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Schildmeijer, KristinaORCID iD iconorcid.org/0000-0002-0895-674x
Publications (10 of 39) Show all publications
Ekstedt, M., Schildmeijer, K., Wennerberg, C., Nilsson, L., Wannheden, C. & Hellström, A. (2019). Enhanced patient activation in cancer care transitions: protocol for a randomized controlled trial of a tailored eectronic health intervention for men with prostate cancer. JMIR Research Protocols, 8(3), 1-13, Article ID e11625.
Open this publication in new window or tab >>Enhanced patient activation in cancer care transitions: protocol for a randomized controlled trial of a tailored eectronic health intervention for men with prostate cancer
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2019 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 3, p. 1-13, article id e11625Article in journal (Refereed) Published
Abstract [en]

Background: Prostate cancer has increased in incidence worldwide and is the leading cause of cancer death in 24 countries. The most common treatment is radical prostatectomy. However, surgery is associated with postoperative complications such as urinary incontinence and sexual dysfunction, causing decreased quality of life. If survivors are encouraged to be more active in self-care management, the symptom burden may decrease and quality of life may improve. An electronic health (eHealth) intervention based on motivational behavioral theory has been developed for this purpose.

Objective: This study aimed to compare the effectiveness of standard care in combination with a tailored eHealth and mobile health self-management support system, electronic Patient Activation in Treatment at Home (ePATH), with standard care of adverse effects of prostate cancer treatment (urinary incontinence and sexual functioning) in men undergoing radical prostatectomy. The secondary aim was to test the effect on patient activation, motivation, overall well-being, and health literacy over time in and between groups.

Methods: A pragmatic multicenter, block-randomized controlled trial with 2 study arms, standard care (control) and eHealth-assisted standard care (intervention), for patients undergoing radical prostatectomy. For 80% power, a sample of 242 men will need to be recruited.

Results: Recruitment started in January 2018 and is expected to be completed by August 2019. Data collection will be completed in August 2020. The first cross-sectional results from this trial are anticipated to be published in January 2020.

Conclusions: With the increasing number of prostate cancer survivors, attention should be paid to rehabilitation, psychosocial care, and support for endurance of self-care to reduce suffering from adverse treatment effects, poor quality of life, and depression because of postoperative complications. This project may increase knowledge of how patients can be supported to feel involved in their care and returning to as normal a life as possible. The anticipated effects of ePATH could improve health outcomes for individuals and facilitate follow-up for health care professionals.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
medical informatics, eHealth, mHealth, motivation, patient activation, prostate cancer, self-management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-81619 (URN)10.2196/11625 (DOI)000462890300001 ()30900999 (PubMedID)
Funder
The Kamprad Family Foundation, 2015-0067Swedish Cancer Society, CAN 2017/748Medical Research Council of Southeast Sweden (FORSS), FORSS-657211;FORSS-760131
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-04-18Bibliographically approved
Schildmeijer, K., Wallerstedt, B. & Ekstedt, M. (2019). Healthcare professionals' perceptions of risk when care is given in patients' homes. Home Healthcare Now, 37(2), 97-105
Open this publication in new window or tab >>Healthcare professionals' perceptions of risk when care is given in patients' homes
2019 (English)In: Home Healthcare Now, ISSN 2374-4529, E-ISSN 2374-4537, Vol. 37, no 2, p. 97-105Article in journal (Refereed) Published
Abstract [en]

Perceptions of risks in decision making for home healthcare were examined. Twenty home healthcare professionals were interviewed. Content analysis yielded one theme (management of known and unpredictable risks) and four categories. Healthcare professionals had to handle both known and unpredictable risks in daily work in patients' homes concerning communication challenges, a fragmented organization at several levels, risky medication management, and balancing respect for patient autonomy and involvement in care against risk taking. Priority must be given to creating safer care in this setting.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81622 (URN)10.1097/NHH.0000000000000717 (DOI)30672823 (PubMedID)
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-04-18Bibliographically approved
Schildmeijer, K., Frykholm, O., Kneck, Å. & Ekstedt, M. (2019). Not a straight line: patient's experiences of prostate cancer and their journey through the healthcare system. Cancer Nursing, 42(1), E36-E43
Open this publication in new window or tab >>Not a straight line: patient's experiences of prostate cancer and their journey through the healthcare system
2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 42, no 1, p. E36-E43Article in journal (Refereed) Published
Abstract [en]

