Systematic Text Condensation Research Articles

Older Adults' Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting.

Owing to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communicating, and self-managing chronic conditions. However, incorporating older adults' health preferences and ensuring active involvement remain challenging. More knowledge is needed to ensure successful participation and eHealth use in care coordination. This study aimed to explore multimorbid older adults' experiences with participation and eHealth in care coordination with general practitioners (GPs) and district nurses (DNs). The study had a qualitative explorative approach. Data collection included semistructured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GPs or nurses at a local intermunicipal acute inpatient care unit. The data analysis was guided by systematic text condensation. We identified 2 categories: (1) older adults in charge of and using eHealth in care coordination, and (2) older adults with a loss of control in care coordination. The first category describes how communication with GPs and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults' information needs. The second category focuses on older adults who depend on guidance and help from their GPs and DNs to manage their health, describing how a lack of capacity and system support to be involved makes these adults lose control of their care coordination. Being in charge of care coordination is important for older multimorbid adults. The results show that older adults are willing to use eHealth to be informed and to seek information, which ensures high levels of participation in care coordination. Future research should investigate how older adults can be involved in electronic information sharing with health care providers.

‘In the end, I’m the one who has to do the job’: Participant experience of a lifestyle intervention for patients with hypertension

Objective Cardiovascular disease can be prevented through lifestyle changes, but such changes are often hard to attain. Text message interventions with lifestyle advice have shown small but promising effects. Our objective was to explore participant experience of a text message lifestyle intervention for patients with hypertension, and implications for future lifestyle interventions. Design and subjects Fourteen participants were purposefully selected for telephone interviews after completion of a text message lifestyle intervention. A semi-structured interview guide with open-ended questions was used. Interviews were recorded and transcribed verbatim. The material was analyzed through systematic text condensation as described by Malterud, a data-driven analysis style that includes deductive elements. Setting Primary care in three regions in southern Sweden. Results The analysis resulted in three themes. ‘Blood pressure and lifestyle, how seriously to take it?’ revealed a remaining need for knowledge regarding to what extent lifestyle affects risk for cardiovascular disease. ‘The text messages – a useful reminder in need of tailoring’ described that the design of the intervention was satisfactory, but suggested improvements through increased individualization. Finally, ‘Water off a duck’s back or a kick in the pants – when does behavior change?’ showed how some participants responded to the push to change while others did not, supplying material for further analysis in a framework of behavioral change theory. Conclusion A key to adoption was advice that was applicable in daily life. Timing in relation to a diagnosis of hypertension or other motivational factors, and tailoring to prior knowledge, habits, and limitations could increase effectiveness.

The diverse invitations to participate in early rehabilitation – A qualitative study of nurse-patient interactions in the intensive care unit

ObjectivesTo gain insight into the interaction between nurses and patients in early rehabilitation and the role of patient participation in this context. Research design and settingA qualitative study with a phenomenological-hermeneutic approach was conducted in two units/hospitals from January 2022 to January 2023, utilizing observations and video recordings of eight nurse/patient dyads combined with post observation interviews with the nurses. The study was analysed by systematic text condensation and video analysis, informed by interaction theory. FindingsTwo contrasting categories emerged: 1) Absent invitations: the nurse performed procedures without involving the patient; in other situations, the nurse informed the patient without requesting participation. Simultaneously, spontaneous patient movements were not acknowledged by the nurse. The nurses explained that this practice occurred due to time pressure, oversights, a lack of belief regarding patients’ capacities, the unit's culture and little training. 2) Invitations that strengthened participation: the nurse verbally requested activity that often resulted in an inadequate response, or bodily extended invitations that sometimes led to joint active movement. Patients were the most active participants when nurses combined verbal prompts, eye contact, physical handling, and dialogue. In the interviews, the nurses emphasized giving patients enough time to participate and repeatedly encouraged participation because the patient's condition and capacity constantly fluctuated. ConclusionInteractions that combine verbal and bodily invitations appear crucial for patient participation in early rehabilitation in the intensive care unit, emphasizing the importance of integrated tailored bodily communication. The nurses' lack of insight into and attention to the patient’s bodily potential for active movement combined with a paternalistic approach to the patient's situation may hinder patients' active participation. Implications for clinical practiceIntegrated forms of interaction that explore patients’ capacity and potential for participation should be employed in line with verbal communication. Developing competence in early rehabilitation should be emphasized in critical care nurses’ education and training.

