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Publications (10 of 105) Show all publications
Weick, L., Ericson, A., Sandman, L., Bostrom, P. & Hansson, E. (2023). Patient experience of implant loss after immediate breast reconstruction: An interpretative phenomenological analysis. Health Care for Women International, 44(1), 61-79
Open this publication in new window or tab >>Patient experience of implant loss after immediate breast reconstruction: An interpretative phenomenological analysis
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2023 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 44, no 1, p. 61-79Article in journal (Refereed) Published
Abstract [en]

Immediate breast reconstruction (IBR) is an integral part of modern breast cancer treatment. Our aim was to investigate patient experience with implant loss after IBR by using interpretative phenomenological analysis (IPA). We conducted semi-structured interviews with eight informants. We analyzed data according to the IPA flexible seven-stage process and four main themes were developed: immediate breast reconstruction as the indisputable choice, a difficult experience, an altered body: redefining normality, and trying to cope. The experience of implant loss appears to affect women for many years and might overshadow some of the benefits of IBR.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023
Keywords
womens experiences, cancer, impact, complications, mastectomy, risk, care
National Category
Surgery
Identifiers
urn:nbn:se:hb:diva-26333 (URN)10.1080/07399332.2021.1944152 (DOI)000688298100001 ()34427538 (PubMedID)2-s2.0-85113360973 (Scopus ID)
Available from: 2021-09-03 Created: 2021-09-03 Last updated: 2024-01-16
Hansson, E., Sandman, L. & Davidson, T. (2021). A systematic review of direct preference measurements in health states treated with plastic surgery. Journal of Plastic Surgery and Hand Surgery
Open this publication in new window or tab >>A systematic review of direct preference measurements in health states treated with plastic surgery
2021 (English)In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764Article in journal (Refereed) Published
Abstract [en]

One way to compare health care needs and outcomes on common scales is by estimating the strength of preferences or willingness-to-pay (WTP). The aim of this study was to review directly measured preference values and WTP estimates for health states treated by plastic surgery. The included articles had to meet the criteria defined in the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). Relevant databases were searched using predetermined strings. Data were extracted in a standardised manner. Included studies were appraised according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for rating the importance of outcomes. In total, 213 abstracts were retrieved. Of these, 179 did not meet the inclusion criteria and were excluded, leaving 34 studies in the review. The risk of bias was considered moderate in four studies and serious in the rest. The overall certainty of evidence for directly measured preference values and WTP estimates for health states treated by plastic surgery is low (Grade ƟƟОО). The lowest preference scores were generally elicited for facial defects/anomalies and the highest for excess skin after massive weight loss. Scientific knowledge about preferences and the resulting health gains might play an essential role in deciding which procedures should be considered for public funding or rather rationed within the system. Better quality studies are required to allow for such applications.

Place, publisher, year, edition, pages
Taylor and Francis Ltd., 2021
Keywords
contingent valuation, health care need, Plastic surgery, preferences, prioritizing, rationing, willingness-to-pay
National Category
Economics
Identifiers
urn:nbn:se:hb:diva-26231 (URN)10.1080/2000656X.2021.1953039 (DOI)000682849000001 ()34369280 (PubMedID)2-s2.0-85112105550 (Scopus ID)
Available from: 2021-08-17 Created: 2021-08-17 Last updated: 2022-06-29
Sandman, L. & Hansson, E. (2020). An ethics analysis of the rationale for publicly funded plastic surgery. BMC Medical Ethics, 21(1)
Open this publication in new window or tab >>An ethics analysis of the rationale for publicly funded plastic surgery
2020 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 21, no 1Article in journal (Refereed) Published
Abstract [en]

Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for anabsolutepriority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.

Keywords
Plastic surgery, Esthetic surgery, Rationing, Prioritizing, Normality, Functional condition, Psychosocial condition, Etiology, Healthcare need, Patient experience
National Category
Health Sciences Philosophy, Ethics and Religion
Identifiers
urn:nbn:se:hb:diva-24810 (URN)10.1186/s12910-020-00539-6 (DOI)000576912600002 ()2-s2.0-85092269172 (Scopus ID)
Available from: 2021-01-25 Created: 2021-01-25 Last updated: 2021-10-20Bibliographically approved
Jonasson, L.-L., Sandman, L. & Bremer, A. (2019). Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training. Journal of Healthcare Leadership, 11(63-74)
Open this publication in new window or tab >>Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training
2019 (English)In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed) Published
Abstract [en]

Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.

Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.

Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.

Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented

Keywords
manager, ethical responsibility, municipal, older person, thematic analysis
National Category
Other Medical Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15232 (URN)10.2147/JHL.S199167 (DOI)000471092500001 ()2-s2.0-85070204322 (Scopus ID)
Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2020-01-31Bibliographically approved
Sandman, L. & Gustavsson, E. (2016). Beyond the Black Box Approach to Ethics!: Comment on "Expanded HTA Enhancing Fairness and Legitimacy". International Journal of Health Policy and Management, 5(6), 393-394
Open this publication in new window or tab >>Beyond the Black Box Approach to Ethics!: Comment on "Expanded HTA Enhancing Fairness and Legitimacy"
2016 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 6, p. 393-394Article in journal, Editorial material (Refereed) Published
Abstract [en]

In the editorial published in this journal, Daniels and colleagues argue that his and Sabin's accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they warn against. This is for a number of reasons: lack of comprehensiveness, lack of guidance for how to assess ethical issues within the "black box" of A4R as to issues covered, competence and legitimate arguments and finally seemingly accepting consensus as the final verdict on ethical issues. We argue that the HTA community is already in a position to move beyond this black box approach.

Keywords
Health Technology Assessment (HTA), Accountability for Reasonableness (A4R), Ethics, Ethical, Competence, Ethical Analysis
National Category
Philosophy, Ethics and Religion
Identifiers
urn:nbn:se:hb:diva-11346 (URN)10.15171/ijhpm.2016.43 (DOI)000379824500009 ()27285520 (PubMedID)2-s2.0-85002249037 (Scopus ID)
Available from: 2016-12-12 Created: 2016-12-12 Last updated: 2017-11-29Bibliographically approved
Bremer, A., Jonasson, L.-L. & Sandman, L. (2016). Chefers etiska värderingar. In: Lotta Dellve, Maria Wolmesjö (Ed.), Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar (pp. 43-56). Borås: Högskolan i Borås
Open this publication in new window or tab >>Chefers etiska värderingar
2016 (Swedish)In: Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar / [ed] Lotta Dellve, Maria Wolmesjö, Borås: Högskolan i Borås, 2016, , p. 16p. 43-56Chapter in book (Other academic)
Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2016. p. 16
Series
Vetenskap för profession: rapport, ISSN 1654-6520 ; 35
Keywords
Etiska värderingar, chefer, äldreomsorg, etisk profil
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9552 (URN)978-91-88269-08-9 (ISBN)978-91-88269-09-6 (ISBN)
Available from: 2016-04-06 Created: 2016-04-06 Last updated: 2019-12-13Bibliographically approved
Sandman, L. & Bremer, A. (2016). Etik inom ambulanssjukvården (2ed.). In: Björn-Ove Suserud & Lars Lundberg (Ed.), Prehospital akutsjukvård: (pp. 26-39). Stockholm: Liber
Open this publication in new window or tab >>Etik inom ambulanssjukvården
2016 (Swedish)In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 26-39Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2016 Edition: 2
Keywords
Etik, ambulanssjukvård, vårdetik, autonomi, integritet, rättvisa, etisk kompetens, etiska problem
National Category
Medical Ethics
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9329 (URN)978-91-47-11474-0 (ISBN)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2019-12-13Bibliographically approved
Bremer, A., Kullén Engström, A., Fredman, M., Jonasson, L.-L., Jutengren, G., Karlsson, P.-Å. & Sandman, L. (2016). Ledarskap i äldreomsorgen: att leda integrerat värdeskapande i en röra av värden och förutsättningar. Borås: Högskolan i Borås
Open this publication in new window or tab >>Ledarskap i äldreomsorgen: att leda integrerat värdeskapande i en röra av värden och förutsättningar
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2016 (Swedish)Report (Refereed)
Abstract [sv]

Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2016. p. 138
Series
Vetenskap för profession: rapport, ISSN 1654-6520 ; 35
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hb:diva-9333 (URN)978-91-88269-08-9 (ISBN)978-91-88269-09-6 (ISBN)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2019-12-13Bibliographically approved
Sjostrand, M., Karlsson, P., Sandman, L., Helgesson, G., Eriksson, S. & Juth, N. (2015). Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists. BMC Medical Ethics, 16, Article ID 34.
Open this publication in new window or tab >>Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists
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2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 34Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8357 (URN)10.1186/s12910-015-0026-8 (DOI)000359415200001 ()25990948 (PubMedID)2-s2.0-84934873646 (Scopus ID)
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2018-12-07Bibliographically approved
Munthe, C., Nykänen, P. & Sandman, L. (2015). Delat beslutsfattande och evidensbaserad praktik inom socialtjänsten: mål, begrepp och etik för utformning och implementering. Göteborg: Göteborgs universitet
Open this publication in new window or tab >>Delat beslutsfattande och evidensbaserad praktik inom socialtjänsten: mål, begrepp och etik för utformning och implementering
2015 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2015. p. 48
Series
Philosophical communications., ISSN 1652-0459 ; 62
Keywords
etik, värderingar, mål, delat beslutsfattande, medbestämmande, inkludering, evidensbaserad praktik, socialtjänsten, social omsorg, psykiatri
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8364 (URN)
Note

Rapport beställd av Socialstyrelsens enhet för kunskapsstyrning, 2014.

Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2016-01-07Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0987-7653

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