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Biomedical subjects

G Grahn

Publications and source records attributed to G Grahn.

14 recordsLinked to original sources
PubMed1999

Learning to live with cancer in European countries.

Patient group education is an evidence-based and powerful intervention for supporting and guiding patients toward an understanding of the cancer experience. An education program for patients and families, entitled Learning to Live With Cancer, has been developed and evaluated in a Swedish research project, and implemented clinically. The program is a core model with a structure that allows flexibility in addressing learning needs. It has grown into a pan-European program through "training the trainers" courses, and is now available in many countries. This has taken the project into a new phase, since Europe is characterized not only by showing many different countries, but also by showing cultural diversity and variety in ethical norms. The aim of this phase thus was to assess the presence of core-model divergences conditioned by cultural values and norms, and if present, to investigate adjustments proposed to increase the relevance of the program to best suit patients' learning needs in different cultures. A questionnaire was distributed to former participants in "training the trainers" courses. The findings indicate that only minor divergences are present, and that the core model thus has the potential to meet the learning needs of cancer patients in many cultures.

Europe↗
PubMed1998

Postoperative energy intake in patients after colorectal cancer surgery.

In a prospective noninterventional study of 75 consecutive patients (mean age 71 +/- 12 years) undergoing surgery for colorectal cancer, standard postoperative energy intake was evaluated. Seventeen patients expended 40%-60% of estimated basal energy during hospitalization, 33 patients 60%-80%, 22 patients 80%-100% and three patients 100%-125%. Weight loss was observed in 67 patients (mean loss 4.7 +/- 4.4%) during hospitalization. Men had a significantly higher mean total calorie deficit (p < 0.001), and mean weight loss percentage (p < 0.01), compared to women. Preoperative nutritional status, nutrition-associated complications and length of hospital stay did not change the nutritional support and intake. Correlation analyses resulted in significant associations between gender and total calorie deficit (rs = 0.41, p < 0.01), postoperative weight loss and total calorie deficit (rs = -0.32, p < 0.01), and between postoperative weight loss and length of stay (rs = 0.27, p < 0.05). We concluded that the patients' energy intake was insufficient compared to estimated basal energy expenditure. These results suggest a need for individualized nutritional care, based on each patient's energy needs and on registration of daily calorie intake, all with the aim of increasing energy intake postoperatively in standard hospital care.

Aged↗
PubMed1997

Quality of life and independence in activities of daily living preoperatively and at follow-up in patients with colorectal cancer.

The aim of this exploratory study was to describe quality of life (QL) domains and independence in activities of daily living (ADL) in patients (n = 86) undergoing surgery for colorectal cancer. The patients were consecutively included, and two validated instruments, EORTC's QLQ-C30 and the Katz'/Hulter Asberg Index of Independence in ADL, were used preoperatively and at follow-up after 5-8 months. The findings were related to tumour localization, tumour burden according to Dukes' classification and to preoperative radiotherapy treatment. The results showed a significant improvement in the patients' scores for emotional functioning, appetite and global QL and a significant increase in financial impact at follow-up. The patients with colon cancer (n = 39) also had significantly less pain and less constipation at follow-up compared with preoperatively than did patients with rectal cancer (n = 47). The patients with rectal cancer, having undergone preoperative radiotherapy treatment, had significantly lower confidence intervals for means (95%) on the physical functioning and role functioning scales at follow-up versus preoperatively. Total ADL independence decreased from 70% of the patients preoperatively to 57% at follow-up, and independence in instrumental ADL decreased from 72% to 64% of the patients. No patient was dependent in personal ADL preoperatively, while 3% were dependent at follow-up. A lower mean score of global QL was found preoperatively and at follow-up for patients who were dependent in ADL than for patients who were independent in ADL. The instruments were found useful for evaluating individual patients in clinical practice.

Activities of Daily Living↗
PubMed1996

Coping with the cancer experience. I. Developing an education and support programme for cancer patients and their significant others.

Cancer patients and their significant others need information to understand events throughout the course of cancer. They also need support in mobilizing coping strategies as situational demands exceed their personal resources. Following a learning-needs assessment, Swedish cancer patients and their significant others demonstrated a desire to learn not only about the disease and treatment procedures, but also about the adaptation process to live with the uncertainty inherent in a diagnosis of cancer. It has, however, repeatedly been reported that communication barriers exist, and that information does not always reach the intended target. Thus, to increase knowledge and facilitate efforts to cope with the cancer experience an approach was used in which the provision of information was combined with emotional support in an education course. Patients and their significant others (n = 149) were actively involved in developing the education and support programme together with extensive learning materials. The programme, entitled Learning to live with cancer, has its roots in the educational philosophy of human learning, and is based on the findings from the original learning-needs assessment.

Adaptation, Psychological↗
PubMed1996

Coping with the cancer experience. II. Evaluating an education and support programme for cancer patients and their significant others.

