Background Welfare technology interventions have become increasingly important in home-based palliative care for facilitating safe, time-efficient, and cost-effective methods to support patients living independently. However, studies evaluating the implementation of welfare technology innovations are scarce, and the empirical evidence for sustainable models using technology in home-based palliative care remains low. This study aimed to report on the use of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess the implementation of remote home care (RHC) a technology-mediated service for home-living patients in the palliative phase of cancer. Furthermore, it aimed to explore areas of particular importance determining the sustainability of technologies for remote palliative home-based care.

Methods A secondary analysis of data collected by semi-structured interviews with patients with cancer in the palliative phase, focus groups, and semi-structured interviews with healthcare professionals (HCPs) experienced with RHC was performed. A deductive reflexive thematic analysis using RE-AIM dimensions was conducted.

Results Five themes illustrating the five RE-AIM dimensions were identified: (1) Reach: protective actions inrecruitment - gatekeeping, (2) Effectiveness: potential to offer person-centered care, (3) Adoption: balancing high touch with high tech, (4) Implementation: moving towards a common understanding, and (5) Maintenance: adjusting to what really matters. The RE-AIM framework highlighted that RHC implementation for patients in the palliative phase of cancer was influenced by HCP gatekeeping behavior, concerns regarding abandoning palliative care as a high-touch specialty, and a lack of competence in palliative care. Although RHC facilitated improved routines in patients’ daily lives, it was perceived as a static service unable to keep pace with disease progression.

Conclusions A person-centered approach that prioritizes individual needs and preferences is necessary for providing optimal care. Although technologies such as RHC are not a panacea, they can be integrated as support for increasingly strained health services.

Bakgrund: Palliativ vård innebär en holistisk vård av personer i alla åldrar. Syftet är att lindra lidande av fysisk, psykologisk, social eller existentiell/andlig natur. Döendet och döden är ofta omgärdade av tystnad, både i samhället i stort och bland vårdpersonal. Vårdpersonal kan känna sig obekväma vid tanken på döden. Djupare existentiella frågor undviks ofta genom att äldre personer inom hälso- och sjukvården avleds genom att prata om mer lättsamma samtalsämnen. Framtidens palliativa vård äger till stor del rum i hemmen och inom äldreomsorgen. 

Frågeställning: Studien är en del av en större interventionsstudie, EDUC-PC studien, och omfattar baslinjedata från 6S-enkäten med fokus på hur personal inom äldreomsorgen uppfattar att de arbetar enligt ett personcentrerat palliativt förhållningssätt.  

Metod: En kvantitativ ansats antogs. Enkäten som innehåller nio frågor skickades till 266 anställda varav 136 svarade.  Resultaten redovisas som deskriptiv statistik i form av antal, procenttal, med median (md) som centralt mått. 

Resultat: Resultaten visar att den vård som ges uppfattas som bra eller mycket bra av personalen men att uppfattningarna varierar mellan olika yrkesgrupper. Innehållet i självbild, självbestämmande, sociala relationer och symtomlindring får alla höga poäng, medan de två existentiellt inriktade S:en; syntes och strategier, visar en större spridning mot lägre poäng.  

Konklusion: Obalansen mellan de olika innehållen i 6S omvårdnadsmodellen visar att det finns brister i den palliativa omvårdnaden inom äldreomsorgen. Detta är tydligast när   de två S:en symtomlindring och strategier jämförs. Resultaten visar på ett behov av fortsatt fokus på äldre personers existentiella frågor inom äldreomsorgen.

Background: Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth in home-based palliative care.

Objective: In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients’ use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients.

Methods: This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ≥18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis.

Results: This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth.

Conclusions: The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process.

I den här sessionen presenterar vi akademisk SÄBO ur olika perspektiv. Vi kommer att berätta om: (x) samskapande, utveckling och uppbyggnad av akademisk SÄBO(x) att vara kommundoktorand och vägen dit. Vi kommer även att berätta om (x) att vara forskare på SÄBO och om (x) samverkan mellan forskning, utveckling och utbildning. I sessionen knyter vi an till palliativ vård genom våra olika exempel. Bland annat kommer vi att beskriva SÄBO som arena för utveckling, följeforskning och deltagarbaserad forskning.samt SÄBO som arena för strukturerade förbättringsarbeten och ett doktorandprojekt om förberedande samtal om livet och döden på SÄBO tillsammans med personal och chefer på SÄBO i Stockholm

Purpose: The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic.

Methods: This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents’ demographics and quality of care, the latter measured by the short form of the Quality from the Patient’s Perspective—Palliative Care instrument, adapted for HCP. The STROBE checklist was used.

Results: This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement.

Conclusion: Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.

Aims  and  Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home.

Background: Introducing welfare technology in home- based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and chal-lenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found.

Design: A qualitative study with a longitudinal, exploratory design.

Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study.

Results: Three themes were identified: (1) potential to facilitate self- governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care.

Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness- management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase.

Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies.

Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals.

