Person-specific evidence has the ability to mobilize relational capacity: A four-step grounded theory developed in people with long-term health conditions.

Person-specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self-determination method with people with various long-term health conditions. It explains the mechanisms of mobilizing relational capacity by including person-specific evidence in shared decision-making. Person-specific self-insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self-management challenges. This step paved the way for sharing these insights and challenges in a relationship with a supportive health professional, who could then rely on person-specific evidence instead of assumptions or a narrow disease perspective for shared decision-making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person-specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self-insights in daily life with other people, decreasing loneliness they experienced in self-management. Relational capacity, the core of the theory, is mobilized in both people with long-term health conditions and healthcare professionals. Further research on person-specific evidence and relational capacity in healthcare is recommended.

Total burden of disease in cancer patients at diagnosis-a Danish nationwide study of multimorbidity and redeemed medication.

BACKGROUND: Multimorbidity is a growing challenge worldwide. In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers. METHODS: We conducted a nationwide register-based cohort study of all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015. Multimorbidity was defined as one or more of 20 conditions (131 specific diagnoses) registered in the Danish National Patient Registry < 5 years before the cancer diagnosis. Polypharmacy was defined as five or more medications registered in the Danish National Prescription Registry and redeemed twice 2-12 months before the cancer diagnosis. RESULTS: We included 261,745 patients with a first primary cancer, of whom 55% had at least one comorbid condition at diagnosis and 27% had two or more. The most prevalent conditions at the time of cancer diagnosis were cardiovascular disease, chronic obstructive pulmonary disease, diabetes, stroke and depression/anxiety disorder. Polypharmacy was present in one-third of the cancer patients with antihypertensives, anti-thrombotic agents, anti-hyperlipidaemic agents, analgesics and diuretics as the most prevalent redeemed medications. CONCLUSION: Among patients with a newly established cancer diagnosis, 55% had at least one comorbid condition and 32% were exposed to polypharmacy.

Labeled as lucky: contradictions between what women and healthcare professionals experience regarding the need for help after the early stages of gynecological cancer.

PURPOSE: To explore how participants perceived a nurse-led, person-centered intervention, Guided Self-Determination Gynecological Cancer (GSD-GYN-C) and how participants felt it influenced the challenges they faced and their rehabilitation after gynecological cancer surgery. METHODS: Participants were invited from a previously conducted randomized trial where GSD-GYN-C improved physical quality of life in the intervention group. Ten semi-structured interviews were conducted, transcribed, and analyzed using thematic analysis. RESULTS: Three central themes were identified: (1) "labeled as the lucky ones," which describes a contrast between the women's perceived problems and the healthcare professionals' tendency to stress their luck in being treated early and cured with no particular problems in sight, leading to an unintended delay in their rehabilitation process; (2) "personal reflections pave the way for change," which shows how new problem-solving skills were mobilized when reflection sheets and dialogue on GSD-GYN-C provided new insight into their situation and the feeling of being taken seriously; and (3) "emerging relational competence," which describes the new skills the women developed in interacting with family, friends, colleagues, and healthcare professionals. CONCLUSIONS: As a supplement to usual care, GSD-GYN-C remedied a tendency among healthcare professionals to underestimate problems in the early stages of gynecological cancer, and GSD-GYN-C involved the women in their rehabilitation process characterized by active problem-solving in relationships with other people.

[Ten recommendations for cancer survivors supporting health improvement and secondary prevention].

An increasing number of individuals diagnosed with cancer survive and die of a new cancer or other lifestyle-related diseases. With the intent to encourage and assist oncologists in promoting lifestyle changes to improve health of their patients, this article sums up the evidence behind a brochure including ten one-line health messages in Danish inspired by the American initiative Cancer Survivors' Eight Ways to Stay Healthy After Cancer. We conclude by discussing the challenges of implementation of preventive and health promoting activities in clinical practice in Denmark.

The psychosocial needs of gynaecological cancer survivors: A framework for the development of a complex intervention.

PURPOSE: To develop and pilot test an intervention targeting the women's psychosocial needs during the follow-up period after surgical treatment for gynaecological cancer. METHODS: The project consisted of four phases. Phase 1 involved development of an intervention on the basis of meetings with key healthcare professionals, a literature review and six semi-structured interviews with women who attended the existing follow-up program. The Guided Self-Determination (GSD) method developed in diabetes care was identified as an appropriate framework for the intervention. GSD consists of reflection sheets for patients and advanced professional communication skills. The GSD method was adapted to women in a follow-up program after gynaecologic cancer treatment (GSD-GYN-C). Phase 2 involved primary pilot testing of the intervention and the findings were used to modify the intervention in phase 3. This modification involved the development of additional reflection sheets and a fidelity assessment tool. A systematic training program was arranged for the GSD-GYN-C-nurses. Phase 4 involved secondary pilot testing where nurses and women confirmed the applicability of GSD-GYN-C and final adjustments were made. Selected measurements were tested for sensitivity during pilot testing. Data from phase 2 and 4 were also used to select the primary outcome and calculate power for a future randomized clinical trial (RCT). RESULTS: Pilot testing supported our hypothesis that GSD-GYN-C may be transferable and useful to survivors of gynaecological cancer. CONCLUSION: GSD-GYN-C was developed and validated and is now ready for evaluation in an RCT.