Qualitative Investigation of Experience and Quality of Life in Patients Treated with Calcium Electroporation for Cutaneous Metastases.

(1) Background: Calcium electroporation is a novel cancer treatment. It includes injecting calcium-solution and applying electric pulses to tumour tissue. Data on quality of life for patients with cutaneous metastases treated with calcium electroporation is limited. We evaluated quality of life in patients with skin metastases treated with calcium electroporation using qualitative interviews. (2) Methods: This investigation featured a subgroup from a non-randomised phase II study (CaEP-R) at Zealand University Hospital, Denmark, studying response to calcium electroporation in cutaneous metastasis (ClinicalTrials no. NCT04225767). Participants were interviewed at baseline before calcium electroporation treatment and after two months. Data was analysed phenomenologically; (3) Results: Interviews were conducted February 2020-November 2021. Nine patients were included, of which seven participated in both interviews. All seven patients expected treated tumours to disappear, symptom relief and minimal side effects. Most patients requested peer accounts. All patients found the treatment uncomfortable but acceptable; all thought their fears of electric pulses exceeded their experience. All would repeat the treatment if effective. Successful treatment had a positive effect on pain, symptomatic wounds, sleep, vigour and social inclination; (4) Conclusions: Calcium electroporation enhanced health-related quality of life by reducing symptoms and increasing social inclination. Peer accounts provide patients with a shortcut to confidence in treatment on top of doctors' recommendations.

Specialised nursing tasks in cancer care and their effects.

Background: Several reviews are available on the effects of specific nursing tasks in oncology care. However, a synthesis across cancer entities and stages is lacking. Aim: To synthesise the results of reviews assessing the scope and effectiveness of tasks of nurses specifically qualified in cancer care. Methods: We conducted an Umbrella Review based on systematic searches in six databases and a search for grey literature following a priori-defined inclusion criteria. Further steps: standardised data extraction and quality assessment, determination of the degree of overlap, and structured narrative summary on outcome measures of health-related quality of life, symptom burden, utilisation of care services/resources, and patient satisfaction. All reviews were categorised according to the EONS Cancer Nursing Education Framework and the Omaha System Intervention Scheme. Results: After screening 2,657 references, 11 reviews (10 high quality) for a total of 148 studies were included. Specially qualified nurses and advanced practice nurses take on a variety of tasks in the disease process, especially related to education, counselling, and case management. Effects on outcome measures are mixed, with increased indications of reduced symptom burden. Conclusion: Specially qualified nurses with expanded roles have the potential to contribute to improved oncology care. This emphasises the importance of appropriate task profiles and qualification programs. More well-reported studies based on theoretical framework models are needed.

Information provision to older patients receiving palliative chemotherapy: a quality study.

OBJECTIVES: Cancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.The aim of this study was to explore how older patients experience the information on absence of curative treatment options. METHODS: Qualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65-76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke. RESULTS: The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth. CONCLUSIONS: Receiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.

Performance of conceptual framework elements for the retrieval of qualitative health literature: a case study.

OBJECTIVE: A growing volume of studies address methods for performing systematic reviews of qualitative studies. One such methodological aspect is the conceptual framework used to structure the review question and plan the search strategy for locating relevant studies. The purpose of this case study was to evaluate the retrieval potential of each element of conceptual frameworks in qualitative systematic reviews in the health sciences. METHODS: The presence of elements from conceptual frameworks in publication titles, abstracts, and controlled vocabulary in CINAHL and PubMed was analyzed using a set of qualitative reviews and their included studies as a gold standard. Using a sample of 101 publications, we determined whether particular publications could be retrieved if a specific element from the conceptual framework was used in the search strategy. RESULTS: We found that the relative recall of conceptual framework elements varied considerably, with higher recall for patient/population (99%) and research type (97%) and lower recall for intervention/phenomenon of interest (74%), outcome (79%), and context (61%). CONCLUSION: The use of patient/population and research type elements had high relative recall for qualitative studies. However, other elements should be used with great care due to lower relative recall.

