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Zusammenfassung. Hintergrund: Bewegung wird bei Frauen während der Brustkrebstherapie mit einer verbesserten Lebensqualität assoziiert. Wie sich das Bewegungsverhalten in den ersten Monaten nach Therapiebeginn verändert und welche Rolle eine pflegerische Beratung dabei spielt, wurde bislang unzureichend untersucht. Ziel: Es sollten Unterschiede im Bewegungsverhalten bei Frauen mit Brustkrebs zum Zeitpunkt des Beginns der Therapie und sechs Monate danach gemessen sowie die Perspektive von Patientinnen und Fachpersonen hinsichtlich einer pflegerischen Beratung zum Thema Bewegung untersucht werden. Methode: Es wurde eine Mixed-Methods Evaluation durchgeführt. Im quantitativen Teil wurde das Bewegungsverhalten an zwei Zeitpunkten (t0 und t1) mit dem SQUASH-Instrument (30-1Wendel-Vos, 2003) erhoben. Im qualitativen Teil wurde jeweils ein Fokusgruppeninterview mit Patientinnen und Gesundheitsfachpersonen durchgeführt. Die quantitativen Daten wurden anhand deskriptiver und induktiver Statistik, die qualitativen Daten thematisch analysiert. Ergebnisse: In der Stichprobe (N = 47) zeigte sich eine geringfügige, nicht signifikante Steigerung im Bewegungsumfang im Vergleich von Zeitpunkt t1 und t0. Eine statistisch signifikante Zunahme des Bewegungsumfangs zwischen t0 und t1 konnte nur in der Kategorie „Arbeit“ (p = 0,002) festgestellt werden. Das zentrale Thema der Frauen war, dass sie sich durch die pflegerische Beratung ermutigt fühlten, „etwas für sich selbst zu tun“. Für die Fachpersonen war im Kontext der Beratung wichtig, dass sie selbst von der Bedeutung der Bewegung überzeugt waren. Schlussfolgerungen: Die Alltagsintegration von Bewegung stellt für die Frauen während der Therapie eine Herausforderung dar. Die Beratung wird als hilfreich empfunden, könnte aber durch ein längerfristiges Bewegungsprogramm nachhaltiger wirken.

Purpose Uncertainty in illness is considered a significant psychosocial stressor, that negatively influences symptom distress, self-management strategies and quality of life in cancer patients and survivors. Women with vulvar neoplasia continue to experience uncertainty up to six months post-surgery. According to the Reconceptualized Uncertainty in Illness Theory, the appraisal of uncertainty changes positively over time in chronic illness. We aimed at exploring how the experience of uncertainty develops in women with vulvar neoplasia. Methods We selected a purposive sample of seven women diagnosed with vulvar neoplasia undergoing surgical treatment in four Swiss and one Austrian women's clinic. By means of a longitudinal qualitative study, we conducted 30 individual interviews at five points of time during one year after diagnosis. We applied Saldaña's analytical questions for longitudinal qualitative research. Findings First, participants experienced uncertainty as an existential threat, then an inherent part of their illness, and finally a certainty. When a new uncertainty arose, the experience of uncertainty changed even during the chronic course of the disease. Women initially associated the existential threat with a high risk for suffering from severe health deteriorations. Participants that could reduce their individually assessed risk by adopting health promoting behaviors, accepted the remaining uncertainty. From now on they reframed uncertainty into a certainty. This new mindset was based on a belief of promoting cancer recovery and reducing the risk of recurrence. Conclusions The long-lasting and oscillating nature of uncertainty should receive attention in supportive oncology care. Uncertainty concerning existential issues is of special importance since it can inhibit a positive development of uncertainty experience.

Purpose Experiencing financial toxicity following a cancer diagnosis is a circular and complex process. We investigate the circular causal mechanisms that either reinforce or balance financial toxicity dynamics. Methods We conducted a literature review, expert interviews, a participatory modeling process and exploratory interviews with N = 11 adults with cancer living in Switzerland. We sampled participants purposively based on health-related and sociodemographic characteristics. Results We describe a conceptual model based on the triangulation of cancer survivor narratives, expert perspectives, and a literature review. This model distinguishes between the reinforcing and balancing feedback loops that drive the dynamics of financial toxicity. It includes the topics “Coping with Cancer and Employment”, “Coping with Limited Economic Resources” and “Maintaining Care Resources While Facing Economic Pressure.” For each topic, we identify a necessary condition for cancer survivors to avoid reinforcing financial toxicity. Conclusions The results allow us to reconstruct participant narratives regarding cancer-related financial toxicity. Based on comparison with scientific literature from Western Europe and North America, we hypothesize the validity of the model beyond the population covered by the sample. The results highlight the importance of screening for the risk of financial toxicity in the clinical context and individual risk and resource assessment in social counseling. Implications for Cancer Survivors: These results can raise cancer survivors’ awareness of risks related to financial toxicity and strengthen their resources for coping with financial burden successfully.