Helpful elements in a brief work-oriented intervention targeting musculoskeletal and mental health literacy.

Musculoskeletal and mental health complaints are common in the general population and frequent reasons for healthcare utilization and work absence. Illness perceptions, coping expectancies, rumination and self-stigma are important factors in the management of these health complaints and factors closely linked to health literacy (HL). The aims of the study were to identify helpful elements in a brief intervention (BI) targeting HL regarding common musculoskeletal and mental health complaints and to identify patient perceptions of how the intervention was helpful and whether it affected their subsequent coping. Three focus group interviews with 14 patients were conducted. Systematic text condensation was used for the analysis, supported by the health literacy skill (HLS) framework to sharpen the focus on intervention elements related to the acquisition and utilization of HLSs. Results revealed the importance of receiving comprehensible health information and guidance, the use of metaphors to create recognizable narratives and the use of practical examples and exercises. Normalizing the experienced health complaints, together with a safe and accommodating clinical environment, facilitated the change process. The BI initiated processes that contributed to acceptance, resilience and empowerment, aiding work-life balance and return to work. The study presents authentic narratives of value for future focus in BI.

Receiving person-centred care in a hospital-A qualitative study of socially marginalised patients' experiences of social nursing.

Socially marginalised people are at a substantially increased risk of diseases and typically have several contacts with the healthcare system. Health professionals at hospitals often lack the knowledge, skills, confidence, and time to provide relevant care for socially marginalised patients. Danish hospitals have implemented a social nursing initiative consisting of social nurses with specialised knowledge about marginalisation to support socially marginalised patients. Limited research into patients' perceptions of social nursing has been undertaken. To explore patients' experiences with the in-hospital social nursing initiative. A qualitative study was conducted using a phenomenological hermeneutical approach. Odense University Hospital, Denmark. Patients aged 18 years and older who had been in contact with a social nurse during hospital admission were purposely sampled. Data saturation was reached when 15 participants were recruited. In-depth patient interviews were conducted from November 2021 to April 2022 using a semi-structured interview guide. The interviews were transcribed verbatim and analysed using systematic text condensation. NVivo 12 software was employed for the analysis. Patient representatives were involved to validate the analysis and interpretations. Three themes were identified: (1) an equal and trusting relationship, (2) receiving person-centred care, and (3) coherence in the patient trajectory. The results show that when patients have established a relationship with a social nurse, they are willing to let her into their lives and share personal information. Patients also experience person-centred care and coherence in their trajectory when a social nurse participated in their treatment and care. The findings indicate that the social nursing initiative bridges the gap between socially marginalised patients and healthcare services.

Residential overcrowding in relation to children's health, environment and schooling - a qualitative study.

To explore how overcrowding affects children's health, environment and schooling. A qualitative study was conducted with individual interviews among 20 participants with occupational experience from overcrowded Stockholm areas but diverse in professions, locations and employers. The interviews were recorded, transcribed and analysed with Systematic Text Condensation. Almost all participants expressed that overcrowding has a negative impact on children's health, environment and schooling - based on perceptions of precarious and different living conditions for children in overcrowded areas, for example, substandard homes, vulnerability, stress, exclusion, limited resources, lack of learning opportunities, gender differences, confinement, shame, insecurity, conflicts, risk of criminality, and bodily impact, both physical and psychological. Our qualitative evidence suggest that overcrowding has a negative impact on children's health, environment and schooling.

