The Symptom Navi© Programme (SN©P) is a structured nurse-led intervention supporting symptom self-management in cancer patients. We describe the development and evaluation of the intervention, implementation strategy, and the evaluation of nurse training for the Symptom Navi© Pilot Study. Methods: The intervention was developed using multiple methods (e.g. literature synthesis, focus groups) to produce SN©P information leaflets (SN©Flyers in French and German) and standardised training for nurses to deliver semi-structured consultations. We evaluated the SN©P using online surveys, focus groups, interviews, and the Item-Content Validity Index (I-CVI). Nurse training was evaluated in relation to content, acceptability, and confidence in implementing the SN©P. We examined the association between scored on the Work-related Sense of Coherence (Work-SoC) scale and nurses' confidence in implementing the SN©P. Thematic analysis was used to analyse qualitative data. Quantitative data was descriptively analysed and the Kendall Tau test was employed for correlations. Results: Patients and health care professionals confirmed that SN©Flyers and semi-structured consultations facilitated symptom self-management. Nurses considered training content/format acceptable and appropriate and felt confident in implementing the SN©P. Overall Work-SoC scores were correlated with nurses' confidence in implementing the SN©P (r π = .47, p = .04). Conclusions: Health care professionals and cancer patients perceived the SN©P as a useful support. Successful implementation of the SN©P depends on centre-specific factors including time, resources and workflow. Clinical trial registry: NCT03649984 and SNCTP000002381.

Zusammenfassung:Hintergrund: Menschen mit einer Krebserkrankung und ihre Angehörigen erleben viele Übergänge in den letzten Lebensmonaten Schlüsselwörter: Krankheitsmanagement, fortgeschrittene onkologische Erkrankung, Übergang, Dyade, qualitative Forschung "Don't let the world become too small" -How patients with advanced cancer and their significant others cope with transitions during the last year of life. A qualitative study Abstract:Background: In the last year of life, persons with advanced cancer and their significant others are affected by several transitions. They perform psychological adjustment processes during transformation. This requires strategies for patients and their significant others. Research in German about this theme is missing. Aim: We explored the experiences with illness management during transitions in the last year of life of patients with advanced cancer and their significant others. Method: In this qualitative study, we conducted structured interviews with five dyads, consisting of persons with Karnofsky Index ≥ 60 % and life expectancy of six to twelve months as well as their significant others. To interpret the interviews, we used qualitative content analysis according to Mayring. Results: The main theme "Don't let the world become too small" expresses that limitations diminished the lifeworld and the participants struggled against this process. This is revealed in three categories: "Being shocked by diagnosis -realigning again", "Bearing limitations and loss -finding new ways in daily life", "Living in uncertainty -holding out together".

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BACKGROUND: The complex care needs of people with chronic illnesses and multimorbidity pose a significant challenge to the Swiss primary care system. Ensuring efficient, high-quality care will require new care models. Internationally, the integration of advanced practice nurses (APNs) into primary care models has shown promising results. The current study investigates how general practitioners (GPs) in Switzerland experience the integration of APNs into their primary care teams with respect to their own professional roles. METHODS: We used a qualitative, social-constructivist approach, focusing on six individual interviews with general practitioners within the frame of a larger study including GPs and APNs in a Swiss multiprofessional primary care practice. Data were analysed following Braun and Clarke’s approach for reflexive thematic analysis. SETTING AND PARTICIPANTS: The study took place between August 2019 and February 2020 in a Swiss multiprofessional primary care practice that had been working with APNs for nine years. Participants included six general practitioners. RESULTS: We identified three main themes characterising Swiss GPs’ experiences with the integration of APNs into their primary care team: (1) trust as foundation for collaboration with APNs; (2) build-up of the APN role by delegation, teaching, and supervision, investing time particularly at the beginning of their collaboration with the APN — a time investment that declined significantly as the APNs’ competencies grew — and (3) synergies of partnership-based collaboration with APNs. Physicians who were experienced teachers and supervisors, and who delegated tasks based on who would be able to fulfil them most efficiently and effectively, experienced not only a broad range of synergies, but also possibilities to further develop the range of their own activities. Comprehensive, high-quality patient care was perceived as a particular added value. CONCLUSION: Our analysis revealed that GPs experienced interprofessional synergies when working collaboratively with APNs. These were rooted in trust and relied on abilities in teaching, supervision and delegation to achieve maximum impact. Capitalising on the integration of APNs into primary care, this new care model can be adapted to diverse individual settings. We conclude this article by highlighting the potential of working collaboratively with APNs, who play increasingly important roles in the primary care of polymorbid patients with complex needs.

Background: Short informations with graphic elements may support self management of symptoms. Enhancing self-management is a key element of cancer care. Since 2011 different organisations have been developing patient education handouts, the so called symptom navi with three different graphical variants and slightly different text. Aim: To lay ground for a Swiss-wide standard of the symptom navi, we evaluated (a) the utility of the sheets and (b) the preference for the graphical layout and c) complexity of provided text with patients, their relatives, and health professionals. Methods: We conducted three focus groups with 14 patients and one relative, and an online-survey with 16 health professionals. Descriptive data analysis were combined with thematic analysis of qualitative data. Results: Overall, the symptom navi were well received by patients and health professionals. All participants welcomed the conciseness of information and requested information was easy to find. The structure of the symptom navi supported the readability and facilitated the self-assessment of a patients’ condition. Smileys to support the evaluation of symptom burden was the most favoured graphic layout. For patients, the graduation of the severity of symptoms with different colours supported their feelings of safety. However, symptom navi do not substitute personal contact and counselling. Conclusions: The most favoured graphical layout will now be further developed and refined. A future evaluation will investigate the content validity of the symptom navi.