Zusammenfassung. Hintergrund: Für Menschen mit einer Krebserkrankung steigt das Angebot für eine onkologische Rehabilitation zunehmend. Es wird ein interdisziplinärer Ansatz verfolgt, um Menschen mit einer Krebserkrankung bestmöglich auf das Leben zuhause vorzubereiten. Pflegefachpersonen sind Teil des interdisziplinären Teams, jedoch ist über ihre Rolle in diesem Setting bis dato wenig bekannt. Ziel: Ziel war es herauszufinden, welche Rolle beziehungsweise Tätigkeiten und Aufgaben Pflegefachpersonen in der onkologischen Rehabilitation innehaben. Methode: Ein Scoping Review wurde durchgeführt. Die Literaturrecherche fand in MEDLINE via PubMed, CINAHL, Google Scholar und Referenzlisten statt. Es gab keine Einschränkung des Publikationszeitraumes. Nach der Bewertung der inkludierten Publikationen erfolgte eine thematische Analyse. Ergebnisse: Insgesamt wurden sieben Publikationen eingeschlossen (eine qualitative Studie, ein Herausgeberwerk, ein White Paper, ein Artikel und drei Literaturübersichten). Drei Hauptthemen wurden identifiziert: die Rolle der Pflege als emotionale und psychische Stütze, als Coach und im interdisziplinären Team. Zusätzlich zur allgemeinen Pflege fördern sie das Selbstmanagement, beraten und schulen, führen Symptommanagement durch und nehmen eine koordinative Funktion ein. Schlussfolgerung: Dieses Scoping Review bildet eine erste Übersicht über die Rolle der Pflegefachpersonen in der onkologischen Rehabilitation. Ihr Fokus liegt auf der bestmöglichen Vorbereitung von Menschen mit einer Krebserkrankung auf das „neue und veränderte“ Leben.

To develop a theoretical definition of self-organization to increase the understanding of the Reconceptualized Uncertainty in Illness Theory (RUIT).Mishel described the change of the uncertainty appraisal over time in people with a chronic illness by means of the RUIT. Therefore, she introduced the concept of self-organization. However, its meaning is difficult to comprehend because its descriptions remained highly abstract.A principle-based concept analysis.Entries of lexicons and journal publications, explicitly or implicitly addressing self-organization in the context of any social phenomenon.We conducted a conceptually driven literature search in lexicons and four databases and performed citation tracking.Self-organization stands for a transition between psychological instability and psychological adjustment. It is conditioned by illness-related obstacles or uncertainties that are perceived as life-threatening. This adaptation process shows overlaps with cognitive reframing and is promoted by time, resilience, social support, and positive development of the disease. It leads to empowerment and a new perspective of life and uncertainty.We enhanced the understanding of the RUIT by developing a theoretical definition of self-organization on a lower level of abstraction and by proposing a new approximation for the operationalization by means of cognitive reframing.

Promoting physical activity in women during breast cancer therapy: A mixed methods evaluation of a nursing counselling intervention

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Supplemental Material for Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis by Ursina Wernli, Désirée Hischier, Christoph R. Meier, Sibylle Jean-Petit-Matile, Alice Panchaud, Andrea Kobleder, and Carla Meyer-Massetti in American Journal of Hospice and Palliative Medicine®.

Background Healthcare is facing a shortage of qualified healthcare professionals. The pandemic has brought to light the fragile balance that affects all healthcare systems. Governments have realized that these systems and the professionals working in them need support at different levels to strengthen the retention of the workforce. Health professionals’ education can play an important role in ensuring that new generations of workers have sound personal and professional competencies to successfully face the challenges of professional practice. These challenges are described in the literature, but the extent to which they are considered in health professionals’ education is less clear. Methods This qualitative study compares the professional challenges and educational needs described in the literature with the current curricula for health professionals offered in Switzerland. Data were collected nationally through focus group interviews with 65% of Switzerland’s directors of bachelor’s and master’s programs of health professions (nursing, physiotherapy, occupational therapy, midwifery, nutrition and dietetics, osteopathy, radiologic medical imaging technology, health promotion and prevention, and health sciences). The data attained were analyzed using knowledge mapping. Results The results reveal a gap among education programs with regard to occupational health promotion and cultural diversity. Both topics are taught with a sole focus on patients, and students are expected to adopt similar strategies for their health promotion and stress management. Physicians are insufficiently involved in interprofessional education. The programs fail to enhance health professionals’ political, economic and digital competencies. Conclusion The results of this study offer clear guidance about what topics need to be integrated into curricula to improve health professionals’ well-being at work and their preparedness to face daily professional challenges.

