Background: Patient activation is associated with both health outcomes and the utilization of healthcare resources. Since various factors influence activation levels among older ill adults, further exploration of this topic is needed. Specifically, we aim to examine the extent to which changes over time in self-rated symptoms of depression are associated with changes in patient activation and to what extent self-rated health status and satisfaction of basic psychological needs (autonomy, relatedness, and competence) have a mediation effect.

Methods: A longitudinal and correlational design was employed in which two hundred and seven participants with heart failure or chronic obstructive pulmonary disease were recruited from two hospitals in the middle of Sweden. The sample used in this study is the same as that used in a randomized controlled trial. A questionnaire was administered at baseline, and at 30-, 90-, and 180 days post-discharge, involving ratings of depression, patient activation, self-rated health, and satisfaction of basic psychological needs (autonomy, relatedness, and competence). As the results from the original study showed no difference between the two randomized groups in patient activation, the analysis in this study was conducted using a combined sample in which the intervention and control groups were merged. For estimation of the direct effects and the components of indirect effects, we employed multilevel modeling using a linear mixed model, and to test mediation, the stand-alone program RMediation was used. Results: Over time, increases in depressive symptoms were associated with reduced patient activation, with this relationship mediated by declines in relatedness and competence. No evidence was found showing that autonomy or self-rated health had a mediation effect.

Conclusions: The results indicate that older chronically ill individuals may benefit from interventions targeting psychological mediators to improve and sustain activation.

Introduction: Prostate cancer treatment commonly affects sexual function. However, how effective rehabilitation programmes should be constructed is yet to be determined. The aim of this study was to describe the expectations, experiences and preliminary effects of a digital sexual rehabilitation programme among couples after radical prostatectomy and to determine its feasibility.

Research design and methods: 19 couples were included in the study, of which 15 completed the programme. Data were collected through semi-structured interviews at baseline and after programme completion using an interview guide developed for this study. Reflexive thematic analysis was used to interpret qualitative data, and descriptive statistics summarised quantitative outcomes from questionnaires.

Results: Participants found the programme meaningful and helpful. The digital format was valued for its flexibility and accessibility. Participants desired more tailored content and interactive elements. The programme positively impacted communication about sexual issues within couples. Participants also highlighted the need for peer support and more structured guidance on physical and pharmaceutical strategies. Some joined the programme to support others rather than for personal need, which may have influenced perceived effects. Questionnaire data showed changes in sexual function among patients and stable relationship satisfaction, though interpretation is limited.

Conclusion: The digital programme was feasible and well-received, with positive effects on communication and perceived support. Findings highlight the importance of clear inclusion criteria, timing of intervention delivery and tailoring content to individual needs. These insights can inform future development of digital psychosocial interventions for sexual rehabilitation in cancer care.

Objectives The aim is to evaluate the effects of a motivational interviewing-based intervention, Supporting Patient Activation in Transition to Home, on rehospitalisation and patient activation among patients with heart failure or chronic obstructive pulmonary disease.Design A randomised, controlled, analysis-blinded trial was conducted.Setting Participants were recruited from two hospitals in mid-Sweden and the intervention and interviews were conducted post-discharge.Participants 207 participants with heart failure or chronic obstructive pulmonary disease were recruited. Participants were randomised to receive five motivational interviewing sessions post-discharge (n=103) or a control group (n=104).Outcome measures Rehospitalisation within 180 days post-discharge was retrieved, and patient activation was assessed using the Patient Activation Measure at baseline, 30, 90 and 180 days post-discharge. We used a generalised estimating equation to assess the difference in the secondary outcome, patient activation, between the intervention group and the control group during the 180-day follow-up.Results No statistically significant differences between the groups were found for rehospitalisation (p=0.33 to 0.41) or patient activation over time (B=-1.67, -0.71 and -0.83 (95% CI -5.45 to 2.10, -4.06 to 2.64 and -4.28 to 2.62), respectively).Conclusion Post-discharge motivational interviewing to decrease rehospitalisation or support patient activation does not seem beneficial for patients with heart failure or chronic obstructive pulmonary disease. The high disease burden may have limited patient participation in the intervention.Trial registration number NCT02823795.

