Ulrika Olsson Möller

Introduction: The complex needs of breast cancer patients should be addressed systematically. This study’s aim was to evaluate a screening-based individualized intervention following breast cancer treatment.Methods: ReScreen is a complex multicenter intervention RCT study in which primary breast cancer patients from southern Sweden were included between 2019 and 2022. Patients were screened using the Distress Thermometer before treatment, with highly distressed patients randomized into the intervention group (n=165) or the control group (n=165). Women with low distress formed an observation group (n=303). The intervention group received individualized rehabilitation that addressed women’s breast cancer treatment-related symptoms and psychosocial needs, and was carried out using a decision support tool. The between-group difference in distress (primary outcome) was evaluated up to 12 months after baseline using linear mixed-model regression analysis, as were differences in physical activity, health-related quality of life, breast cancer symptoms, and resilience.Results: The effect of the intervention on distress was small and not statistically significant. However, effects on physical activity at 6 and 12 months and on fatigue at 12 months were observed. Exploratory analyses revealed some evidence for stronger intervention effects in patients with higher initial distress.Conclusions: Individualized rehabilitation did not change distress but did increase physical activity. Vulnerable patients benefited most from the intervention.Clinical Trial Registration: The ReScreen RCT was registered in the ClinicalTrials.gov registry on 2018/11/15, NCT03434717.

Introduction: Many municipalities in Sweden offer group exercises for older persons at meeting places, i.e., senior centres. However, it is unclear whether older persons experience group exercises as in accordance with their needs and wishes. Aim: The aim was to explore older persons’ experiences of participating in group exercises held at meeting places in municipalities from a person‐centred perspective. Methods: Individual interviews were conducted with 18 persons aged 65 and over who participated in group exercises at meeting places in six different municipalities. The interview guide was based on a person‐centred framework. The data were analysed using content analysis, first deductively and then inductively. Findings: The findings were presented in two main categories. The first concerned incentives for older persons to continue exercising in groups, which were held at meeting places. Such incentives were the encouragement they felt from the power of the group and the fact that the group exercises made them feel good. They also felt a sense of worth from having time and effort invested in them. The second main category included mixed feelings about the interaction between the older persons and the stakeholders, primarily the exercise leader. On the one hand, the older persons felt a strong trust in the exercise leaders, but on the other, they felt ambivalent and had ambiguous feelings regarding their own opportunities to influence the group exercises. Conclusions: To conclude, the group exercises held at meeting places contribute to meaningful relationships and a sense of social belonging and togetherness. The intervention not only promotes physical and mental health but also counters loneliness and social isolation, and therefore needs to be scaled up even more. This study highlights the need to make group exercises more person‐centred and to introduce processes that include the needs and wishes of older persons in the design of such interventions.

Background: Falls are common among older persons and can have a major impact on their lives. Wearable sensors used in free-living conditions (moving naturally in one’s daily living environment) can be used to predict falls and fall risks. To understand if using the wearable sensors is an acceptable way for older persons to be screened for fall risks, it is important to have knowledge of older persons’ experiences using wearable sensor-based technologies for fall risk assessment in free-living conditions Therefore, this study aimed to describe older persons’ experiences of using such technology. Methods: A qualitative study using individual interviews was conducted with 21 community-dwelling older persons (aged 77–81) in Sweden between April and September 2024. The older persons wore a thigh-mounted wearable sensor for one week to screen for fall risks in free-living conditions. Interviews were conducted 9–89 days (median 15 days) after sensor use and were analysed using conventional qualitative content analysis. Results: Older persons’ experiences with wearable sensor-based fall risk screening were described using the overarching theme ‘Being an older person in a fall screening process’ containing five categories: ‘Seeing a need for a fall risk sensor but imagining it as an unattainable ideal’, ‘Utilising a wearable sensor can be uncomplicated and fun’, ‘Having worries and experiencing problems’, ‘Thinking about what the wearable sensor has registered about me’, and ‘Reflecting on how I can benefit from the screening’. Conclusions: The older persons had various experiences with the wearable sensor-based screening for fall risks in free-living conditions. The wearable sensor was easy to use, although problems could occur while wearing it, such as losing the sensor or developing skin problems. The older persons wanted to benefit from the screening and improve their health based on the results. Further research could focus on the accuracy of fall predictors used in free-living conditions for assessing fall risks in older persons, since the wearable sensor was perceived as acceptable to use.

Background: Health-promotive interventions targeting older persons are important for active and healthy ageing. Hence, physical group exercises for community-dwelling older persons are arranged by various stakeholders via meeting places within the municipalities. Increased knowledge of how group exercises via meeting places can be arranged to promote health for the older population is needed. Therefore, the aim was to explore involved stakeholders’ experiences of group exercises for older persons arranged via meeting places in municipalities in relation to health promotion. Methods: Six focus group interviews were conducted online with 25 stakeholders from seven municipalities in Sweden. The stakeholders were managers of prevention units, municipal coordinators for physical activity, group exercise leaders, stakeholders from study associations, sports associations and private stakeholders, and non-profit stakeholders who arranged group exercises via the meeting places. The data was analysed using focus group methodology, where the focus of the analysis was to obtain the stakeholders’ collective understanding of the topic. Findings: The analysis resulted in two main themes and seven categories. In the main theme Strategies to strengthen empowerment and exercise habits among older persons, the stakeholders highlighted strategies on an individual level. Strategies of importance to attract new participants and supporting them in maintaining their exercise habits, empowering them through social belonging, adapting to older persons through responsiveness and evaluation, facilitating participation in decision-making, and enabling older persons to lead group exercises. The other main theme, Strategies to strengthen the arrangement of group exercises over time, highlighted strategies on an organisational level concerning financial resources, supportive environments, the importance of human resources, competence development as well as collaboration. Conclusions: Person-centredness emerges in health-promoting strategies both at the individual and organisational level. The study contributes to an understanding of how person-centredness is significant when working with health-promotive interventions for healthy ageing. Thus, a potential implication is to use a person-centred approach in the encounter with older persons and in the organisation when arranging group exercises for community-dwelling older persons.

Background: Treatment for breast cancer poses major challenges and leads to a variety of side-effects and problems that affect life for a long time. Experiences and symptoms vary, and research indicates a lack of structures for ensuring individualized rehabilitation. This qualitative focus group study aims to explore the experience of women with BC after participating in a complex randomized controlled trial (RCT) (Clinicaltrials.gov NCT03434717) focusing on cancer rehabilitation from a comprehensive perspective. Method: Nine semi-structured focus group interviews with women (n = 30) who participated in the Rescreen RCT were conducted. The women were interviewed divided into three RCT groups (intervention, control, or observation group). Data were initially analyzed inductively using conventional content analysis, followed by a deductive approach, guided by the result from the inductive analysis. Results: The inductive analysis resulted in two categories and four sub-categories and showed a great variation in experiences and needs. Some women described a well-functioning process, while others described lack of individualized information, continuity with healthcare providers, and clear pathways for support. After the deductive analysis, a variation between the groups appeared. Women in the intervention group expressed that a proactive and individualized approach facilitated rehabilitation and they experienced a feeling of being recognized as a person, which they highlighted as important. On the contrary, women from the control group described feelings of being abandoned from healthcare, hindering rehabilitation. The observation group expressed that their needs had been fulfilled within the healthcare system. Conclusions: This study adds important knowledge to the evaluation of the ReScreen model and contributes to existing research on how individualized rehabilitation after breast cancer can be applied in clinical practice. A proactive, person-centered approach in rehabilitation, aimed at those with extended needs, would potentially optimize rehabilitation and facilitate the recovery process after breast cancer treatment.