Background

Cancer and its treatment can severely impact quality of life, giving rise to complex needs with respect to follow-up care. To support patient needs and increase efficiency of care with limited resources, the Swedish government has launched national reforms to redesign cancer care pathways.

Objective

The aim of this study was to explore how prostate cancer patients experience their journey through the healthcare system when their care is provided according to the standardized care pathway, as described in healthcare policy documents.

Methods

A qualitative, descriptive approach with individual interviews was used. A template of a standardized prostate cancer pathway, created together with healthcare professionals, was used during interviews. Fourteen interviews were conducted with prostate cancer patients all operated on at a midsized hospital in southeast Sweden between October 2015 and April 2016. The interviews were analyzed with qualitative content analysis and illustrated in a patient journey map.

Results

We identified an overall theme, “walking a tightrope,” consisting of 4 categories: “waiting,” “becoming familiar with a troublesome body,” “adjusting to a different life,” and “information challenges.”

Conclusions

The clinical implementation of the standardized care pathway is described as a straight path through care, but patients described their experiences as walking a tightrope. Lack of information, especially about cancer treatment and its adverse effects, was the most common experience.

Implications for Practice

Our findings indicate areas where further healthcare tools could improve patient experiences of cancer treatment. This could include offering individualized information and tools to increase patient empowerment, as well as patient/caregiver collaboration (co-care).

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-70033 (URN)10.1097/NCC.0000000000000559 (DOI)000453788200010 ()29334523 (PubMedID)
Funder
The Kamprad Family Foundation
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2019-04-12Bibliographically approved
Magneli, M., Unbeck, M., Rogmark, C., Rolfson, O., Hommel, A., Samuelsson, B., . . . Sköldenberg, O. (2019). Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study. BMJ Open, 9(3), 1-9, Article ID e02377.
Open this publication in new window or tab >>Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, p. 1-9, article id e02377Article in journal (Refereed) Published
Abstract [en]

Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument’s ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.

Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.

Setting 24 different hospitals in four major regions of Sweden.

Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.

Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.

Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).

Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Orthopaedics
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-81621 (URN)10.1136/bmjopen-2018-023773 (DOI)
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-04-15Bibliographically approved
Wallerstedt, B., Benzein, E., Schildmeijer, K. & Sandgren, A. (2019). What is palliative care?: Perceptions of healthcare professionals. Scandinavian Journal of Caring Sciences, 33(1), 77-84
Open this publication in new window or tab >>What is palliative care?: Perceptions of healthcare professionals
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Background Despite increased attention and knowledge in palliative care, there is still confusion concerning how to interpret the concept of palliative care and implement it in practice. This can result in difficulties for healthcare professionals in identifying patients whom would benefit from palliative care, which, in turn, could lead to a delay in meeting patients' needs. Aim To explore healthcare professionals' perceptions of palliative care. Method Data were collected through twelve interprofessional focus group interviews in community care and hospital wards in south Sweden (n = 74). All interviews were analysed with latent content analysis. Results Three domains were revealed: first, a blurred conceptual understanding as participants described palliative care using synonyms, diagnoses, phases, natural care and holism; second, a challenge to communicate transitions concerned the importance of how and when the transition to palliative care was communicated and documented; finally, a need for interprofessional collaboration was described as well as the consequences for severely ill persons, relatives and healthcare professionals when it was not established. Conclusion The perceptions about how to interpret palliative care differed as well as when palliative care should be offered and decided, which might have practical consequences. How long a person has left to live is of great significance for decision-making, caregiving and preparation in palliative care. The challenge is to use interprofessional communication to promote understanding and collaborate across varied care levels. Integrating palliative care across diverse care levels could be one way to reduce the ambiguity of palliative care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
palliative care, perceptions, healthcare professionals, focus group interviews, conceptual definition, communication, collaboration
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81850 (URN)10.1111/scs.12603 (DOI)000462154100007 ()30101989 (PubMedID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Schildmeijer, K., Unbeck, M., Ekstedt, M., Lindblad, M. & Nilsson, L. (2018). Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology. BMJ Open, 8(1), Article ID e019267.
Open this publication in new window or tab >>Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 1, article id e019267Article in journal (Refereed) Published
Abstract [en]

