BackgroundCaregivers take on several tasks to support the patients during their disease trajectory. The price caregivers pay might have impact on their health, schedule, necessity of support from others, economic situation, and quality of life. Therefore, health care personnel need assessment tools to capture the caregivers' reaction and situation. Clinical practice is characterized as a busy setting and long assessment tools might be time-consuming to complete.MethodsThis study aims to present a short form from an original (long) version of The Caregiver Reaction Assessment (24 items) and to show how these tools correlate in a repeated measures design with three assessment points. Demographics and clinical variables are analysed by means of descriptive statistics. To assess possible sex differences for the long version of The Caregiver Reaction Assessment, the short version of it, and a single item assessing global quality of life, we performed independent sample t-test and Pearson's correlation analysis.ResultsSufficient correlation was shown between the long version (24 items), the short version (6 items), and the single item measuring global quality of life. We present how assessment of the caregivers' reaction and situation can be managed by means of a stepwise approach with one single item on quality of life as the first step, a short form tool on caregiver reaction as the next, and finally a long version of a reputable tool, The Caregiver Reaction Assessment, as the third step.ConclusionIn this study we have shown how different tools correlate. We suggest these tools to be used in a three-step approach to assess caregivers' reaction and situation.

Background

While patient perspectives in healthcare are recognized, endometrial cancer (EC) care quality and patient experiences remain understudied. The aim of this nationwide cross-sectional study was to explore how women treated for EC perceived the quality of care during treatment and waiting times until diagnosis and surgery.

Methods

EC patients (n=684) diagnosed January 2017 to March 2018, participated in the study six to eight months after diagnosis. Data were collected digitally by means of the Quality from the Patient’s Perspective – Gynecological Cancer instrument. Each item (n=27) was answered in two ways: both as actual care received and perceived importance of different aspects of care.

Results

The highest levels of perceived quality of actual received care and the corresponding subjective importance were reported related to physical-technical conditions comprising the items “Acceptable waiting times”, “Access to necessary equipment” and for the factor “Respect and empathy from healthcare personnel”. The lowest levels were reported regarding information related to self-care and aspects of sexuality. Most of the women (79%) reported less than one month waiting time until diagnosis and

Conclusions

This study contributes to a better understanding of the quality of care among women with endometrial cancer during illness, treatment and early cancer rehabilitation. Women perceived the quality of endometrial cancer care mostly as good or high and age had limited impact. Particularly identified areas for improvement were information on self-care and aspects of sexuality, along with reducing waiting times, all important for reducing patient distress.

Background and AimsSeveral factors exist regarding the risk for, healing and prevention of pressure ulcers (PUs). A mobile PU team with an individualized holistic approach adapted to the home or outpatient clinic setting could be beneficial for the prevention, and management of PUs.AimsTo describe the mobile PU team's interventions among individuals who had deep PUs and were living at home. Another aim was to describe the patients' perceptions of the quality of the care and having a deep PU.MethodsA quantitative study with a cross-sectional design. At an outpatient clinic, a mobile PU team was established to perform and follow up PU prevention interventions and advanced wound care treatment at home and at the outpatient clinic. All adult patients with existing deep category four PUs remitted to the outpatient clinic were asked to participate, and 16 out of 24 individuals consented. Instruments used for data collection were "Quality from the Patient's Perspective," "Wound-Quality of Life," "Modified Norton Scale," and a study developed protocol for the mobile team's PU interventions.ResultsThe patients chose home visits 20 times and outpatient clinic visits 89 times. In total, 8-13 interventions per participant were performed by the mobile team. The results show that having PUs affected the participants' perceptions of care and general well-being. The PUs did not heal completely but they did improve, six patients underwent flap surgery.ConclusionWhen organizing care regarding patient safety for patients with deep PUs, it is important to consider the patient's perspective and well-being and to involve patients in their care plans. Home care is perhaps not the only way of caring; other aspects, in addition to telemedicine, could be an option.

Background: Research focusing on patients’ perceptions of the quality of gynecological cancer care is needed.

