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Samtal vid allvarlig sjukdom - Kronobergsmodellen
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0003-4300-6229
2024 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to explore clinicians’ perceptions and self-efficacy regarding the use of the ‘Serious illness conversation’ structured workflow, and to explore their self-efficacy in caring for patients with palliative care needs.

Methods: This thesis is comprised of four studies: two qualitative studies, one methodological study, and one quantitative study. In studies I and II, observations of clinic meetings and training sessions were undertaken with clinicians. Interviews were performed and a thematic analysis was conducted. In study III, the Self-Efficacy in Palliative Care scale (SEPC) was translated, adapted, and validated. In study IV, the SEPC-SE was completed by nurses and physicians. Factor analysis and Cronbach's alpha were calculated, and the Mann-Whitney U test was used to compare self-efficacy. Multiple linear regression was used to explore associated factors.

Results: In study I, clinicians expressed that working with serious illness conversations was vital, but the conversations were also considered in terms of risks. The conversation training sessions created feelings of exposure but were perceived to be rewarding due to an increase in self-awareness. Obstacles in practice were identified as barriers to change. Study II showed that positive experiences and the group’s level of support, consensus, and behaviour was important for self-efficacy. Some clinicians were affected by perceived high demands, failures, anxiety, stress, when working with serious illness conversations. Study III showed that the SEPC-SE needed improvements in understandability and clarity. In study IV, the SEPC-SE reported high reliability. Physicians reported higher self-efficacy than nurses. Education at work and experience in advanced homecare had the strongest associations with self-efficacy.

Conclusions: Implementing serious illness conversations can increase clinicians’ awareness about the importance of engaging in serious illness conversations and thus contribute to increased motivation through behavioural and attitudinal changes. However, building a support system for clinicians within the organisation seems essential for improving self-efficacy. The SEPC-SE was found to be valid and reliable. Clinicians’ estimation of their perceived self-efficacy indicates that healthcare organisations should prioritise work-related education and experience to improve self-efficacy in providing palliative care.

Place, publisher, year, edition, pages
Linnaeus University Press, 2024. , p. 78
Series
Linnaeus University Dissertations ; 529
Keywords [en]
Clinicians, Palliative Care, Self-efficacy, Serious illness conversations
Keywords [sv]
Vårdpersonal, palliativ vård, tilltro till egen förmåga, samtal vid allvarlig sjukdom
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-129525DOI: 10.15626/LUD.529.2024ISBN: 9789180821650 (print)ISBN: 9789180821667 (electronic)OAI: oai:DiVA.org:lnu-129525DiVA, id: diva2:1859822
Public defence
2024-06-14, Weber, Växjö, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-05-22 Created: 2024-05-22 Last updated: 2024-06-17Bibliographically approved
List of papers
1. Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings
Open this publication in new window or tab >>Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings
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2022 (English)In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 21, no 1, article id 48Article in journal (Refereed) Published
Abstract [en]

Background

One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context.

Methods

This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method.

Results

Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant.

Conclusions

The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Confidence, Healthcare professionals, Instrument, Palliative care, Self-efficacy, SEPC-scale, Validation
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-111280 (URN)10.1186/s12904-022-00940-5 (DOI)000781170600001 ()35410328 (PubMedID)2-s2.0-85128049591 (Scopus ID)2022 (Local ID)2022 (Archive number)2022 (OAI)
Available from: 2022-04-11 Created: 2022-04-11 Last updated: 2024-06-17Bibliographically approved
2. Evaluation of the Swedish Self-Efficacy in Palliative Care Scale and exploration of nurses' and physicians' self-efficacy in Swedish hospitals: A cross-sectional study
Open this publication in new window or tab >>Evaluation of the Swedish Self-Efficacy in Palliative Care Scale and exploration of nurses' and physicians' self-efficacy in Swedish hospitals: A cross-sectional study
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2024 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Previous research found that healthcare professionals had low preparedness for palliative care. Thus, it is necessary to explore healthcare professionals' self-efficacy. The Swedish Self-Efficacy in Palliative Care Scale (SEPC-SE) evaluates readiness in communication, patient management and multidisciplinary teamwork; however, it should be tested on a larger population. Furthermore, the constructs of the SEPC-SE should be compared to that of the original SEPC. Aim: This study aimed to evaluate the consensus between the construct validity and reliability of the SEPC and the translated and adapted SEPC-SE. Furthermore, it aimed to describe and compare the self-efficacy of nurses and physicians in hospitals and explore the associated factors. Methods: The nurses (n = 288) and physicians (n = 104) completed the SEPC-SE. Factor analysis with Cronbach's alpha evaluated validity and reliability, and an analysis using the Mann-Whitney U test compared self-efficacy and multiple linear regression-associated factors. Results: The SEPC-SE revealed three factors with high reliability. Education or experience in specialised palliative care was minor, especially for nurses. Self-efficacy was highest in patient management (nurses, median [md] = 74.57, physicians md = 81.71, p = 0.010) and communication (nurses md = 69.88, physicians md = 77.00, p = 0.141) and lowest in multidisciplinary teamwork (nurses md = 52.44, physicians md = 62.88, p = 0.001). The strongest associations with self-efficacy were education at work and advanced homecare experiences. In addition, there were significant associations between years in the profession, male sex, physicians and university education. Conclusion: The SEPC-SE is valid and reliable for measuring self-efficacy. Nurses had lower self-efficacy than physicians. Physicians were associated with higher self-efficacy and had more education and experience in palliative care settings, which may explain their levels of self-efficacy.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
construct validity, hospitals, nurses, palliative care, physicians, reliability, self-efficacy, SEPC scale
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-128695 (URN)10.1111/scs.13244 (DOI)001181113000001 ()38454579 (PubMedID)2-s2.0-85187105443 (Scopus ID)
Available from: 2024-04-09 Created: 2024-04-09 Last updated: 2024-06-17

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