Objective Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.

Design A study using retrospective record review and trigger tool methodology. setting and methods Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 prede ned triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed. Primary and secondary outcome measures The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.

results The patients were aged 20–79 years, 280 men and 320 women. The review teams identi ed 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.

conclusions AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Sciences
Research subject
Health and Caring Sciences; Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-69507 (URN)10.1136/bmjopen-2017-019267 (DOI)000431743500241 ()
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2019-04-12Bibliographically approved
Schildmeijer, K., Wannheden, C., Nilsson, L., Frykholm, O., Hellström, A., Flink, M. & Ekstedt, M. (2018). Developing an eHealth Tool to Support Patient Empowerment at Home. In: Adrien Ugon, Daniel Karlsson, Gunnar O. Klein & Anne Moen (Ed.), Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth. Paper presented at MIE2018, Gothenburg, Sweden, April 24-26, 2018 (pp. 925-929). IOS Press, 247
Open this publication in new window or tab >>Developing an eHealth Tool to Support Patient Empowerment at Home
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2018 (English)In: Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth / [ed] Adrien Ugon, Daniel Karlsson, Gunnar O. Klein & Anne Moen, IOS Press, 2018, Vol. 247, p. 925-929Conference paper, Published paper (Refereed)
Abstract [en]

In previous research we have learned that patients with chronic or complex diseases often experience difficulties when transitioning from hospital care to self-care in their home. We address these difficulties by developing an eHealth tool for patients - ePATH (electronic Patient Activation in Treatment at Home) - intended to empower each patient to manage their individual situation. We have employed a user-centered design process involving both patients and healthcare personnel to specify the content and functionality of ePATH. The system is deployed as a web application with secure login for patients. In this article, we describe the main content and functionality of the system that makes it possible for a patient to manage symptoms development in relation to treatment progression Interactive functionality, e.g., reminders and social support, is included to make the ePATH a useful and informative bridge between patients, next-of-kin and different caregivers. One lesson learned is that it is necessary to incorporate motivational components in the development of an eHealth tool to successfully overcome the "intention-behavior" gap. The self-determination theory of motivation can be used to ensure that important aspects are not missed.

Place, publisher, year, edition, pages
IOS Press, 2018
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 247
Keywords
eHealth, patient participation, personalized care, transitions in care, user-centered design
National Category
Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-75584 (URN)10.3233/978-1-61499-852-5-925 (DOI)29678096 (PubMedID)9781614998518 (ISBN)9781614998525 (ISBN)
Conference
MIE2018, Gothenburg, Sweden, April 24-26, 2018
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4948
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2019-04-12Bibliographically approved
Lindblad, M., Schildmeijer, K., Nilsson, L., Ekstedt, M. & Unbeck, M. (2018). Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare. BMJ Quality and Safety, 27(7), 502-511
Open this publication in new window or tab >>Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare
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2018 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 27, no 7, p. 502-511Article in journal (Refereed) Published
Abstract [en]

Background Adverse events (AEs) and no-harm incidents are common and of great concern in healthcare. A common method for identification of AEs is retrospective record review (RRR) using predefined triggers. This method has been used frequently in inpatient care, but AEs in home healthcare have not been explored to the same extent. The aim of this study was to develop a trigger tool (TT) for the identification of both AEs and no-harm incidents affecting adult patients admitted to home healthcare in Sweden, and to describe the methodology used for this development.