Being in-between; exploring former cult members' experiences of an acculturation process using the cultural formulation interview (DSM-5).

To explore the experiences of acculturation into secular Swedish society of former members of cults, with particular focus on mental health, needs and resources. Qualitative method using the Cultural Formulation Interview (CFI) from the DSM-5 as an interview guide. Analysis of participants' experiences of acculturation through systematic text condensation. Eleven Swedish former members of ideological or religion-based cults. Swedish mainstream, secular society. Former cult members experience an 'in-between time' in the period after leaving the cult and find themselves in a confusing, chaotic state. They describe having lived in an honor culture where acts of violence were normalized. In the cult, they felt disconnected from themselves, and post-cult they try to regain access to their own values and feelings as well as create new bonds with family members and friends outside the cult. They find it hard to talk about their cult background and find relief in communicating with other former cult members. In their post-cult life, they eventually start seeing the world in a brighter, more hopeful way than before. However, they are also at risk of re-experiencing cult-related traumatic events and of new traumatic experiences within the post-cult acculturation process, and of persistent psychological distress. Former cult members face a challenging acculturation process, having lost a functioning worldview upon leaving the cult but not yet gained another to take its place. While the in-between time is often transient, they may need support from the healthcare system, especially regarding mental health concerns, while establishing themselves into mainstream society.

P08.05.A A LONGITUDINAL CASE STUDY OF PATIENTS' EXPERIENCES IN THE INITIAL PHASE OF A BRAIN CANCER PATHWAY - AIMING TO IMPROVE PATIENT CARE

Abstract BACKGROUND A brain cancer diagnosis is life-transforming and involves accelerated diagnostics and treatment and care involving multiple settings and healthcare professionals. Patients are confronted with an uncurable cancer disease but also face progressive neurological and cognitive deficits over time, adding to the uncertain and stressful situation. Knowledge of patients' experiences during their hospital stay in the initial diagnostic phase is sparse. This study aimed to explore patients' experiences at the hospital during the diagnostic workup, the brain surgery, and the post-operative period until discharge and to describe what matters to patients when diagnosed with a malignant brain tumour. MATERIAL AND METHODS We used a descriptive longitudinal single-case study design to produce in-depth, context-dependent knowledge and capture real-life situations in patients' day-to-day care experiences from admission to discharge across three different departments throughout the initial diagnostic phase. To explore patients' views directly in the actual situations unfolding in practice, we followed one patient at a time and did 180 hours of field observation and 16 semi-structured interviews. We analyzed field notes and interviews by applying systematic text condensation. RESULTS An overarching theme, "A fast transition", was identified, describing the patients' experiences in the two central themes; "From feeling fine to an unknown journey" and "Patient involvement determined by system factors". Within the two themes, six subthemes emerged from the data: Overwhelming uncertainty and fear, Putting life on hold, An unfamiliar dependency and Being unprepared and side-lined, The significance of close relatives, and Managing care needs and demands. CONCLUSION The results add to understanding patients' experiences during the initial diagnostic phase. While part of the findings are a fact of life for patients diagnosed with a brain tumour, others point to specific areas for improvement. Small changes in care delivery can enhance patient involvement by proactively informing patients about their care plan, ensuring the presence of relatives during information giving and identifying patients' care needs and preferences. Establishing a patient and public involvement group in 2023 will provide more knowledge gaps for future research.

The 'inbetweeners': living on a watch and wait approach for chronic lymphocytic leukaemia - a qualitative study.

Chronic lymphocytic leukaemia (CLL) is an incurable disease; many people with the condition do not require active treatment and are monitored using a watch and wait approach. The aim of this study was to explore the experiences of people living with a diagnosis of CLL and on watch and wait. Using a descriptive qualitative approach, seven participants on the watch and wait approach were interviewed. Data analysis was guided by systematic text condensation. Participants reported anxiety, referring to 'wait and worry'. Their information needs were not met, and they resorted to seeking information on possible future treatments themselves. They also experienced feeling like an imposter because they were not receiving active treatment like other patients with cancer. A greater understanding of how information provision affects levels of anxiety and worry among people living with CLL on watch and wait is needed. In addition, clinical nurse specialists could deliver education on the watch and wait approach, supplemented by video-based educational materials developed by the haematology team.

