Patient preferences and experiences of participation in surgical cancer care.

BACKGROUND: Quality cancer care necessitates opportunities for patient participation, supposedly recognizing the individual's preferences and experiences for being involved in their health and healthcare issues. Previous research shows that surgical cancer patients wish to be more involved, requiring professionals to be sensitive of patients' needs. AIMS: To explore preference-based patient participation in surgical cancer care. METHODS: A cross-sectional study was conducted. The Patient Preferences for Patient Participation tool (4Ps) was used, which includes 12 attributes of preferences for and experiences of patient participation. Data were analyzed with descriptive and comparative statistical methods. RESULTS: The results are based on a total of 101 questionnaires. Having reciprocal communication and being listened to by healthcare staff were commonly deemed crucial for patient participation. While 60% of the patients suggested that taking part in planning was crucial for their participation, they had experienced this only to some extent. Learning to manage symptoms and phrasing personal goals were items most often representing insufficient conditions for preference-based patient participation. LINKING EVIDENCE TO ACTION: To support person-centered surgical care, further efforts to suffice preference-based participation are needed, including opportunities for patients to share their experiences and engage in the planning of healthcare activities.

Patient-reported participation in hepatopancreatobiliary surgery cancer care: A pilot intervention study with patient-owned fast-track protocols.

OBJECTIVE: Fast-track concepts have been implemented in hepatopancreatobiliary surgery cancer care to improve postoperative recovery. For optimal postoperative care, patient participation is also required. The aim was to investigate and analyse whether an intervention with patient-owned fast-track protocols (PFTPs) may lead to increased patient participation and improve information for patients who underwent surgery for hepatopancreatobiliary cancer. METHODS: A quantitative comparative design with a control and intervention group was used. The participants in the intervention group followed a PFTP during their admission. After discharge, the patients answered a questionnaire regarding patient participation. Data analyses were performed with descriptive statistics and ANCOVA. RESULTS: The results are based on a total of 222 completed questionnaires: 116 in the control group and 106 in the intervention group. It is uncertain whether the PFTP increased patient participation and information, but its use may indicate an improvement for the patient group. CONCLUSION: A successful implementation strategy for the use of PFTP, with daily reconciliations, could be part of the work required to improve overall satisfaction with patient participation. CLINICALTRIALS: gov ID: NCT04061902.

The Swedish radiological environmental protection regulations applied in a review of a license application for a geological repository for spent nuclear fuel.

For the first time, a system for specific consideration of radiological environmental protection has been applied in a major license application in Sweden. In 2011 the Swedish Nuclear Fuel & Waste Management Co. (SKB) submitted a license application for construction of a geological repository for spent nuclear fuel at the Forsmark site. The license application is supported by a post-closure safety assessment, which in accordance with regulatory requirements includes an assessment of environmental consequences. SKB's environmental risk assessment uses the freely available ERICA Tool. Environmental media activity concentrations needed as input to the tool are calculated by means of complex biosphere modelling based on site-specific information gathered from site investigations, as well as from supporting modelling studies and projections of future biosphere conditions in response to climate change and land rise due to glacial rebound. SKB's application is currently being reviewed by the Swedish Radiation Safety Authority (SSM). In addition to a traditional document review with an aim to determine whether SKB's models are relevant, correctly implemented and adequately parametrized, SSM has performed independent modelling in order to gain confidence in the robustness of SKB's assessment. Thus, SSM has used alternative stylized reference biosphere models to calculate environmental activity concentrations for use in subsequent exposure calculations. Secondly, an alternative dose model (RESRAD-BIOTA) is used to calculate doses to biota that are compared with SKB's calculations with the ERICA tool. SSM's experience from this review is that existing tools for environmental dose assessment are possible to use in order to show compliance with Swedish legislation. However, care is needed when site representative species are assessed with the aim to contrast them to generic reference organism. The alternative modelling of environmental concentrations resulted in much lower concentrations compared to SKB's results. However, SSM judges that SKB's in this part conservative approach is relevant for a screening assessment. SSM also concludes that there are big differences in dose rates calculated to different organisms depending on which tool that is used, although not systematically higher for either of them. Finally, independent regulatory modelling has proven valuable for SSM's review in gaining understanding and confidence in SKB's assessment presented in the license application.

Impacts of (14)C discharges from a nuclear fuel reprocessing plant on surrounding vegetation: Comparison between grass field measurements and TOCATTA-χ and SSPAM(14)C model computations.

This article compares and discusses the ability of two different models to reproduce the observed temporal variability in grass (14)C activity in the vicinity of AREVA-NC La Hague nuclear fuel reprocessing plant in France. These two models are the TOCATTA-χ model, which is specifically designed for modelling transfer of (14)C (and tritium) in the terrestrial environment over short to medium timescales (days to years), and SSPAM(14)C, which has been developed to model the transfer of (14)C in the soil-plant-atmosphere with consideration over both short and long timescales (days to thousands of years). The main goal of this article is to discuss the strengths and weaknesses of the models studied, and to investigate if modelling could be improved through consideration of a much higher level of detail of plant physiology and/or higher number of plant compartments. These models have been applied here to the La Hague field data as it represents a medium term data set with both short term variation and a sizeable time series of measurements against which to compare the models. The two models have different objectives in terms of the timescales they are intended to be applied over, and thus incorporate biological processes, such as photosynthesis and plant growth, at different levels of complexity. It was found that the inclusion of seasonal dynamics in the models improved predictions of the specific activity in grass for such a source term of atmospheric (14)C.