As reported, cancer patients and their significant others need information promoting their understanding of events throughout the illness, and support in mobilizing coping strategies when they consider the situational demands to exceed their personal resources. In the present study the provision of information was merged into the field of education and combined with emotional support to facilitate efforts to cope with the cancer experience. A patient education programme entitled Learning to live with cancer was developed (part I) and evaluated (part II). Cancer patients and their significant others (n = 127) participated in group sessions. Open interviews organized around experiences of increased knowledge and understanding, decreased confusion and anxiety, and enhanced coping capacity related to participation in the programme were conducted with the participants. The interviews were analysed using the Grounded Theory approach. The findings indicate that supportive education, sensitively responsive to expressed learning needs and learning capability, has the power to promote proper understanding and facilitate coping efforts. Becoming familiar with facts and feelings reinforced confidence in evolving appropriate coping strategies for living with cancer.

Adaptation, Psychological↗
PubMed1993

"Learning to cope"--an intervention in cancer care.

As reported, cancer patients and their significant others need information to promote their understanding of events throughout the illness, and support to mobilize coping strategies when they consider the demands of the situation exceed their personal resources. It has, however, repeatedly been reported that communication barriers exist and that information does not always reach the target. In the present study the provision of information entered the field of education. An education and support program was developed, based on results from a learning-needs assessment. The program has now been evaluated. Cancer patients and their significant others (n = 127) participated in group sessions. After completion of the program, open interactive interviews organized around experiences of increased knowledge and understanding, and enhanced coping capacity related to participation in the program were conducted with the participants. The interviews were analyzed using the grounded theory approach. The findings indicate that supportive education, sensitively responsive to expressed needs and learning capability, has the power to promote proper understanding and facilitate coping efforts. Becoming familiar with facts and feeling reinforced confidence in evolving appropriate coping strategies for living with cancer.

Adaptation, Psychological↗
PubMed1993

Subjective assessment of nutritional status-validity and reliability of a modified Detsky index in a Swedish setting.

In the search for a clinically useful nutritional index for use in a European context, we have translated an American nutritional assessment index - Subjective Global Assessment (SGA), and tested the modified translated version for validity and reliability in a Swedish setting. Judgements by an expert panel resulted in a mean agreement of 71% for clarity, 80% for content validity and 65% for internal consistency. Construct validity was demonstrated by the use of contrasting patient-groups (n = 20) and by 90% agreement with a medical expert as 'gold standard' for unknown patients (n = 20). Inter-rater reliability showed 75% agreement by 3 Registered Nurses (RNs) (n = 20). The individual Kappas for the raters varied from 0.68 to 0.89. The study showed difficulties experienced by raters in relating certain aspects in the SGA-index to normality. However, we concluded that a modified SGA-index translated from one language to another, with all the problems of cultural and idiomatic differences, can be of value for assessing and documenting pre-operative nutritional status of patients undergoing gastrointestinal surgery in a Swedish setting.

Journal Article↗
PubMed1991

Needs and care of patients undergoing subtotal pancreatectomy for cancer.

Charts of 45 patients, who underwent subtotal pancreatectomy for cancer, at the University Hospital in Lund, over a 5-year period, were reviewed. The aim was to determine how the patients' symptoms and needs were assessed and cared for as documented by medical and nursing professionals. Data were collected on 107 items of interest for nursing care. The symptoms the patients experienced had consequences on many aspects of their lives. Basic functions, such as eating and elimination, were seriously disturbed before surgery, as well as after the first 3 weeks and 3 months. Pain and changes in sleeping pattern and in mood state were recorded for a majority of the patients. Due to inadequate notes the study cannot reveal the total care given to assist these patients with symptom control. However, certain insufficiencies could be found. The conclusion is that nurses can take a more active part in caring for patients with pancreatic cancer. By using assessment tools, and in cooperation with the surgeons, nurses can assist the patients with nutritional support, pain management, information and emotional support, as well as with physical training, leading to qualitative improvements in the lives of patients with pancreatic cancer.

Adult↗
PubMed1990

Learning to cope and living with cancer. Learning-needs assessment in cancer patient education.

Giving of information to cancer patients and their family members regarding the disease, the treatment procedures and the adaptation process for living with the uncertainty inherent in a diagnosis of cancer, is as reported often not effective due to peoples' failure to understand. The impact of emotional stress creates communication difficulties. Information not based on assessed learning needs and considered individual differences as to learning militates against proper understanding. In developing an educational programme a study has been carried out aiming to assess learning needs. Cancer patients (n = 50), their family members (n = 20) and staff members within cancer care (n = 30) were asked to answer a need assessment questionnaire. The patients/family members indicated an extensive desire to learn about cancer and its ramifications, whereas staff members indicated that they seldom were approached regarding some questions in the area. The findings support the appropriateness for providing a structured patient education programme based on assessed needs and planned to meet individual differences in learning readiness and learning capabilities, that would complement the information currently given by staff members.

Adaptation, Psychological↗