness. METHOD: A socio-narrative approach was chosen to study the humorous stories and their use in everyday contexts. Fourteen participants aged 23-83 with a variety of experiences across diagnoses, times since diagnosis, prognoses and life situations were interviewed. FINDINGS: Participants described humour as helpful and utilised its capacity to deal with difficult situations or related distress, although fluctuations in the course of the illness coincided with two extremes: humour that disappeared and humour that returned. Their use of humour was related to three key themes: facing a life-threatening situation, togetherness and communication, and living with the situation. CONCLUSION: Depending on the aim, humour contributes variously through the stress-coping process within the distinctions of emotion-, problem- and meaning-focused coping. Humour served to relieve the anxiety burden, enhance problem-solving ability, safeguard important relationships, communicate difficult topics, regain identity and help significant others to cope, even enabling the richness of life to help living with the risk. Humour should be considered as a significant engaging coping strategy by which the cancer survivors seek to manage their situation throughout the illness trajectory.

Predicting interest in liposuction among women with eating problems: a population-based study.

The purpose of this paper was to examine predictors of an interest in liposuction among women with eating problems. A questionnaire was sent to 3500 women aged 18-35 years, whereof 378 of 1861 responders screened positively on eating problems. Assessments included sociodemographic status, social network, physical exercise, attitudes towards cosmetic surgery, teasing history, body dysmorphic disorder-like symptoms, body image, self-esteem, personality, interpersonal attachment and emotional distress. Fifty-two percent reported an interest in liposuction, which was independently predicted by appearance orientation, appearance evaluation, being critical/quarrelsome, teasing history, wish for a better relationship with father, low education and being unmarried. Predictors differed somewhat from those previously found in the general population. Considering that our sample consisted of women with self-reported eating problems, the association between liposuction and eating behaviors should be further examined in a sample of patients with a formal eating disorder diagnosis.

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work.

OBJECTIVES: Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway. DESIGN: Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records. METHODS: Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis. RESULTS: A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health. CONCLUSIONS: Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.

Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: a population-based study.

BACKGROUND: The present study investigated psychosocial factors expected to predict an interest in cosmetic surgery. It was hypothesized that body dysmorphic disorder-like symptoms, personality, interpersonal attachment insecurity, low self-esteem, poor body image, dissatisfaction with sexual life, distorted eating behavior, emotional distress, low education, poor relationship with parents and friends, teasing history, social acceptance of cosmetic surgery, and low level of physical activity would relate to an interest in cosmetic surgery. METHODS: Questionnaire data were obtained from 1880 participants who responded to a survey distributed to a representative sample of 3500 Norwegian women between 18 and 35 years of age living in the two northernmost counties. Data were analyzed by univariate and multiple logistic regression analyses. RESULTS: Multiple regression analyses showed that an interest in cosmetic surgery was positively related to body dysmorphic disorder-like symptoms, body image orientation, having children, been teased for appearance, knowing someone who has had cosmetic surgery, and being recommended cosmetic surgery. Agreeability, body image evaluation, education, and quality of relationship with parents were negatively related to an interest in cosmetic surgery. CONCLUSIONS: The study gives new insights into psychosocial factors predicting an interest in cosmetic surgery. In addition to previously known predictors, having been teased for appearance and having children were positive predictors, whereas education and quality of relationship with parents were negative predictors of an interest in cosmetic surgery. The results may contribute to a better understanding of the various factors that may motivate an individual to undergo cosmetic surgery.

Approach and avoidance coping and regulatory focus in patients having coronary artery bypass graft surgery.

Coronary artery bypass graft (CABG) surgery is stressful, and the patient's coping affects recovery and outcome. The aim of the study was to identify patients' thoughts and concerns, and explore the relevance of approach/avoidant coping and Regulatory Focus Theory (RFT). Nine patients were interviewed, using an interpretative phenomenological approach. The patients made use of various avoidant (e.g. neglecting symptoms, delaying help-seeking, avoiding thoughts) and approach strategies (e.g. persistent search for the diagnosis, mental preparation for surgery). RFT versus approach/avoidant coping is discussed. RFT may contribute to our understanding of motivational cognitions in patients' coping with illness and treatment.

Psychosocial characteristics of young Norwegian women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty: a population-based study.