Objective: To adapt the Quality from the Patient’s Perspective instrument for use in gynecological cancer care (QPP-GynCa) and describe patients’ perceptions of their quality of care in terms of the care received and the subjective importance of the aspects of care.

Methods: A cross-sectional study 6–8 months after diagnosis was conducted, involving 1511 patients (response rate of 50.4%) included in the Swedish quality registry for gynecologic cancer.

Results: The exploratory factor analysis (n = 1431) resulted in the QPP-GynCa with a 5-factor structure and an eigenvalue of ≥1, explaining 73.1% of the total scale variance. The final 27-item version of the QPP-GynCa consisted of 18 items with 8 additional single items and 1 global single item. The Cronbach’s alpha was acceptable for most factors (>.80). Subjective importance scores were higher than corresponding quality of care scores for care received (P ≤ .01)in all dimensions, factors, and items.

Conclusions: The QPP-GynCa instrument reflects all 4 dimensions of the theoretical model of quality of care and achieved good validity as a reliable instrument in assessing the quality of gynecological cancer care.

Implication for Practice: Information related to self-care, aspects of sexuality, and reducing patient waiting times need improvement.

What Is Foundational: This study contributes to a better understanding of quality of gynecological cancer treatment and care. The validated QPP-GynCa instrument will be a platform for more research on how this group of patients experience their received care, as well as importance of each aspect of care.

Background: The wish to be cared for and to die at home is common among people with end-stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the pref‑ erences for home care over time to enable home death among adult patients with cancer in the late palliative phase.

Methods: A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n=15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously.

Results: The findings are presented as a conceptual model of patients’ preferences for care to enable home death. The core category “Hope and trust to get the care I need to die at home” showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five cat‑ egories were related to the core category. The categories “being in the present”, “be safe and in charge” and “be seen and acknowledged” describe the patients’ preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: “reliable, compassionate and competent healthcare personnel” and “timely, predictive, continuous and adaptive organisation”.

Conclusion: An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person-centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person-centred care model and the use of advanced home care plans with continued re-evaluation for patients’ preferences of home care were proposed measures to enable home death.

It is a challenge to ensure high-quality palliative care. The aim was to investigate the perceptions of health care professionals(HCPs) working in a combined acute oncology-palliative care unit regarding the quality of the palliative care received by thepatients and how important the care was to the patients. A Swedish total-survey cross-sectional study including 41 HCPs (54%response rate) was conducted with the 52 items Quality from the Patient’s Perspective – Palliative Care instrument, answeredin two different ways: as actual care received and subjective importance. The STROBE-checklist was used. The areas forimprovements were related to symptom relief, spiritual and existential needs, information, patient participation, continuity ofcare, care planning, cooperation and coordination of care, as subjective importance scores were higher than correspondingscores for care received (p .025). Providing high-quality palliative care alongside curative treatments for cancer patients isknown to be challenging and could explain the results in this study. Implementation of a person-centred palliative care modelbased on the hospice philosophy could be a solution.

Background As palliative care increasingly takes place in patients' homes, perceptions of security among patients in the late palliative phase and their relatives are important. Aim To describe and compare patient-relative dyads regarding their perceptions of security in palliative homecare, including the perceived security of the actual care given to the patients, as well as the subjective importance of that care. Methods A cross sectional questionnaire study including 32 patient-relative dyads was conducted in an urban municipality in Norway. Patients were in a late palliative phase and received palliative homecare. Each patient proposed one relative. Data were collected using a modified version of the Quality from the Patients' Perspective instrument (QPP), which focuses on security and comprises three dimensions: medical-technical competence, identity-orientation approach and physical-technical conditions. Context-specific scales containing four aspects (competence, continuity, coordination/cooperation, availability) were added. The instrument contains two response scales; perceived reality (PR) and subjective importance (SI). Data were analysed by descriptive statistics, Chi-squared test, T-test and Wilcoxon's signed rank test. Results Patients had high mean scores on the PR-scale for the sense of security in palliative homecare in the dimensions of medical-technical competence and physical-technical conditions. There were three low mean scores on the PR-scale: the aspect of continuity from patients and the aspects of continuity and coordination/cooperation from relatives. The patients scored the SI scale statistically significantly higher than the PR scale in the identity-orientation approach dimension and in the aspect of continuity, while relatives did so in all dimensions and aspects. The intra-dyadic patient-relative comparisons show statistically significant lower scores from relatives on the PR-scale in the dimensions of medical-technical competence, physical-technical conditions, identity-orientation approach and the aspect coordination/cooperation. Conclusions There are several statistically significant differences between patients and relatives' perceptions of security in the palliative homecare received (PR) compared with the subjective importance of the care (SI) and statistically significant differences in the patient-relative dyads in PR. A relatively mutual sense of security in palliative homecare is important for patient-relative dyads, as relatives often provide care and act as patients' spokespersons. What they assess as important can guide the development of palliative homecare.

