'Stuck or unstable': partnerships between GPs and patients with complex chronic conditions. A qualitative study.

Background: In chronic care, patient-GP collaboration is essential, but might be challenging if patients have complex health problems due to multimorbidity, psychosocial predicaments and addiction problems. To understand and manage these challenges, it is important to explore how patients' and GPs' attempt to collaborate, to maintain and achieve an alliance in order to gain good quality of care.

Aim: To explore how dyads of GPs and patients that GPs deem have complex health problems and difficulties following treatment perceive and manage challenges in their chronic care partnership.

Healthcare seeking for people diagnosed with severe mental illness: Sensations, symptoms and diagnostic work.

For people with mental and somatic illnesses, the interpretive process of attending to a multitude of bodily sensations and recognising them as potential symptoms represents daily and 'chronic homework'. Based on 16 months of ethnographic fieldwork in Denmark, this study explores diagnostic work and healthcare seeking among people with severe mental and somatic illnesses. As multiple studies have shown, the transformation process for a perceived sensation to become a symptom is a socially constructed interpretative process highly dependent on social legitimisation and shaped by prior cultural knowledge.

Physiotherapists' Treatment Strategies and Delineation of Areas of Responsibility for People With Musculoskeletal Conditions and Comorbidities in Private Physiotherapy Practice: A Qualitative Study.

Background: Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients.

Aim: To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities.

Rethinking the logic of early diagnosis in cancer.

To reduce morbidity and mortality of cancer, more countries have implemented strategies to detect cancer, based on the logic of 'the sooner the better'. is thereby an essential component in how cancer research, policies, and prevention are practiced today. Where the logic of early diagnosis benefits some, the logic also produces harms.

'There's a will, but not a way': Norwegian GPs' experiences of collaboration with child welfare services - a grounded theory study.

Background: Adverse childhood experiences can have immediate effects on a child's wellbeing and health and may also result in disorders and illness in adult life. General practitioners are in a good position to identify and support vulnerable children and parents and to collaborate with other agencies such as child welfare services. There is a need for better integration of relevant services.

Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers.

Objective: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.

Design: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020.

Managing persistent physical symptoms when being social and active is the norm: a qualitative study among young people in Denmark.

Background: An increasing number of young people in Western countries report persistent physical symptoms (PPS). PPS may disturb everyday activities and they may have negative consequences for later adult mental and physical health. Still little is known about how young people handle PPS in their everyday lives.

Exploring the potential of a standardized test in physiotherapy: making emotion, embodiment, and therapeutic alliance count for women with chronic pelvic pain.

Introduction: There has been an increased use of standardized measurements in health care meant to provide objective information to enhance the quality and effectivity of care. Patient performance tests are based on standardized predefined criteria with a limited focus. When facing multifaceted health conditions, information expanding the predefined criteria in a standardized test may be required to understand the patient's complex symptoms.

Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study.

Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.

How life events are perceived to link to bodily distress: A qualitative study of women with chronic pelvic pain.

Chronic pelvic pain (CPP) is highly prevalent among women and the condition is poorly understood. In addition to multiple symptoms from the pelvis, CPP patients frequently suffer bodily distress like musculoskeletal pain and negative emotional, behavioral, and sexual implications. This paper is based on a qualitative study including semi-structured interviews with eight women with CPP.

Luckily-I am not the worrying kind: Experiences of patients in the Danish cancer patient pathway for non-specific symptoms and signs of cancer.

In Denmark, due to the implementation of the Non-specific Symptoms and Signs of Cancer-Cancer Patient Pathway (NSSC-CPP), more people with symptoms such as fatigue and weight loss are informed that their symptoms might indicate cancer and they are referred to the pathway. But what do patients in the NSSC-CPP experience, in particular, with respect to being in an affective state of anticipation of a cancer diagnosis? We conducted participant observation and semi-structured interviews with patients to investigate their experience of the NSSC-CPP with a specific focus on their perception of symptoms and their thoughts on worrying about cancer. We found that the phrase 'worried about cancer' was not recognised by the participants, but worry was visible in their increased healthcare use and their interpretation of bodily sensations.

Senses of Touch: The Absence and Presence of Touch in Health Care Encounters of Patients with Mental Illness.

Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs.

Responsibilities of Risk: Living with Mental Illness During COVID-19.

Following the COVID-19 pandemic, Denmark introduced repeated lock-downs of society, including outreach services and visits from social workers for people living with mental illnesses. Based on ethnographic fieldwork, in this article we explore how people with mental illness react to and manage their lives amid COVID-19 mitigations, focusing on how they experience and negotiate vulnerability at personal and community level. We argue, that the subjective management of restrictions implicated in their personal lives notions of risk, vulnerability and agency, and shows a diversity and heterogeneity of responses to the pandemic that allowed the mentally ill to perform good citizenship.

Caught up in Care: Crafting Moral Subjects of Chronic Fatigue.

Patients with chronic fatigue receive advice to improve symptom management and well-being. This advice is based on ideas of self-management and is conveyed during clinical assessment as "activity regulation." Based on ethnographic fieldwork in a hospital clinic in Norway, we show how these patients attempt to demonstrate their competences and everyday concerns, and how the ideology of self-management frames the hope for recovery and crafts a subject with the ability to improve.

'Fixing my life': young people's everyday efforts towards recovery from persistent bodily complaints.

Little is known about the perspectives of young people suffering from medically unexplained symptoms. This study aims to explore the experiences and strategies of young Norwegians related to incipient and persistent health complaints affecting everyday life functioning. The study draws on field notes, video material and interview transcripts from a multi-sited ethnographic study of healthcare services and select schools in a small Norwegian town between 2015 and 2016.

'I can hardly breathe': Exploring the parental experience of having a child with a functional disorder.

Functional disorders in children and adolescents are common. Still, little is known about parents' experience of having a child with a functional disorder. The aim of this qualitative interview study was to explore challenges encountered by parents caring for a child undergoing treatment for functional disorder.

Illness perceptions of youths with functional disorders and their parents: An interpretative phenomenological analysis study.

Background: Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed.

Epistemological and methodological paradoxes: secondary care specialists and their challenges working with adolescents with medically unexplained symptoms.

Background: Early adolescence is considered a critical period for the development of chronic and recurrent medically unexplained symptoms (MUS), and referrals and system-initiated patient trajectories often lead to an excess of examinations and hospitalizations in the cross-section between mental and somatic specialist care for this group of patients. Dimensions of the relationship and communication between clinician and patient are shown in primary care studies to be decisive for subsequent illness pathways, often creating adverse effects, but knowledge on clinical communication in specialist care is still scarce.

Methods: This study explores communicative challenges specific to clinical encounters between health professionals and adolescent patients in specialist care, as presented through interviews and focus group data with highly experienced specialists working in adolescent and child services at a Norwegian university hospital.

'Not a film about my slackness': Making sense of medically unexplained illness in youth using collaborative visual methods.

Persistent medically unexplained symptoms have debilitating consequences for adolescents, dramatically altering their social world and future aspirations. Few studies have focused on social and moral aspects of illness experience relevant to adolescents. In this study, the aim is to explore these aspects in depth by focusing on a single case and to address how young people attempt to create social accountability in a search for meaning when facing illness and adversity.

The cancer may come back: experiencing and managing worries of relapse in a North Norwegian village after treatment.

Little is known about how people living in the aftermath of cancer treatment experience and manage worries about possible signs of cancer relapse, not as an individual enterprise but as socially embedded management. One-year ethnographic fieldwork was conducted in a coastal village of under 3000 inhabitants in northern Norway. Ten villagers who had undergone cancer treatment from six months to five years earlier were the main informants.

Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study.

Unlabelled: Smoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment in their chronic obstructive pulmonary disease patients.

Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition - a qualitative study of COPD patients' perspectives on self-treatment.

Background: Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged as a promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, the effect of self-treatment, particularly when not part of comprehensive self-management programs, remains unclear. Therefore, this study aims to get insight into the patients' perspective on self-treatment of acute exacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment with antibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects which might interfere with successful implementation.

How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study.

Purpose: To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations.

Methods: Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong.

Results: Four main themes were identified.

What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies.

Objective: To gain a deeper understanding of challenges faced by GPs when managing patients with MUS.

Methods: We used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS.

Results: The problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness.