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      The pre- and postoperative illness trajectory in patients with pituitary tumours

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          Abstract

          Objective

          Experiences and need of support during surgery and start of replacement therapy in patients with pituitary tumours are highly unknown. This study aimed at exploring patient experiences during pre- and postoperative care and recovery after pituitary surgery in patients with a pituitary tumour.

          Methods

          Within a qualitative study design, 16 consecutive patients who underwent surgery for pituitary tumours were repeatedly interviewed. In total, 42 interviews were performed before and after surgery. Analysis was performed using qualitative interpretation.

          Results

          Suffering a pituitary tumour was overwhelming for many patients and struggling with existential issues was common. Patients expressed loneliness and vulnerability before and after surgery. How professionals handled information in connection with diagnosis greatly affected the patients. Other patients with the same diagnosis were experienced as the greatest support. Normalisation of bodily symptoms and relationships with others were reported during postoperative recovery. However, a fear that the tumour would return was present.

          Conclusions

          Patients with pituitary tumours need structured support, including peer support, which acknowledges physical, cognitive as well as emotional and existential concerns. Information related to diagnosis and surgery should be adapted in relation to the loneliness and the existential seriousness of the situation. Care and support for patients with pituitary tumours should preferably be organised based on continuity and an unbroken care pathway from the first pre-operative evaluation through to postoperative care and the start of a life-long endocrine treatment and tumour surveillance.

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          Most cited references 26

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          Experiencing transitions: an emerging middle-range theory.

          Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.
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            Validity in Qualitative Research

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              Systematic review of peer-support programs for people with cancer.

              To identify models of peer support for cancer patients and systematically review evidence of their effectiveness in improving psychosocial adjustment. CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and PsychINFO databases were used to identify relevant literature published from 1980 to April 2007. Data on characteristics of the peer-support program, sample size, design, measures, and findings were extracted and papers were also rated with respect to research quality (categories 'poor', 'fair' or 'good'). Forty-three research papers that included data from at least 1 group were reviewed in detail, including 26 descriptive papers, 8 non-randomized comparative papers, and 10 papers reporting eight randomized controlled trials (RCTs). Five models of peer support were identified: one-on-one face-to-face, one-on-one telephone, group face-to-face, group telephone, and group Internet. Papers indicated a high level of satisfaction with peer-support programs; however, evidence for psychosocial benefit was mixed. One-on-one face-to-face and group Internet peer-support programs should be given priority when considering ways to offer peer support. Nevertheless, the other models discussed in this review should not be dismissed until further research is conducted with a wide range of cancer populations.
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                Author and article information

                Journal
                Endocr Connect
                Endocr Connect
                EC
                Endocrine Connections
                Bioscientifica Ltd (Bristol )
                2049-3614
                July 2019
                06 June 2019
                : 8
                : 7
                : 878-886
                Affiliations
                [1 ]Institute of Health and Care Sciences , Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
                [2 ]Centre for Person-Centred Care (GPCC) , University of Gothenburg, Gothenburg, Sweden
                [3 ]Department of Medicine , Sahlgrenska University Hospital, Gothenburg, Sweden
                [4 ]Department of Neurosurgery , Sahlgrenska University Hospital, Gothenburg, Sweden
                [5 ]Institute of Neuroscience and Physiology , University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
                [6 ]Department of Internal Medicine and Clinical Nutrition , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
                Author notes
                Correspondence should be addressed to G Johannsson: gudmundur.johannsson@ 123456medic.gu.se

                *(S Jakobsson and G Johannsson contributed equally to this work)

                Article
                EC-19-0202
                10.1530/EC-19-0202
                6599075
                31176303
                © 2019 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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