Methods The TT was developed and validated in a stepwise manner, in collaboration with experts with different skills, using (1) literature review and interviews, (2) a five-round modified Delphi process, and (3) two-stage RRRs. Ten trained teams from different sites in Sweden reviewed 600 randomly selected records.

Results In all, triggers were found 4031 times in 518 (86.3%) records, with a mean of 6.7 (median 4, range 1–54) triggers per record with triggers. The positive predictive values (PPVs) for AEs and no-harm incidents were 25.4% and 16.3%, respectively, resulting in a PPV of 41.7% (range 0.0%–96.1% per trigger) for the total TT when using 38 triggers. The most common triggers were unplanned contact with physician and/or registered nursemoderate/severe painmoderate/severe worry, anxiety, suffering, existential pain and/or psychological pain. AEs were identified in 37.7% of the patients and no-harm incidents in 29.5%.

Conclusion This study shows that adapted triggers with definitions and decision support, developed to identify AEs and no-harm incidents that affect patients admitted to home healthcare, may be a valid method for safety and quality improvement work in home healthcare.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-69475 (URN)10.1136/bmjqs-2017-006755 (DOI)000439842800002 ()28971884 (PubMedID)
Available from: 2017-12-22 Created: 2017-12-22 Last updated: 2019-04-12Bibliographically approved
Årestedt, K., Allert, C., Djukanovic, I., Israelsson, J., Schildmeijer, K., Agerström, J., . . . Bremer, A. (2018). Health-related quality of life among in-hospital cardiac arrest survivors in working age. Paper presented at The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy. Resuscitation, 130(s1), Article ID e18.
Open this publication in new window or tab >>Health-related quality of life among in-hospital cardiac arrest survivors in working age
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, article id e18Article in journal, Meeting abstract (Refereed) Published
Keywords
Health-related quality of life, in-hospital, cardiac arrest, working age, anxiety, depression
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77900 (URN)10.1016/j.resuscitation.2018.07.342 (DOI)
Conference
The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy
Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2019-04-12Bibliographically approved
Schildmeijer, K., Skagerström, J., Ericsson, C. & Nilsen, P. (2018). Så ville patienter förbättra vårdmötet för att få säkrare vård. Läkartidningen, 115, 1-4, Article ID EXIL.
Open this publication in new window or tab >>Så ville patienter förbättra vårdmötet för att få säkrare vård
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, p. 1-4, article id EXILArticle in journal (Refereed) Published
Abstract [sv]

Patienterna i denna enkätstudie hade många förslag på hur mötet i vården kan förbättras för att åstadkomma ökad patientsäkerhet.

Patienternas åtgärdsförslag avsåg både individnivå (vårdpersonalens kunskaper och tilltro till patienten) och systemnivå (kommunikationssätt, vårdstruktur och personalplanering samt arbetsförhållanden).

Det finns en förbättringspotential avseende mötet mellan patienter och vårdpersonal för att främja en säkrare vård.

Abstract [en]

Patients had several suggestions on how to improve healthcare meetings in order to create safer care

An open question "Do you have suggestions on how to improve meetings between patients and healthcare professionals in order to create safer care?" was incorporated into a questionnaire survey to 2673 patients in Sweden. The survey addressed patient participation for safer care. The open question was answered by 591 respondents. Content analysis was used to analyze the responses. The proposed suggestions concerned both the individual level (healthcare staff's competence and trust in the patient) and the system level (forms of communication, planning and structure, and time and staffing). The study findings show that there are many ways to improve meetings in healthcare of potential relevance for patient safety. Further research is needed to develop, apply and evaluate interventions based on patient suggestions.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2018
National Category
Other Health Sciences
Identifiers
urn:nbn:se:lnu:diva-72081 (URN)29485674 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2019-04-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0895-674x

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