Study protocol designed to investigate tumour response to calcium electroporation in cancers affecting the skin: a non-randomised phase II clinical trial.

INTRODUCTION: Skin malignancy is a distressing problem for many patients, and clinical management is challenging. This article describes the protocol for the Calcium Electroporation Response Study (CaEP-R) designed to investigate tumour response to calcium electroporation and is a descriptive guide to calcium electroporation treatment of malignant tumours in the skin. Calcium electroporation is a local treatment that induces supraphysiological intracellular calcium levels by intratumoural calcium administration and application of electrical pulses. The pulses create transient membrane pores allowing diffusion of non-permeant calcium ions into target cells. High calcium levels can kill cancer cells, while normal cells can restore homeostasis. Prior trials with smaller cohorts have found calcium electroporation to be safe and efficient. This trial aims to include a larger multiregional cohort of patients with different cancer diagnoses and also to investigate treatment areas using MRI as well as assess impact on quality of life. METHODS AND ANALYSIS: This non-randomised phase II multicentre study will investigate response to calcium electroporation in 30 patients with cutaneous or subcutaneous malignancy. Enrolment of 10 patients is planned at three centres: Zealand University Hospital, University Hospital of Southern Denmark and University Hospital Schleswig-Holstein. Response after 2 months was chosen as the primary endpoint based on short-term response rates observed in a prior clinical study. Secondary endpoints include response to treatment using MRI and change in quality of life assessed by questionnaires and qualitative interviews. ETHICS AND DISSEMINATION: The trial is approved by the Danish Medicines Agency and The Danish Regional Committee on Health Research Ethics. All included patients will receive active treatment (calcium electroporation). Patients can continue systemic treatment during the study, and side effects are expected to be limited. Data will be published in a peer-reviewed journal and made available to the public. TRIAL REGISTRATION NUMBERS: NCT04225767 and EudraCT no: 2019-004314-34.

The personalised discharge letter: the experience of patients and parents from the Filadelfia Epilepsy Hospital.

OBJECTIVE: To examine the experience of a discharge letter received by patients suffering from epilepsy and parents with children who suffer from epilepsy. DESIGN: Qualitative research inspired by a phenomenological methodology approach. SETTING: Face-to-face interviews with patients and parents of epileptic children in their own homes. SAMPLE: Participants (total n = 11). METHODS: In-depth interviews were recorded verbatim, transcribed and analysed. RESULTS: Two themes were identified: (i) it was written about me and (ii) a sense of feeling secure. By being discharged with a personalised letter, the participants felt seen and heard. The discharge letter enabled them to contact their doctor and the Filadelfia hospital more efficiently if needed. Parents indicated that the discharge letter bridged the uncertainty that they often experienced when dealing with the child's school or authorities in general. CONCLUSIONS: The discharge letter enables the participants to make the transition into everyday life with the best and most up-to-date information about themselves and their current condition as an epilepsy patient. The discharge letter empowers the patient or parents to face everyday life. The discharge becomes a kind of passport to the outside world when encountering the general practitioner, the school or other circumstances where the patient engages. The discharge letter becomes a patient-centred tool proving that enhanced communication and understanding between healthcare professionals, patients and parents succeeds. This example could be transferable to other hospitals to heighten the patient's self-efficacy and quality of life after being discharged from the hospital.

Using the full PICO model as a search tool for systematic reviews resulted in lower recall for some PICO elements.

OBJECTIVES: The use of the four-part PICO model to facilitate search strategy development for a precise answer is recommended for structuring searches for systematic reviews. Existing guidelines generally recommend that a search strategy should include the population, intervention(s), and types of study design. Consequently, comparison and outcome are not recommended as a part of the search strategy. There is evidence that comparison and particularly outcome is not represented in enough detail, but this needs to be confirmed. STUDY DESIGN AND SETTING: The present study examines the presence of PICO elements in the records in two commonly used databases for health sciences research: Embase and PubMed. We examine the field of upper GI and pancreatic diseases as well as the field of pregnancy and childbirth by extracting the included studies as well as the related PICO elements from a random selection of Cochrane reviews within these two areas. RESULTS: We find that the PICO elements C and O had a lower retrieval potential across the two Cochrane groups and databases also when combining text words and subject headings. In particular, we find a lower retrieval when searching for both primary and secondary outcomes. CONCLUSION: Our results support the existing recommendation not to search for outcomes.