Restless legs syndrome (RLS) is a highly prevalent condition that significantly disrupts sleep and causes reduced quality of life. While previous RLS research has mainly focused on the pharmacological treatment, this study presents the first instrument to measure self-care, the RLS-Self-care Behaviour questionnaire (RLS-ScBq). Self-care, defined as an active decision-making process, can empower patients to effectively participate in their own healthcare through awareness, self-control, and self-reliance to cope with their disease. Self-care can in a RLS context include actions such as physical exercise, meditation, and massage. Hence, the aim of this study is to explore the psychometric properties of the RLS-ScBq in patients with RLS. A cross-sectional design, including 788 patients with RLS (65% women, mean age 70.8 years, [standard deviation (SD) =11.4]) was used. Sociodemographics, comorbidities, and RLS-related treatment data, including insomnia symptoms (i.e., Insomnia Severity Index), daytime sleepiness (i.e., Epworth Sleepiness Scale) and RLS symptoms (i.e., RLS-6 scale) were collected. The validity and reliability of the RLS-ScBq were investigated using exploratory factor analysis and Rasch models. The two-factor solution (i.e., physical, and mental actions) showed an explained variance of 32.33% for The Self-care Behaviour Frequency part and 36.28% for The Benefit of Self-care Behaviour part. The internal consistency measured by Cronbach's alpha was 0.57 and 0.60, and McDonald's omega was 0.60 and 0.67, respectively. No differential item functioning was identified for gender, age, insomnia, daytime sleepiness, or RLS severity. The eight-item RLS-ScBq can serve as a tool enabling healthcare personnel to explore use and benefit of self-care activities in patients with RLS.

Introduction

Prostate cancer is often treated with radical prostatectomy, but surgery can leave patients with side effects. Patients who actively take part in their rehabilitation have been shown to achieve better clinical outcomes. eHealth support has the potential to increase patient activation, but has rarely been evaluated in long-term randomized controlled trials. Therefore, we evaluated the effects on patient activation of eHealth support (electronic Patient Activation in Treatment at Home, ePATH) based on motivational theory. The aim was to investigate the effects of eHealth support on patient activation at 6 and 12 months after radical prostatectomy, compared with standard care alone, and associations with baseline patient activation and depression.

Methods

A multicentre randomized controlled trial with two study arms was conducted. Men planned for radical prostatectomy at three county hospitals in southern Sweden were included and randomized to the intervention or control group. The effects of ePATH on the secondary outcome, patient activation, were evaluated for one year after surgery using the patient activation measure and analysed using a linear mixed model.

Results

The study included 170 men during 2018-2019. In the intervention group, 64% (53/83) used ePATH. The linear mixed model showed no significant differences between groups in patient activation [beta -2.32, P .39; CI -7.64-3.00]. Baseline patient activation [beta 0.65, P < .001; CI 0.40-0.91] and depression [beta -0.86, P .03; CI -1.64- -0.07] statistically impacted patient activation scores over one year.

Conclusions

ePATH had no impact on patient activation during long-term prostate cancer rehabilitation. However, patient activation at baseline and depression scores significantly influenced patient activation, underlining the need to assess these aspects in prostate cancer surgery rehabilitation. Trial registration ISRCTN Registry ISRCTN18055968, (07/06/2018); https://www.isrctn.com/ISRCTN18055968; International Registered Report Identifier: RR2-10.2196/11625.

Background: Patients diagnosed with colorectal cancer follow standardized care pathways with diagnostic procedures and tailored treatment to ensure high-quality surgical care. The focus is primarily on surgical procedures and outcomes, and patients and healthcare professionals describe shortcomings in individual support and a lack of opportunities for participation.