Background Education in palliative care for undergraduate nursing students is important for the competence of general nurses. Newly graduated nurses have reported challenges in coping with their own emotions when encountering dying persons. They express a wish for more education before they graduate, particularly in psychosocial and existential areas, such as having difficult conversations and supporting grieving persons. Despite awareness of the importance of palliative care education for nurses, there is a lack of knowledge on how to effectively convey this knowledge to students. The aim of the present study was to explore how teaching to prepare undergraduate nursing students for palliative care practice is conducted in Sweden.

Methods Educators from 22 Bachelor of Science nursing programmes in Sweden were interviewed about how they conducted palliative care education, with a focus on teaching situations that have been successful or less successful. The interviews were transcribed and analysed using qualitative inductive content analysis.

Results Educators described that they play a crucial role in preparing undergraduate nursing students to face death and dying and to care for persons at the end of life. In the main theme, “Transforming person-centred palliative care into student-centred education”, educators described how they incorporated the person-centred palliative approach into their teaching. Educators used a dynamic style of teaching where they let the students’ stories form the basis in a co-constructed learning process. The educators trusted the students to be active partners in their own learning but at the same time they were prepared to use their expert knowledge and guide the students when necessary. Discussion and reflection in small groups was described as being essential for the students to achieve a deeper understanding of palliative care and to process personal emotions related to encountering dying and grieving individuals.

Conclusions This study suggests that palliative care education for undergraduate nursing students benefits from teaching in smaller groups with room for discussion and reflection. Furthermore, gains are described relating to educators taking the role of facilitators rather than traditional lecturers, being flexible and ready to address students’ emotions. Educators also draw on their experiences as palliative care nurses in their teaching practices.

Background Key predictors of distress for healthcare professionals during the COVID-19 pandemic include working long hours, lack of support, feelings of vulnerability or loss of control, and concerns about health of oneself and one’s family. In this Scandinavian study we explore psychosocial work environment in geriatric, medicine, surgery, oncology and intensive care units at hospitals, palliative care units and nursing homes with focus on end-of-life care. The aim was to explore how relocation during the COVID-19 pandemic impacted on self-reported psychosocial work environment among registered nurses and assistant nurses in Sweden and Norway when caring for seriously ill patients.

Methods This is a part of a survey study during autumn 2021 regarding healthcare professionals’ (n=808) psychosocial work environment, occupational self-efficacy, own health and palliative care quality. We will present results from the Copenhagen Psychosocial Questionnaire III by univariate analyzes of variance and t-tests.

Results Out of 743 nurses were 111 relocated. Relocation impacted negatively (statistically significant) on the subscales social support from managers, social support from colleagues and insecurity of working conditions, as well as self-rated health and stress. This was most prominent common among registered nurses. Compared to Swedish reference values the participants scored statistically significant lower values within these subscales.

Conclusions This study highlight the importance of a health care organisation where managers take responsibility and support the employees’ psychosocial work environment. This is especially important during extraordinary event such as a pandemic to prevent burnout and achieve high-quality palliative care.

Kliniskt verksamma sjuksköterskor och omvårdnadsforskare har under mer än 30 år tillsammans utvecklat De 6 S:n som stöd för planering, dokumentation och utvärdering av palliativ vård utifrån patientens perspektiv. De 6 S:n vilar på en humanistisk grund, den palliativa vårdens mål och stämmer väl överens med samhälleliga mål och styrdokument för hälso- och sjukvården. De 6 S:n kan ses som ett sätt att kvalitetssäkra vården. Modellen utgår från följande begrepp: 

• Självbild

• Självbestämmande 

• Symtomlindring

• Sociala relationer

• Sammanhang 

• Strategier

I denna tredje upplaga av boken har samtliga kapitel uppdaterats. Självbestämmande- och symtomkapitlen har utvecklats, det senare med kroppslig omvårdnad och det har tillkommit kapitel om De 6 S:n inom äldreomsorg och om användning av dem för ett livslångt lärande.

Boken vänder sig till studerande inom specialistutbildning, magister- eller masterprogram, till studerande på grundnivå och till personal inom olika vårdformer som vill utveckla den palliativa vården.

De 6 S:n, självbild, symtomlindring, sociala relationer, sammanhang, strategier och självbestämmande, har använts för att bidra till personcentrerad palliativ vård i Sverige sedan 1990-talet. De 6 S:n har traditionellt använts inom specialiserad palliativ vård, men passar också för allmän palliativ vård under hela livsspannet. Palliativ vård av barn ställer stora krav. Ett projekt där De 6 S:n används för att bidra till personcentrerad palliativ vård av barn kommer att presenteras. Inom äldreomsorg ställs stora krav på att bevara integritet och personcentrering när funktion, kognition och möjlighet till självbestämmande börjar avta. Vi presenterar forskning om hur kroppslig omvårdnad inom äldreomsorg kan bli mer personcentrerad och en modell för att förbättra självbestämmande och därmed bidra till en personcentrerad palliativ vård inom äldreomsorgen. De 6S:n har diskuterats, preciserats och utvecklats av det nationella 6S-nätverket för att beskriva det teoretiska innehållet och för att utveckla den praktiska användbarheten. Diskussionen är levande och ständigt fortgående för att förbättra personcentrerad palliativ vård för personer i olika åldrar och olika vårdkontext.