Barriers to Organ Donation: A Qualitative Study of Intensive Care Nurses' Experiences.

An increasing number of patients affected by organ failure can be treated with organ transplantation. The need for organs available for transplantation is critical and patients die while on the transplant list. Intensive care unit (ICU) nurses are essential in facilitating organ donation through their ceaseless bedside care for potential organ donors and their families. The aim of this study was to describe the challenges faced by ICU nurses in the organ donation process. A descriptive qualitative study design was used. Semistructured individual interviews of 9 ICU nurses from 1 university hospital were performed. Data were analyzed using Malterud's systematic text condensation. Three themes describe the core of the results: (1) practical tasks, (2) challenging care for the next of kin, and (3) ethical and emotional challenges. Practical tasks represent challenges in the organ donation process that are not previously revealed. Actions to address these challenges should be prioritized to promote organ donation. Simulation-based training may optimize practical aspects of the organ donation process and implementation of simulation-based training should be assessed by future research.

Midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic: A qualitative study.

To explore midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic in Norway. A descriptive and explorative qualitative study. The study is based on semi-structured individual interviews with 11 midwives experienced in offering home-based postpartum care. We explored their experiences of such care during the first wave of the COVID-19 pandemic. Data collection occurred from October through November 2020. An inductive thematic analysis was performed using Systematic Text Condensation (STC) by Malterud (2012). The following two main results emerged from the analyses: (1) the midwives adapted quickly to changes in postpartum care during the pandemic and (2) midwives saw the experience as an opportunity to re-evaluate their practices. This study highlights midwives' resilience and adaptability during the first wave of COVID-19 pandemic. It emphasises the crucial role of face-to-face interactions in postpartum care, while recognising the value of technology when direct access is limited. By shedding light on midwives' experiences, this research contributes to improving postpartum care in unforeseen circumstances. It underscores the significance of interdisciplinary integration in planning postpartum care services and the lasting influence of lessons learned on addressing future challenges. The valuable insights gained from lessons learned during the COVID-19 pandemic may have a lasting influence on the postpartum care system, empowering it to tackle unforeseen challenges both today and in the future. The current study addressed midwives' experience with providing home-based postpartum care during the COVID-19 pandemic in Norway. Midwives received an opportunity to re-evaluate their own practices and valued being included when changes were implemented. The current findings should alert policy makers, leaders and clinicians in postpartum care services when planning future practice.

Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study.

To explore whether patients with multiple myeloma changed their construct of health-related quality of life during treatment. 14 participants were selected from 10 hematology-oncology departments in Denmark. This interview study used a prospective, longitudinal, exploratory design. Semistructured interviews were conducted while participants were undergoing active treatment for multiple myeloma and six months after the baseline interview. Interviews were analyzed using systematic text condensation. The overall theme at baseline was insecurity, and the overall theme at six months was coping. The following subthemes were also identified based on participants' description of their health-related quality of life: concerns about having a meaningful life, dealing with everyday limitations, and maintaining social networks; adjusting expectations to abilities; expanding social networks; and exploring a meaningful life. Patients' ability to use coping strategies should be considered when screening for rehabilitation needs. During systematic in-depth symptom screening, unmet rehabilitation needs (e.g., physical functioning, fatigue, pain) may become apparent.

A study of the experience of Norwegian IVF physicians in evaluating the parenting capacity of patients

Research questionHow do Norwegian fertility doctors assess the parenting capacity of applicants, and how do they experience and evaluate the assessment practice? DesignQualitative interview study with 14 Norwegian fertility doctors. Interviews were analysed with systematic text condensation, a qualitative analysis framework. ResultsNorwegian fertility doctors deem parenting capacity assessments of applicants to be straightforward and simple in most cases. Yet, some cases of doubt pose difficulties. Physicians can then draw on resources such as colleagues, physicians from other specialties who know the patient and patient records. All the participating physicians agreed with the principle of parenting capacity assessment for patients seeking fertility treatment. The assessment enabled physicians to refuse patients whom they thought should definitely not have responsibility for children. The physicians’ main argument was their own felt responsibility for the future child. Even though assessments could be challenging, the participants all thought of themselves as competent to perform them. Indeed, some thought that delegating the assessments would imply abdicating a responsibility that was properly theirs. Although national guidelines might aid decision-making, the physicians would not want guidelines to curtail the significant discretion that they exercised. ConclusionsWhether societies should assess applicants’ capacity for parenthood before fertility treatment is an ethical and political question. Although sometimes a difficult task, Norwegian fertility doctors see it as important, and as something they are competent and suited to undertake.

The Feasibility of the Adverse Childhood Experiences Questionnaire among Women in Danish Antenatal Care: A Mixed-Methods Study.

A traumatic upbringing increases the risks of antenatal health problems, unfavourable pregnancy outcomes, and mental disorders. Such childhood experiences may affect women's pa-renting skills and the social-emotional functioning of their children. Research on screening for adverse childhood experiences in antenatal care is limited. The objective of this study was to explore pregnant women's attitudes towards and experiences of an adverse childhood experiences questionnaire, and to assess the relevance of the questionnaire among a population of pregnant women referred to antenatal care levels one and two, targeting women who are generally not perceived to be vulnerable. Data were collected at three maternity wards and consisted of quantitative data on 1352 women's adverse childhood experience scores, structured observations of 18 midwifery visits, and in-depth interviews with 15 pregnant women. Quantitative data were analysed by descriptive statistics, and qualitative data were analysed using systematic text condensation. The qualitative analysis revealed two main categories: "Being screened for childhood adversities" and "Having adverse childhood experiences". In the study population, the prevalence of adverse childhood experiences was high. The women assessed the adverse childhood experiences questionnaire to be a relevant and acceptable screening method. Furthermore, women's perceptions of their relationship with their midwife greatly impacted their attitudes towards and experiences of the questionnaire.

A qualitative study on people with opioid use disorders' perspectives on smoking and smoking cessation interventions.

Smoking-related diseases are major contributors to disability and shorter life expectancy among opioid-dependent patients. Smoking prevalence is considerably higher for opioid-dependent persons than among the general population, and only a minority quit smoking in treatment settings. Studies show that pharmacological smoking cessation interventions have modest success rates. This study aimed to investigate patients' receiving opioid agonist therapy perspectives on factors affecting behavior and decisions related to smoking cessation, and their experiences with smoking cessation. This is a qualitative study using semi-structured individual interviews. The participants were asked, among others, to elaborate on the participants' thoughts about smoking, previous attempts to quit tobacco use, and what could prompt a smoking cessation attempt. We analyzed the transcripts with systematic text condensation. The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Opioid-dependent patients receiving opioid agonist therapy in outpatient clinics were invited to participate using a purposive sampling method. In total, fourteen individuals participated in this study. We identified six themes which were: (1) reflections on how smoking affected decisions, (2) smoking and its impact on physical and mental health, (3) the economy as a motivator to stop smoking, (4) emotions, desires, and habits related to smoking, (5) knowledge of smoking, smoking cessation, and quit attempts, and (6) social factors influencing the participants' choices and activities. The participants were well informed about the consequences of smoking and had some knowledge and experience in quitting. The participants' pulmonary health was an important motivational factor for change. Withdrawal symptoms, anxiety, and fear of using other substances discouraged several from attempting to quit smoking. In contrast, social support from partners and access to meaningful activities were considered important factors for success. Few reported being offered help from health professionals to make a smoking cessation attempt. Experiencing social support, being encouraged to quit smoking, and patients' concerns for their physical health were important reasons for wanting to quit smoking. Smoking cessation interventions based on patient preferences and on the behavior change wheel may enable a higher success rate among patients receiving opioid agonist therapy.

Significant reduction in diabetes distress and improvements in psychosocial outcomes: A pilot test of an intervention to reduce diabetes distress in adults with type 1 diabetes and moderate-to-severe diabetes distress (REDUCE).

To pilot-test an intervention, co-designed with people with type 1 diabetes (T1DM) and diabetes specialist nurses, to reduce diabetes distress (DD) in adults with T1DM and moderate-to-severe DD. A group-based programme to reduce DD in people with T1DM and moderate-to-severe DD (REDUCE) was pilot-tested in four groups with five bi-weekly two and a half-hour meetings facilitated by two trained diabetes specialist nurses. Data collection included baseline and post-intervention questionnaires measuring DD and psychosocial outcomes and semi-structured interviews with participants post-intervention (n = 18). Data were analysed using descriptive statistics and systematic text condensation. Twenty-five adults with T1DM participated in the study. The median age and diabetes duration of participants were 50 (IQR: 32;57.5) years and 26 (IQR: 18;45) years, respectively. Seventeen (68%) were women. The pilot study showed a significant reduction in DD (measured by Type 1 Diabetes Distress Scale) between baseline and post-intervention from 2.6 ± 0.7 to 1.9 ± 0.6 (mean ± SD) (p < 0.001). The largest reductions were seen on the subscales: powerlessness 1.2 ± 1.1, eating distress 0.9 ± 1.2 and fear of hypoglycaemia 0.8 ± 1.0 (mean ± SD). Significant improvements were also seen for quality of life, diabetes empowerment and emotion regulation. Qualitative data showed that REDUCE supported participants in verbalizing emotions and seeing worries in a more constructive perspective. Acknowledgement of negative diabetes experiences eased negative self-judgments. Sharing experiences among peers increased relatedness and reduced loneliness. Participation in REDUCE was associated with significant reduction in DD and significant increase in quality of life. Larger scale studies are planned to determine sustained effectiveness of REDUCE.

Involvement of service user representatives on a healthcare organizational level at Norwegian Healthy Life Centres: A qualitative study exploring health professionals' experiences.

The involvement of service user representatives in planning, delivering, and evaluating health care services is regarded as essential in Healthy Life Centres (HLCs) to ensure high-quality services. However, information on how HLC-professionals involve service user representatives at a healthcare organizational level at HLCs remains sparse. To explore HLC professionals' experiences involving service user representatives in planning, delivering, and evaluating the HLC services. Five qualitative semi-structured focus group interviews with 27 health professionals from 27 Norwegian HLCs were conducted. Data were analysed using systematic text condensation. The involvement of service user representatives at the HLCs varied from well-integrated and systematized to the opposite. The professionals' primary rationale for involving service user representatives was to include the representatives' unique experiential knowledge to ensure the quality of the service. Experiential knowledge was seen as a 'different' competence, which came in addition to professional competence. The professionals' choice of service user representatives depended on the purpose behind the involvement initiative. The HLC professionals often hand-picked former service users according to their health problems, motivation, and the HLC's need. The professionals said they were responsible for initiating the facilitation to accomplish genuine involvement. Support from their leaders to prioritize these tasks was essential. To meet the demand for adequate service user representatives, the HLCs need access to different service user representatives, representing both diagnose-based and generic service user organisations and the public. To achieve genuine involvement, the rationale behind the involvement and the representatives' role must be clarified, both for the HLC professionals and service user representatives. This will require resources for continuous organizational preparation and facilitation.

Specialist and Primary Physicians' Experiences and Perspectives of Collaboration While Caring for Palliative Patients-A Qualitative Study.