BACKGROUND Subcutaneous drug administration is an interesting approach for symptom control in hospice and palliative care. However, most drugs have no marketing authorization for subcutaneous administration and are therefore used off-label. In order to meet the requirements of a safe and effective drug therapy, especially in highly vulnerable patients, it is essential to investigate the scope of evidence of these common practices. OBJECTIVES The purpose of this scoping review was to provide an overview of available data on the tolerability and/or effectiveness of subcutaneously administered and off-label used drugs. METHOD We performed a scoping review according to the PRISMA extension to identify data available on the tolerability and/or effectiveness of 17 predefined drugs that are commonly administered subcutaneously in Swiss hospices and hospice-like institutions and that have no marketing authorization (off-label use). RESULTS The scoping review identified 57 studies with most data available on their tolerability (68% local, 54% systemic), clinical effects (82%), details on dosage (96%) and routes of application (100%). Information on pharmacokinetic properties was mostly missing and only available for fentanyl, levetiracetam, midazolam, and ondansetron. For seven drugs, less than five articles were identified and no studies on codeine or clonazepam were available. CONCLUSION This work provides an overview of current evidence on subcutaneous and off-label used drugs in hospice and palliative care. Although both are common practices, evidence on tolerability and effectiveness, particularly pharmacokinetic data, is limited and the identified information gaps need to be closed. This work establishes a basis for further research in this area.

Background and PurposeThe Reconceptualized Uncertainty in Illness Theory (RUIT) includes the concept of “probabilistic thinking” intending to explain the positive reappraisal of uncertainty in chronic illness. However, the description of the concept is vague, thereby limiting the understanding of the theory. Thus, the aim was to develop a theoretical definition of probabilistic thinking in order to increase the explanatory value of RUIT.MethodsWe conducted a principle-based concept analysis by means of a conceptually driven literature search. Methods consisted of database, dictionary, lexicon, and free web searching as well as citation tracking. We analyzed the concept in terms of (a) epistemology, (b) pragmatics, (c) logic, and (d) linguistics.ResultsThe final data set included 27 publications, 14 of them from nursing. (a) Probabilistic thinking is a coping strategy to handle uncertainty. It involves a focus on either possibilities (in nursing) or probabilities (in other disciplines). (b) There is a lack of operationalization in nursing, though three measurements focusing the handling of probabilities are offered in psychology. (c) Nursing authors interpreting probabilistic thinking as accepted uncertainty lacked logical appropriateness, since probability negotiates uncertainty. (d) Probabilistic thinking is used synonymously with positive thinking and probabilistic reasoning.Implications for PracticeNurses working with chronically ill patients should consider the findings for the application of RUIT. They should recognize whether uncertainty is perceived as a danger and encourage probabilistic thinking. Efforts are necessary to achieve a common language between nursing and other disciplines in order to avoid misunderstandings in clinical practice and research.

Zusammenfassung. Hintergrund: Die Advanced Practice Nurse (APN) kann für Frauen mit einer gynäkologischen Krebserkrankung eine bedeutsame Unterstützung im Behandlungsprozess darstellen. In Österreich und der Schweiz steht die APN-Entwicklung allerdings erst am Anfang und es fehlt an systematisch entwickelten Konzepten. Fragestellung: Welche Merkmale sollte ein auf wissenschaftlichen Erkenntnissen basierendes APN-Konzept in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz beinhalten? Methode: Die Entwicklung des Konzepts erfolgte mit Hilfe einer Matrix, die basierend auf dem PEPPA plus-Framework entstand, Inhalte des Nursing Role Effectiveness Models (NREM) enthielt und Daten aus vier vorangegangenen Einzelstudien zusammenführte. Dreizehn Expertinnen und Experten aus Pflege und Medizin waren an der Vernehmlassung des Konzepts beteiligt. Ergebnisse: Unterteilt in Struktur-, Prozess- und Outcome-Kriterien beschreibt das Konzept zentrale Inhalte der APN-Rolle in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz. Zusätzlich werden die Beziehungen zwischen Struktur-Prozess, Struktur-Outcome und Prozess-Outcome dargestellt. Schlussfolgerungen: Das in dieser Studie entwickelte Konzept bietet eine Grundlage zur (1) weiteren Ausgestaltung einer APN-Rollenbeschreibung in der gynäkologischen Onkologie auf institutioneller Ebene sowie (2) curricularen Entwicklung entsprechender Studiengänge. Durch die gemeinsame Basis kann eine Harmonisierung der APN-Rolle im Versorgungskontext Österreich und Schweiz gefördert werden.

Background In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends. Objectives To explore prescription trends and describe changes to drug regimens in inpatient hospice care. Design We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice. Setting/subjects Prescription records of all patients ([Formula: see text] 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion. Results Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death. Conclusions Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.

Vorherrschende Grunderkrankungen und Polypharmazie machen Palliative-Care-Patient:innen besonders anfällig für medikationsassoziierte Probleme wie unerwünschte Arzneimittelwirkungen oder Medikationsfehler. Ein reflektierter Umgang mit den eingesetzten Medikamenten ist von zentraler Bedeutung für eine sichere und rationale Arzneimitteltherapie. Wie gestaltet sich das Medikationsmanagement im Schweizer Hospiz-Setting und welche Rolle können Apotheker:innen einnehmen, um zur Medikationssicherheit beizutragen?