Purpose: Resilience has been suggested as an important predictor of both physical and mental health-related quality of life in breast cancer patients. However, it is unclear why resilient women handle their diagnosis better, not only mentally, but also physically. The aim of this study was to investigate paths between resilience, physical activity, and mental, physical, and global health-related quality of life in breast cancer patients. Patients and Methods: Structural equation modeling was conducted to evaluate the proposed structural paths using a sample of 638 women with newly diagnosed breast cancer patients from Sweden. Results: Resilience was directly associated with physical activity and mental health-related quality of life. It was indirectly associated with physical functioning, through mental health-related quality of life and physical activity. Resilience was also indirectly associated with global quality of life, through mental health-related quality of life. Conclusion: Mental health support and encouraging physical activity may be especially relevant to enhance all aspects of health-related quality of life early in the breast cancer process. Results should be replicated longitudinally. Plain Language Summary: Receiving a breast cancer diagnosis can be highly disruptive to one’s worldview and sense of normalcy. Many women with breast cancer describe the diagnostic period as even more stressful than receiving treatment. However, some women handle their breast cancer diagnosis better than others. Resilience is a psychological trait that refers to one’s ability to cope with highly stressful events and maintain good wellbeing despite adversity. More resilient women were shown to handle a breast cancer diagnosis better, not only mentally, but also physically. They also describe their quality of life as higher than low resilient women. However, it is unclear why resilient women have not only better mental health, but also physical health. In this study, we addressed this question by examining the relationships between resilience, mental health, physical functioning, physical activity, and patients’ self-reported quality of life. We found that mental health and physical activity explained the relationship between resilience and physical functioning and self-reported quality of life. This suggests that highly resilient women experience less psychological distress following a breast cancer diagnosis and are more inclined to maintain physical activity during this stressful period. Consequently, they may manage to have better physical functioning and evaluate their quality of life as better. This study highlights the importance of psychosocial support and encouraging physical activity in women with breast cancer who may struggle to cope with their diagnosis. This study implies that this can not only alleviate psychological distress, but also aid one’s physical functioning and overall quality of life.

Purpose: Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions’ actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods: Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results: Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥ 65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95– 4.49). About 50% (n=517) of the cases involved 1– 2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥ 6 visits over ≥ 7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion: Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients’ needs and wishes, or conversely an expression of limited resources, remains to be investigated.

AimTo explore nurses' experiences of using the Integrated Palliative care Outcome Scale (IPOS) as a communication tool in specialized palliative care.DesignThis study employed a qualitative inductive approach. The Standards for Reporting Qualitative Research were followed for reporting.MethodsFive focus groups were conducted with nurses from four specialized palliative care units, and the discussions were analysed with quality content analysis.ResultsUsing IPOS for communication with the patient gave an opportunity to understand the patient's care needs and to let these care needs guide care interventions. Prerequisites in terms of relation, atmosphere, skills and flexibility were needed to establish an interactive communication. It was challenging to communicate about issues that evoked emotional reactions in the patient. There was a balancing act between the use of a structured scale and overcoming communication challenges. Nonetheless, when the two complemented each other, IPOS was a useful tool for nurses to promote person-centred care.

Many municipalities today, together with other stakeholders, offer group exercises for the older population via municipal meeting places, focusing on promoting good health. During the Covid-19 pandemic, these group exercises either continued in a modified form or ceased. The aim of this study was to explore involved stakeholders’ experiences of group exercises for older persons arranged via municipal meeting places during the Covid-19 pandemic. Six online focus group interviews were conducted with 25 stakeholders, such as decision-makers and representatives from the non-profit sector, from seven municipalities in Sweden. Data were analysed using thematic analysis. The collaboration around the group exercises was challenged due to affected communication and decision-making. The stakeholders described the importance of adapting and finding new ways to offer group exercise. Furthermore, the re-arranging of group exercises created concerns about the well-being of the older persons but also happiness with the older persons ability to act for their own well-being during the pandemic. This study highlights the importance of the municipalities exchanging experiences, making the older persons more involved in the decision-making process, enabling a person-centred encounter with the older persons when exercising in groups, and strengthening supportive environments by sharing the ownership of arranging the group exercises with the older persons.