This study was conducted within the project “Compassion and ethical sensitivity in care” which has a particular focus on dignity preservation and alleviation of patients’ suffering within care contexts such as cancer care, palliative care and homecare, led by associate professor Jessica Hemberg at Åbo Akademi University. Link to the project:
Our article about healthcare professionals’ experiences of person-centred cancer care was recently published in the Scandinavian Journal of Caring Sciences. It was my first article as a doctoral student of health sciences at Åbo Akademi University in Vaasa. Cancer care in Finland is usually considered respectful and empathetic. However, in our study, I interviewed a group of cancer patients who had particularly difficult experiences with healthcare professionals in cancer care. This sparked my interest in further researching this phenomenon and exploring how the organisation impacts healthcare professionals and, consequently, the suffering of patients in cancer care.
Person-centred care considers people’s comprehensive and unique needs, not just illnesses, and represents a more holistic way of thinking about health and care, building a long-term relationship between people and caregivers (WHO, 2024). Today’s cancer care risks being system-focused and operating in an environment with little regard for patients’ life experiences or room for their participation (Petersson et al., 2023). In Sweden, person-centred care has been mapped at a regional level, and efforts are being made to systematically implement it at a national level. It is believed that person-centred care is something both patients and healthcare professionals want and that it contributes to resource savings (Sveriges Kommuner och Landsting, 2018). In Finland, person-centred care has not been systematised, but research has emerged in the field (Pakkonen et al., 2021). A person-centred approach transforms patients from passive targets to active participants in their own care (Goni-Fuste et al., 2023; Håkansson Eklund et al., 2019). Respect for inherent human value and building care relationships on mutual trust and kindness are essential (McCormack & McCance, 2021b). This approach involves co-creating care with patients by listening, engaging in dialogue, setting common goals, and focusing on well-being (Bergdahl et al., 2019). Person-centredness in the workplace is beneficial for healthcare professionals because it generates improved communication, greater satisfaction, and increased engagement (McCormack & McCance, 2021a; Pakkonen et al., 2021). A person-centred care model can be recommended for cancer patients since it has been shown to benefit crucial patient outcomes (Kullberg et al., 2019). Person-centred care improves patients’ experience of care by increasing hope, providing dignified care, and offering greater participation (McCormack & McCance, 2021a).
The purpose of the study was to gain a deeper understanding of healthcare professionals’ experiences of possibilities and limitations for providing person-centred care, to alleviate suffering among patients with cancer in Finland. A qualitative design was used in the study. The data consisted of texts from four focus-group interviews with 15 physicians and nurses from one cancer clinic in Finland. Content analysis according to Lundman & Hällgren Graneheim (2008) was used for analysing the data. Four categories emerged: (1) Organisational factors that promote person-centred care, (2) Work ethics and competence as internal abilities, (3) Organisational factors that limit the provision of person-centred care and (4) Emotional internal limitations to provide person-centred care.
The participants revealed that having the same physician at every visit increases the possibility for person-centred care, saves time, and improves patient safety (cf. Appiah et al., 2023; Oelschlägel et al., 2021). Little things seem to have great importance, especially in cancer care, providing a sense of dignity in the patients’ vulnerable life situations. The healthcare professionals exercise flexibility to make the care more adapted to each individual patient, using the time, competence, space, and multiprofessional collaboration at their disposal (cf. Petersson et al., 2023). The participants emphasised a high level of work ethics and morale, wishing that patients would feel as good as possible. Limited time was considered the greatest constraint for the healthcare professionals (cf. Alharbi et al., 2014; Petersson et al., 2023). The organisation also sets very strict rules for the healthcare professionals’ work, limiting their ability to provide person-centred care. The feeling of not being able to influence their work led to frustration, discouragement, powerlessness, and ethical stress (cf. Ulrich et al., 2010; Vargas Celis & Concha Méndez, 2019). A feeling of “them” and “us” can create a distance between different units. This can lead to patients being “passed around,” which may be experienced as fragmented care (cf. Ahmed et al., 2022; Glasby, 2021). Patients contacting care for the same need many times is called failure demand. The problem of failure demand also occurs when healthcare professionals from different units contact other units for the same patient matter several times. The experience of inner emotional limitations was described as carrying a backpack and sometimes placing heavy things in it (cf. Appiah et al., 2023; Arman, 2023; Moghadam et al., 2022). The study shows that too little time and too strict management leaves little or no room for promoting person-centred care, which can lead to increased suffering among patients (cf. Eriksson, 1994, Chapter 7). According to Eriksson (1994, Chapters 7, 11), there is a risk of increasing patient suffering when healthcare professionals do not have time to confirm the suffering, if care is neglected, or if the patient feels abandoned. Glasby (2021) describes a person-centred approach as healthcare services that collaborate to meet the patients’ needs in a holistic way. Walley et al. (2019) suggest that failure demand arises because administration counts all healthcare contacts as demand without efforts to reduce staff workload or improve care quality (cf. James et al., 2024).