BACKGROUND: The present study investigated various psychosocial factors expected to predict an interest in liposuction, breast augmentation, rhinoplasty, and abdominoplasty. METHODS: Questionnaire data were obtained from 1862 participants who responded to a survey distributed to a representative sample of 3500 women from northern Norway aged 18 to 35 years. RESULTS: Liposuction was the most popular procedure (25 percent), followed by breast augmentation (15 percent), rhinoplasty (7.0 percent), and abdominoplasty (5.6 percent). Most of the women interested in rhinoplasty and breast augmentation reported interest in more than one procedure, whereas the vast majority of women interested in abdominoplasty were not interested in any other procedure. Multiple regression analyses showed that a low level of education, indicators of social acceptance of cosmetic surgery, and negative appearance evaluation were predictors of an interest in all procedures. Body dysmorphic disorder-like symptoms, appearance orientation, and teasing history were predictors of an interest in all procedures except for abdominoplasty, whereas having children was a predictor of all procedures except for rhinoplasty. Divorce rate and eating disorder were predictors of an interest in liposuction only. Univariate regression analyses showed that the Big-Five personality traits were associated with all procedures except abdominoplasty. CONCLUSIONS: It appears that women interested in abdominoplasty may be motivated by a desire to repair the bodily changes occurring after childbirth, whereas women interested in liposuction, breast augmentation, and rhinoplasty may have more complex psychological factors associated with their interest in cosmetic surgery. The findings of this study provide increased knowledge about psychosocial factors characterizing women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty.

Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: a population-based study.

BACKGROUND: The present study investigated psychosocial factors expected to predict an interest in cosmetic surgery. It was hypothesized that body dysmorphic disorder-like symptoms, personality, interpersonal attachment insecurity, low self-esteem, poor body image, dissatisfaction with sexual life, distorted eating behavior, emotional distress, low education, poor relationship with parents and friends, teasing history, social acceptance of cosmetic surgery, and low level of physical activity would relate to an interest in cosmetic surgery. METHODS: Questionnaire data were obtained from 1880 participants who responded to a survey distributed to a representative sample of 3500 Norwegian women between 18 and 35 years of age living in the two northernmost counties. Data were analyzed by univariate and multiple logistic regression analyses. RESULTS: Multiple regression analyses showed that an interest in cosmetic surgery was positively related to body dysmorphic disorder-like symptoms, body image orientation, having children, been teased for appearance, knowing someone who has had cosmetic surgery, and being recommended cosmetic surgery. Agreeability, body image evaluation, education, and quality of relationship with parents were negatively related to an interest in cosmetic surgery. CONCLUSIONS: The study gives new insights into psychosocial factors predicting an interest in cosmetic surgery. In addition to previously known predictors, having been teased for appearance and having children were positive predictors, whereas education and quality of relationship with parents were negative predictors of an interest in cosmetic surgery. The results may contribute to a better understanding of the various factors that may motivate an individual to undergo cosmetic surgery.

Nurse training of a patient-centered information procedure for CABG patients.

OBJECTIVE: At the study hospital, all elective coronary artery bypass graft (CABG) surgery patients were given similar, standardized information by the nurses. The nurses reported problems in establishing contact and interacting with patients when using this approach. To help remedy communication problems between nurses and CABG patients, a programme training nurses in a patient-centred information procedure was developed and implemented. This article describes how challenging interactions were recorded and analysed for training nurses in the patient-centred approach. METHOD: In group training for patient-centeredness, nurses presented audio-recordings of nurse-patient interactions they found problematic. These were used as a basis for discussions and training in the patient-centered approach. A set of cases was developed using a qualitative phenomenological approach, illustrating how the patient-centered approach could be applied to the difficult situations. RESULTS: The nurses found the patient-centered approach particularly useful in situations when patients frequently asked questions, seemed to have difficulties expressing their worries, frequently complained, or when spouses expressed worries. CONCLUSION: Nurses found the patient-centered approach and the training procedure used in this study useful in their clinical work with CABG patients. PRACTICE IMPLICATIONS: This training which requires minimal resources and can be easily implemented, may guide the nurses in their interaction with patients. Providing a patient-centered approach to the CABG patients may enhance the nurse-patient contact and improve patients' hospital experience and subjective health.

Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery--A randomized trial.