Nursing care for older patients with pressure ulcers: A qualitative study.

Aim: To explore the experience and perception of pressure ulcers in a group of nurses caring for older patients. Design: A qualitative study based on interviews with (N = 6) nurses working with older patients. Method: A qualitative approach was applied using thematic analysis influenced by Braun and Clarke. Results: The findings comprised one main theme "Prevention of pressure ulcers is important" and four sub-themes "Nursing resources on the ward," "Basic nursing skills-lift the duvet," "Introduction of new nurses on the ward-bedside teaching" and "Missing articulation of pressure ulcers." Bedside teaching and experienced nurses may create a culture on the ward where basic nursing skills and observations are articulated.

Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses.

BACKGROUND: Nursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer. METHODS: Qualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used. RESULTS: Three themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential. CONCLUSIONS: The use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.

Motivational interviewing in obese women with polycystic ovary syndrome - a pilot study.

Lifestyle intervention is first line treatment in obese women with polycystic ovary syndrome (PCOS). The effect of motivational interviewing (MI) as add on to standard advice (SA) on weight loss and quality of life (QoL) has not been evaluated in obese women with PCOS. We aimed to examine whether MI as add on to SA induced higher weight loss and improved QoL in obese women with PCOS. Thirty-seven obese women with PCOS (BMI ≥30 kg/m2) were randomized to MI + SA (n = 19) vs. SA (n = 18) for six months. Anthropometric measures (BMI, waist) and questionnaires (World Health Organization-5 (WHO-5), Major Depression Index (MDI), Short Form-36 (SF-36) and PCOS-Questionnaire (PCOS-Q)) were performed at baseline and at follow-up, www.clinicaltrials.gov, NCT02924025. Twenty-eight (14 + 14) women completed the study. At baseline, 24/28 women had WHO-5 scores <67 and 12/28 women had MDI scores indicating depression. Changes in weight and QoL were similar between MI + SA vs. SA group. However, WHO-5 (p=.028) and MDI (p=.008) scores improved significantly in the 12/24 women with MDI scores indicating depression. MI as add on to SA did not improve QoL or weight loss. Obese women with PCOS had low QoL.

Healthcare professionals experience with motivational interviewing in their encounter with obese pregnant women.

OBJECTIVE: to explore and describe how healthcare professionals in the Southern Region of Denmark experienced motivational interviewing as a communication method when working with pregnant women with obesity. DESIGN: a qualitative, descriptive study based on face-to-face interviews with 11 obstetric healthcare professionals working in a perinatal setting. METHODS: a thematic descriptive method was applied to semi-structured interviews. The healthcare professional's experiences were recorded verbatim during individual semi-structured qualitative interviews, transcribed, and analysed using a descriptive analysis methodology. FINDINGS: motivational interviewing was found to be a useful method when communicating with obese pregnant women. The method made the healthcare professionals more aware of their own communication style both when encountering pregnant women and in their interaction with colleagues. However, most of the healthcare professionals emphasised that time was crucial and they had to be dedicated to the motivational interviewing method. The healthcare professionals further stated that it enabled them to become more professional in their daily work and made some of them feel less 'burned out', 'powerless' and 'stressed' as they felt they had a communication method in handling difficult workloads. CONCLUSION: healthcare professionals experienced motivational interviewing to be a useful method when working perinatally. The motivational interviewing method permitted heightened awareness of the healthcare professionals communication method with the patients and increased their ability to handle a difficult workload. Overall, lack of time restricted the use of the motivational interviewing method on a daily basis.