Aims and Objectives: To describe patient experiences within standardized care pathways for colorectal cancer.

Methods: A qualitative descriptive design was used. The study was conducted at a surgery unit in southern Sweden. Convenience sampling was used and included sixteen patients. Data were collected using in-depth semi-structured interviews and analysed using qualitative conventional content analysis.

Results: Three themes emerged in the analysis: Travelling along the colorectal cancer care pathway, bearing the mark of the disease, and telling one’s story. According to the patients’ narratives, interacting and continuous relationships with healthcare professionals were highlighted as important, feelings such as loneliness and the need for inclusion played a significant role to achieve participation.

Conclusion: There is a discrepancy between the intentions of standardized care pathways and the patients experience within. Despite having access to healthcare professionals during standardized care pathways, patients may still experience feelings of loneliness and exclusion. Continuous contact with a specialist/contact nurse is seen as crucial to facilitate individual support and active participation. These insights underscore the importance of the role of specialist nurses in providing person-centered care within standardized care pathways, in bridging the gaps between clinical practice and patient expectations.

Objective/BackgroundThe Consensus Sleep Diary (CSD) is widely used to assess subjective sleep. Psychometric evaluations and focus-groups support its validity and clinical usefulness, but further research into its validity is needed. The aim of the study was to evaluate a Swedish translation of the CSD regarding test content and response processes in patients with insomnia.Patients/MethodsIn connection with translating the CSD into Swedish, we used cognitive interviewing to evaluate test content and the response process, that is, how people make decisions when responding to survey items. Cognitive interviews were conducted with 13 primary health care patients with insomnia disorder (mean age, 49 years; SD 15.5). Iterative, reparative analysis was used to investigate test content. Descriptive deductive analysis was used to investigate interview transcripts for the themes of the cognitive model: comprehension, retrieval, decision process, and judgement. Together, the themes explain the response process when responding to a patient-reported outcome measure.ResultsThe overall comprehension of the CSD could be affected by poor adherence to the instructions (comprehension). Patients had difficulty with recall if they did not complete the diary immediately in the morning and just before bedtime (retrieval). They could have problems deciding how to respond to certain items because they imbued sleep-related concepts with extra meaning (decision process), and had trouble finding response alternatives nuanced enough to describe their experience of sleep and tiredness (judgement).ConclusionsThis study contributes knowledge on how the instrument is perceived and used by care-seeking patients with insomnia. In this context, the CSD exhibits known flaws such as memory lapses if the diary is not filled in directly in the morning. To increase the accuracy of patients' responses, therapists should support patients in reading the instructions.

Aim: The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer.

Methods: Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers.

Results: Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01).

Discussion: There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.

Purpose

The aim of this study was to validate the Ethos Brief Index (EBI) in patients with Restless Legs Syndrome (RLS).

Methods

A cross-sectional design, including 788 subjects with RLS (65% women, 70.8 years, SD 11.3) from the Swedish RLS Association, was used. A postal survey was sent out to collect data regarding socio demographics, comorbidities, and RLS-related treatment data. Questionnaires included were EBI, the Restless Legs Syndrome-6 Scale (RLS-6), Restless Legs Syndrome-Quality of Life questionnaire (RLSQoL), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis (CFA) models. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age and gender groups, as well as insomnia, daytime sleepiness, RLS-related QoL and RLS severity were assessed.

Results

The results supported the unidimensionality of the EBI in the CFA (i.e., explaining 61.5% of the variance) and the Rasch model. The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. No DIF was identified for gender, age, insomnia, daytime sleepiness, RLS severity or RLS-related QoL.

Conclusion

The EBI showed good validity and reliability and operated equivalently for male and female patients with RLS. Accordingly, healthcare professionals can use the EBI as a psychometrically sound tool to explore and identify patient-centered problems related to the whole life situation.