Introduction: In recent decades, major competency shifts have taken place in prehospital care in Sweden because staffing ambulances with registered/specialized nurses has become a priority. The aim of this study was to develop and validate a new instrument to measure the self-reported professional competency of specialist ambulance nursing students and registered/specialist nurses working in prehospital care. Methods: This study used a quantitative cross-sectional design to evaluate psychometric properties of a new instrument. The sample included 179 registered/specialist ambulance nurses and 34 specialist ambulance nursing students. Results: The analyses resulted in the Ambulance Nurse Competence (ANC) scale, consisting of 43 items and covering 8 factors: Nursing Care (n = 8), Value-based Nursing Care (n = 5), Medical Technical Care (n = 5), Care Environment's Community (n = 4), Care Environment's Serious Events (n = 8), Leadership Management (n = 3), Supervision and Professional Conduct (n = 4), and Research and Development (n = 6). All factors except Leadership Management achieved a Cronbach's alpha value greater than 0.71, explaining 59.62% of the total variance. Discussion: The ANC scale was systematically tested and showed satisfactory psychometrical properties. The ANC scale can be used in the education programs of future registered/specialist ambulance nurses as a tool for self-reflected learning and could also be of potential use in identifying competence gaps in registered/specialist ambulance nurses, which could direct the design of introductory programs. The scale could also be used as an outcome measure together with other instruments.

Purpose: Patients' views on quality are important to improve person-centered palliative care. There is a lack of short, validated instruments incorporating patients' perspectives of the multidisciplinary palliative care services. The aim of this study was to develop a short form of the instrument Quality from the Patient's Perspective for Palliative Care (QPP-PC) and to describe and compare patients' perceptions of the subjective importance (SI) of care aspects and their perceptions of care received (PR). Methods: A cross-sectional study was conducted in Norway including 128 patients (67% response rate) in four palliative care contexts. The QPP-PC, based on a person-centered theoretical framework, incorporating the multidisciplinary palliative care, comprises 4 dimensions; medical-technical competence, physical-technical conditions, identity-oriented approach and sociocultural atmosphere, 12 factors (49 items) and 3 single items. The instrument measures SI and PR. Development of the short form of the QPP-PC was inspired by previously published methodological guidelines. Descriptive statistics, paired t-tests, confirmatory factor analysis and Cronbach's a were used. Results: The short form of QPP-PC consists of 4 dimensions, 20 items and 4 single items. Psychometric evaluation showed a root-mean-square error of approximation (RMSEA) value of 0.109 (SI). Cronbach's a values ranged between 0.64 and 0.85 for most dimensions on SI scales. Scores on SI and PR scales were mostly high. Significantly higher scores for SI than PR were present for the identity-oriented approach dimension, especially on items about information. Conclusion: RMSEA value was slightly above the recommended level. Cronbach's a was acceptable for most dimensions. The short form of QPP-PC shows promising results and may be used with caution as an indicator of person-centered patient-reported experience measures evaluating the multidisciplinary palliative care for patients in a late palliative phase. However, the short version of QPP-PC needs to be further validated using new samples of patients.