OBJECTIVE: To test the efficacy of an information intervention upon emotional recovery following coronary artery bypass surgery. METHODS: Randomized trial. Video information was combined with individualized information sessions carried out by nurses at admission and at discharge from the hospital. The video was shown pre-operatively and again during the session at admission. Patients were helped to express their questions and worries and congruent information and support was provided. Control group patients received standardized information and no video. Recordings were made at baseline, discharge from hospital and during a 2 years follow-up period. RESULTS: One hundred and nine patients were randomized to the intervention or the control groups. A MANOVA was used to test of the variance of the outcome variables at each time point. At discharge intervention patients reported less anxiety (p = 0.046) and better subjective health (p = 0.005). They reported better subjective health during the whole follow-up period (0.040 > or = p > or = 0.000), less anxiety up to 1 year (0.042 > or = p > or = 0.004), and less depression from 6 months to 2 years following discharge (0.023 > or = p > or = 0.004). CONCLUSION: The effects of the intervention probably relate to the combined use of the video and patient centered information sessions. PRACTICE IMPLICATIONS: The intervention can easily be implemented in clinical practice and nurses strongly identified with its principles.

Management satisfaction in survivors of testicular cancer.

BACKGROUND: The aim of this study was to examine satisfaction with the quality of the doctor-patient relationship (QCD) and the information (INF) made available, as well as the influence of different treatment modalities and psychosocial variables in testicular cancer survivors (TCSs). MATERIALS AND METHODS: Two-hundred and 6 TCSs, seen at 2 Norwegian university hospitals, were studied retrospectively and currently in a cross-sectional follow-up design. Questionnaires were filled in prior to and at the patients' follow-up examination. The mean length of time since their management period had ended was 6.5 years (range 0-17 years). RESULTS: The QCD was rated higher than the INF. The QCD was also the strongest contributor to the variance in the INF. The patients in the surveillance group had the lowest QCD. CONCLUSION: The relatively high QCD scores may reflect the fact that the patients had been cured from a life-threatening disease. The low INF scores may indicate that the TCSs were poorly informed about the potential health problems related to their treatment. Thus, it is suggested that more attention should be focused on the education of the patients.

Coronary bypass surgery patients' experiences with treatment and perioperative care - a qualitative interview-based study.

AIMS: The purpose of this study was to examine how coronary bypass surgery patients experienced their care. BACKGROUND: In many hospitals, including the study hospital, perioperative care is still organized in such a manner that theatre nurses have little contact with patients prior to and after surgery. Little is known about how patients experience this type of perioperative care. METHOD: Nine patients were interviewed approximately a year after their operations. The interviews were qualitative and were analysed by drawing on the phenomenological method. RESULTS: The patients were generally satisfied with the quality of the staff-patient interactions and the information that was given prior to surgery, but some patients expressed a need for a closer postoperative followup by staff directly involved in the surgery. Most patients believed that information and support given by fellow patients was even more important to them than the support and information that was given by staff. CONCLUSIONS: The findings suggest that the quality of care and patients' satisfaction can be further enhanced by implementing principles from the perioperative dialogue model. For instance, by allowing for a postoperative meeting between the patient and a theatre nurse, continuity of care can be further enhanced.

Breast cancer: a manual for a proposed group treatment integrating evidence based resilience factors.

The paper presents the structure and content of a manual for a proposed treatment of breast cancer patients in groups. The proposed treatment is structured, time limited, and integrates elements from 1995 work of Spiegel and the Yalom 1995 theory of group therapy as well as empirically derived resilience factors. Addressing the psychological specificity of breast cancer, the overall treatment goals are to help patients to acquire new coping skills for relieving stress, to increase their personal and social competence and their use of available social support, to increase family coherence, to enhance optimism and quality of life, and to help patients develop new values and priorities that comply with their current and future life situation.

[Patient satisfaction after hospitalisation for surgery]. / Pasienttilfredshet etter opphold i kirurgisk avdeling.

BACKGROUND: What illness-related, psychosocial or treatment-related factors predict treatment satisfaction following hospitalisation for surgery? MATERIAL AND METHODS: 482 patients electively admitted to three different surgical departments at a university hospital. Assessments were made before admission, at discharge and two and four months after discharge. RESULTS: The central treatment-related measures were global treatment satisfaction, perceived quality of contact with nurses and doctors, and the information received. Out of 49% explained variance in global treatment satisfaction, one half was explained by the quality of contact with nurses. Only a small portion of the variance in quality of contact with nurses and doctors could be accounted for by the characteristics of the patients. Much of the unexplained variance must relate to characteristics and skills of the medical staff. Treatment information was predicted by characteristics of the patients, their illness and situation in life, and by treatment-related factors. Quality of contact with the nurses was the strongest predictor of satisfaction with the information received. INTERPRETATION: The experienced quality of contact with nurses appears to be the major determinant of both global treatment satisfaction and satisfaction with the information received. Among other predictors, the quality of contact with doctors is also important. The relationship between patients and caregivers can probably be better utilised to improve treatment satisfaction.