Increasing numbers of people living with chronic and life-limiting diseases are actualising a greater need for palliative care. Physicians are an important provider for identifying the need for palliation, and effective follow-up requires physician collaboration across different service levels. This study aimed to explore and describe how physicians in hospitals and municipalities experience their roles and interactions in the care of palliative patients. Pair interviews were performed with seven physicians working in hospitals, primary care and nursing homes in Mid-Norway. Systematic text condensation was used to analyse the data, resulting in three main themes: The boundaries of palliative care, Alternating understandings of roles and Absence of planning. The physicians' interactions with palliative patients appeared as a fragmented distribution of tasks rather than a real collaboration with shared responsibility. At both levels, the physicians seemed to assume withdrawn roles as a reaction to unclear and unspoken expectations and to avoid interfering with others' responsibilities. Moreover, their understanding of palliative care and which groups should be included varied. Realising a collaboration between physicians that is beneficial for both patients and physicians, greater openness and real arenas for discussion and decision-making support are required.

“The challenge is the complexity” – A qualitative study about decision-making in advanced lung cancer treatment

IntroductionThe value of shared decision-making and decision aids (DA) has been well documented yet remain difficult to integrate into clinical practice. We wanted to investigate needs and challenges regarding decision-making about advanced lung cancer treatment after first-line therapy, focusing on DA applicability. MethodsQualitative data from separate, semi-structured focus groups with patients/relatives and healthcare professionals were analysed using systematic text condensation. 12 patients with incurable lung cancer, seven relatives, 12 nurses and 18 doctors were recruited from four different hospitals in Norway. ResultsThe participants described the following needs and challenges affecting treatment decisions: 1) Continuity of clinician-patient-relationships as a basic framework for decision-making; 2) barriers to information exchange; 3) negotiation of autonomy; and 4) assessment of uncertainty and how to deal with it. Some clinicians feared DA would steal valuable time and disrupt consultations, arguing that such tools could not incorporate the complexity and uncertainty of decision-making. Patients and relatives reported a need for more information and the possibility both to decline or continue burdensome therapy. Participants welcomed interventions supporting information exchange, like communicative techniques and organizational changes ensuring continuity and more time for dialogue. Doctors called for tools decreasing uncertainty about treatment tolerance and futile therapy. ConclusionOur study suggests it is difficult to develop an applicable DA for advanced lung cancer after first-line therapy that meets the composite requirements of stakeholders. Comprehensive decision support interventions are needed to address organizational structures, communication training including scientific and existential uncertainty, and assessment of frailty and treatment toxicity.

“Does anyone know? Can you get any help?” Experiences from an ambassador-facilitated health programme: insights from a qualitative study

PurposeHealth ambassadors are co-workers assigned to facilitate healthy choices amongst the ambassadors'' colleagues and are increasingly used in workplace health promotion. In a municipality in the southern region of Denmark, occupational health and safety (OHS) representatives were appointed as health ambassadors to facilitate the development of healthy lifestyle initiatives at the ambassadors' workplace and the uptake of various health offers from the municipality's workplace health programme amongst the ambassadors' colleagues. The aim of this study was to understand how employees and managers from the municipality experienced the health ambassador-facilitated implementation of the health programme.Design/methodology/approachThe study was designed as an interview study with (n = 13) semi-structured interviews. Using purposeful sampling, the authors invited participants who held different positions (e.g. managers and regular employees) on two different work teams in the municipality. The work teams (a construction team and a healthcare team) differed in gender profile and work tasks but were both categorised as physically heavy work. Malterud's systematic text condensation was used to devise the strategy for the analysis.FindingsThe authors' findings show that the employees considered health a private matter that the workplace should not interfere with, and this challenged the implementation of the health programme. Secondly, the health ambassadors were not properly trained to facilitate health initiatives amongst the ambassadors' colleagues; instead, the managers were the driving force in the implementation of health initiatives.Originality/valueThe study provides useful insights into the processes of implementing health in the workplace and emphasises the importance of involving employees in design and planning of initiatives for workplace health promotion.