To Örebro University

INTRODUCTION: Treatment of older cancer patients can be complex due to frailty that comes with age, and the benefits of radiation therapy for frail older patients are unclear. Radiation therapy staff play a crucial role in identifying and monitoring frailty and tailoring treatment. Research on radiation therapy in frail older patients is limited, and frailty assessments are not widely used in routine care. Understanding staff experiences with clinical judgement and frailty assessment is important for effective treatment. This study explored the radiation therapy staff's experiences of clinical judgement, treatment decision-making, and managing frail older cancer patients.

METHODS: The study has an inductive design in which 12 specialist oncology nurses and four clinical oncologists working with cancer patients at four radiation therapy units across four counties in Sweden were interviewed. In total, 16 participants were interviewed for the study. Data were collected in semi-structured individual interviews and were analysed using reflexive thematic analysis.

RESULTS: Three themes were identified from the interview analysis: Putting the patient first, Care with integrity and humanity and Receiving support in treatment decisions, along with nine sub-themes. None of the participants was using any structured instrument for assessing frailty.

CONCLUSIONS: Radiation therapy staff face significant and complex challenges when treating frail older cancer patients, which can lead to feelings of doubt and powerlessness. Awareness and use of structured frailty assessment are limited. Integrating structured frailty assessment could address the complex challenges experienced by staff by improving decision-making, communication, and patient outcomes, contributing to more ethical and person-centred care.

The aim of this study is to examine older adults' experience of receiving medical and care efforts from a Mobile Geriatric Team (MGT). A phenomenologically inspired approach guides this study to stay empirically close to the data while exploring the experiences of five older adults with comorbidity receiving medical and care efforts from a MGT. Three themes emerged from the interviews: The relief of integrated treatment, Reclaiming time from the emergency room, and Finding sanctuary at home. The findings reveal that older adults particularly valued the MGT's comprehensive view of their medical history and medication, highlighting how this holistic approach provided significant comfort. Participants also emphasized the relief brought by staff continuity and the ability to receive acute medical treatments in the familiarity of their own homes, thereby avoiding the stress and inconvenience of emergency room visits. While reducing emergency room visits was a stated goal of the MGT, this study distinctively illuminates the profound positive impact of this outcome from the older adults' perspective. These findings demonstrate a project successfully aligning with initiatives for good, close, and coordinated care, ultimately promoting health and well-being for older adults.

OBJECTIVES: To explore and describe how healthcare professionals within the oncological outpatient setting perceive quality of care.

DESIGN: A qualitative, descriptive design with a phenomenographic approach was used, with focus group discussions as the means of data collection.

SETTING: Primary care in oncological outpatient units in four hospitals in Sweden.

PARTICIPANTS: Through purposive sampling, 20 healthcare professionals entered and completed the study by participating in four focus groups, five participants in each group. Inclusion criteria were assistant nurses, nurses or physicians delivering treatment and care with radiation and/or anticancer drugs in oncological outpatient units. Excluded were healthcare professionals who had worked less than 3 months at the oncological outpatient unit.

RESULTS: Two descriptive categories emerged from the data: 'The professional's personal ability for good care' and 'The structural conditions for good care'. These categories consist of descriptions of quality of care being perceived as a good meeting with patients, patient participation, continuity, accessibility and care grounded in science.

CONCLUSIONS: According to the healthcare professionals, quality of care relies on organisational structures in combination with a professional and personal interaction between the patients and the healthcare professionals. Knowledge about what healthcare professionals believe constitutes quality of care should therefore be highly valuable to policymakers and hospital management.

University years are an important transitional time for young adults. Recently, an increasing number of students have reported mental health problems. The increasing numbers are an international phenomenon. Qualitative research on mental health promotion for students is, however, scarce. The aim of this study is to explore students' descriptions of experiences in their student life that are beneficial to mental health. A Norwegian project named "In my experience" collected descriptions, through the web-based tool Sensemaker, from students about experiences that have had an impact on their student life. This study explores the descriptions of experiences beneficial to students' mental health that the students categorized as having had a positive or very positive impact on their student life. A total of 171 descriptions from students aged 18-29 were analyzed using thematic analysis. Two main themes were identified: becoming a student, which consisted of descriptions about the feeling of a new life as a student, and being a student, which described experiences with managing student life that were beneficial for mental health. Experiences such as being welcomed, being included, belonging to a social group, finding one's own identity, maturing, and developing were all highlighted in the descriptions. Student societies and other forms of civic engagement and being accepted and included in an academic community were fundamental. A limitation of the study was the relatively low number of male participants, and further research on male students' descriptions about beneficial experiences is needed.

AIM: The aim of the present study is to evaluate the psychometric properties and factor structure of the Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) instrument and briefly describe the staff's views on the quality of care provided in general outpatient clinics as well as demographic and clinical factors associated with quality of care.

METHOD: The study employed a cross-sectional design to conduct a psychometric evaluation and survey of staff perspectives. A sample of 143 permanently employed members of staff in multiprofessional teams at 15 outpatient clinics in Sweden completed the QPC-OPS, which consists of 30 items covering eight dimensions of quality of care.

RESULTS: The QPC-OPS exhibited excellent psychometric properties, with a total alpha coefficient of 0.94, a test-retest reliability of 0.96 and a goodness-of-fit measure for the proposed model with a RMSEA value of 0.048. The staff's rating was generally high. Ratings were highest for Encounter and lowest for Accessibility. Staff who rated their own mental health as higher rated quality of care higher in most of the dimensions.

CONCLUSION: The Swedish QPC-OPS showed excellent psychometric properties and is a useful, inexpensive and simple way to evaluate the quality of care in outpatient care and contributes to health care improvement in the field of psychiatric care. The low quality of the dimension of Accessibility indicates an important area for improvement.