The internal abilities of the healthcare professionals, such as high work morale, inner drive, and knowledge, are comprehensive. Hidden potential exists within cancer care. If the healthcare organisation were to become more integrated with better collaboration and greater flexibility between different units and instances, and if healthcare professionals had more time to provide person-centred care, then care could improve in quality, alleviate patient suffering, and at the same time reduce failure demand. However, this phenomenon needs to be studied further. Failure demand is something that unnecessarily increases pressure on care. By gaining a deeper understanding of the problems, leaders together with healthcare professionals in healthcare organisations can find solutions, saving time and resources. Healthcare professionals want to provide person-centred care because they recognise patients’ comprehensive individual needs that need to be met. A person-centred care approach should strive for empathy and compassion within cancer care at an organisational level.
With my doctoral thesis, I aim to provide a deeper understanding of how suffering is experienced by patients with cancer, and the relationship with healthcare professionals’ compassionate encounters and person-centred care. In the next study we will explore the experiences of patient suffering related to the care process and cancer treatments by interviewing patients and analysing their medical documents. Following this, we aim to study the experiences of existential suffering in patients with three different types of cancer. The research will be significant in enhancing our understanding of the experience of suffering among patients with cancer. It will also provide insights into the possibilities and limitations for healthcare professionals in delivering person-centred care.
You can find our study in the Scandinavian Journal of Caring Sciences.
Link to the article: https://doi.org/10.1111/scs.70002
Sunny spring wishes!
Cecilia Linnanen
Authors:
Cecilia Linnanen
MSc, PHN, RN, PhD student in Health Sciences, Department of Health Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland. Research interests include the health and suffering of patients, the ethos and wellbeing of healthcare professionals, as well as person-centred care and failure demand within caring contexts. I am also interested in new organisational models in health care.
E-mail: cecilia.linnanen@abo.fi
Orcid: https://orcid.org/0009-0004-2511-508x
Link to Åbo Akademi University profile: https://research.abo.fi/en/persons/cecilia-linnanen
Jessica Hemberg
PhD in Health Sciences, PHN, RN, associate professor, senior lecturer, Department of Health Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland. Subject leader in pedagogical studies for teachers within health sciences didactics, and head subject leader for leadership in health and social care. Research interests include well-being, suffering and loneliness among older adults and young people, as well as leadership, compassion and ethical issues in caring.
E-mail: jessica.hemberg@abo.fi
Orcid: https://orcid.org/0000-0002-0829-8249
Link to Åbo Akademi University profile: https://research.abo.fi/en/persons/jessica-hemberg
Bjerga, Grethe H.
PhD, RN, associate professor, senior lecturer, University of Stavanger, Faculty of Health Sciences, Department of Caring and Ethics.
Bjerga, G. H. Orcid: https://orcid.org/0009-0008-5545-740x
Ueland, Venke
Professor, PhD in Health Sciences, University of Stavanger, Faculty of Health Sciences, Department of Caring and Ethics.
Bergdahl, Elisabeth
PhD, RN, senior lecturer. Örebro University, School of Health Sciences.
Bergdahl E. Orcid: https://orcid.org/0000-0003-4917-7766
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