BACKGROUND: The therapeutic relationship has been identified as essential for ensuring high-quality care in psychiatric outpatient services, as highlighted in several studies. This study focuses on the content of interactions between patients and staff in psychiatric outpatient care, as well as the quality of care provided, as perceived by the patients. AIM: The aim of this study is to explore the relationship between these interactions and aspects of the perceived quality of care from the perspective of patients in psychiatric outpatient services.

METHODS: A sample of 706 patients from psychiatric outpatient clinics in Sweden completed the Verbal and Social Interaction Outpatient (VSI-OP) and the Quality in Psychiatric Care-Outpatient (QPC-OP) instruments. A structural equation model was conducted to explore these associations. The study was approved by the Regional Ethical Review Board in Uppsala, Sweden (Dnr. 2018/186).

RESULTS: The model revealed that the staff showing an interest in the patients' feelings, experiences and behaviour influences the patients' perceived quality of participation through an intricate network of mediator variables, including the staff's ability to establish a relationship, a good encounter, support and a high level of information to the patients. High levels of Participation/Empowerment indicate a high level of quality of care in a psychiatric outpatient context.

IMPLICATION FOR PRACTICE: The presented model provides an understanding of the associations between staff and patient interactions and perceived quality of care and sheds light on important aspects of quality of care from the perspective of the patients.

A review of the existing literature shows that although numerous factors influence the quality of care, only a few have been thoroughly investigated as potential mediators impacting mental health professionals' perceptions of quality in psychiatric inpatient care. This study aimed to explore how burnout mediates the relationship between individual characteristics, ward environment conditions and professionals' perceptions of the quality of psychiatric care patients receive. A total of 117 professionals from two Norwegian health trusts participated in the study. Data were collected through an online questionnaire comprising validated instruments measuring quality of care, job satisfaction, perceived stress and burnout while collecting background information on sociodemographic and work-related factors. The relationships between these variables were analyzed using univariate and multiple regression analyses. The results showed that professionals who were open for developing quality work, found their work stimulating, had sufficient time for tasks and were satisfied with their job reported lower levels of burnout. In turn, burnout was associated with lower perceived quality of participation and secure environment. Overall, professionals generally rated the quality of care as high. These findings provide insights for designing interventions to improve workplace conditions, reduce risk of burnout and enhance the quality in psychiatric inpatients settings.

As a Norwegian/Swedish research network based on a family-focused practice in mental healthcare, we recognise the need to highlight this approach for the future quality and sustainability of the care and services provided. The role of family members in caring for individuals with mental health conditions is situational and diverse, encompassing several support areas such as emotional support, continuation of social and living skills, economic assistance, and monitoring for signs of illness and relapse prevention. In this context, volunteers have also been encouraged to contribute as partners in the support and follow-up of individuals with mental health issues. Although mental health services were primarily hospital-based in the past, there has been a shift in recent decades towards community-based care with support from specialist services. The aim has been to foster a respectful partnership between patients, families, and professionals, including a commitment to increasing family involvement and providing greater support to family members. Despite the recommendation for family-focused practice, we believe that health professionals still prioritise their alliance with the patient as their foremost responsibility. In this article, we advocate for an enhanced emphasis on family-focused approaches and underscore the importance of utilising knowledge-based family-focused practice models.

Patient perspectives on the quality of care received are fundamental to mental health care. This study aimed to investigate the association between patient-reported mental health care quality, perceived coercion, and various demographic, clinical, and ward-related factors. Using a cross-sectional design, data were collected from 169 patients in Norwegian mental health wards using the quality in psychiatric care-inpatient (QPC-IP) instrument and experienced coercion scale (ECS). The analysis revealed a consistent pattern in which patients with higher perceived coercion consistently rated lower quality on all QPC-IP dimensions. The significant findings of the multiple regression models further supported this association. Beyond coercion, the factors influencing quality ratings include self-reported treatment results, participation in treatment planning, and knowledge of complaint procedures. Emphasizing the pivotal role of coercion in enhancing mental health care quality, these findings contribute to a nuanced understanding of patient experiences and underscore the importance of patient participation in mental health care improvement efforts.

BACKGROUND: Validated instruments measuring the quality of mental healthcare from patients' perspectives are scarce, and available instruments have been requested. One of the few instruments measuring the quality of care from a patient's perspective is the Swedish Quality in Psychiatric Care-In-Patient (QPC-IP). This cross-sectional study aimed to translate and adapt the QPC-IP instrument for a Norwegian context and assess its psychometric properties.

METHODS: The QPC-IP was translated and adapted to a Norwegian context using a translation back-translation process model. A total of 169 inpatients from specialised mental health services responded to the questionnaire. The QPC-IP comprises six dimensions: Encounter (eight items), Participation (eight items), Discharge (four items), Support (four items), Secluded Environment (three items), and Secure Environment (three items), totalling 30 items. Confirmatory factor analysis was conducted to assess the instrument's factor structure. Additionally, Cronbach's alpha was used to establish the instrument's internal consistency.

RESULTS: The results indicated that the Norwegian adaptation of the QPC-IP possesses good psychometric properties, including internal consistency, content, and construct validity, as confirmed by the confirmatory factor analysis results. The confirmatory factor analysis demonstrated an adequate fit for the six-factor structure, consistent with the original Swedish instrument.

CONCLUSIONS: The QPC-IP is a user-friendly and easily implementable tool that assesses various dimensions of the quality of inpatient mental healthcare from a patient's perspective. Moreover, the Norwegian QPC-IP holds potential for use in comparative, cross-cultural studies within mental healthcare services to monitor the quality of the provided services.