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Aim: To explore spouses' experiences of living with a partner suffering from non-cardiac chest pain (NCPP). Design: An inductive qualitative study. Methods: Individual interviews (n = 10) were performed with spouses of partners having NCCP and cardiac anxiety. The analysis was performed according to Patton's guide for content analysis of qualitative data. Results: Three categories and seven subcategories were identified. First, 'a feeling of being neglected', where spouses felt ignored by healthcare professionals and excluded by their partners. Secondly, 'a tension between hope and despair' encompassed feelings of faith, support, unpreparedness for chest pain and situational frustration. Lastly, in 'a threat to ordinary life', spouses noted chest pain-induced changes impacting daily life, finances, leisure and relationships. To conclude, NCCP in partners significantly affects their spouses emotionally and practically. Spouses felt neglected and isolated, oscillating between hope and despair and experiencing faith, powerlessness and frustration. They also faced challenges in daily life and relationships., Funding Agencies|Familjen Kamprads Stiftelse [ISV-2018-00033]; Kamprad Family Foundation

Background Non-cardiac chest pain (NCCP) is a common issue, accounting for roughly half of all emergency department visits related to chest pain. Patients afflicted with NCCP often endure cardiac anxiety, misinterpreting the pain as heart-related and fearing it, despite the absence of any life-threatening cardiac issues. This anxiety often leads to the avoidance of physical activities, negatively impacting their quality of life. Cognitive behavioural therapy (CBT) has been shown to be effective in managing psychological distress such as anxiety and depression. CBT is a structured process that helps patients identify and restructure their negative thoughts, get a corrected and more realistic perception of their symptoms, and learn to manage their thoughts about chest pain. Despite its effectiveness, CBT is resource-intensive, and therefore internet-delivered cognitive behavioural therapy (iCBT) may be an alternative as it increases accessibility and is more cost-effective compared to traditional therapy methods. However, there is a lack of re-search on the effectiveness of this treatment approach for patients with NCCP and cardiac anxiety. Moreover, digital care technologies are still relatively unfamiliar in clinical practice, particularly in emergency departments, and the successful implementation of iCBT relies on healthcare professionals' acceptance and integration of digital care into clinical practice. Aim The overall aim of this dissertation was to evaluate the short- and long-term effects of a nurse-led iCBT program on psychological distress in patients with NCCP, and to explore their experiences participating in the iCBT program. In addition, the study aimed to describe healthcare professionals' perceptions of digital care in the emergency and cardiac care for patients with NCCP. Methods This dissertation comprises two quantitative and two qualitative studies. A randomised clinical trial (RCT) (studies I, II, and III) was conducted to evaluate cardia, Bakgrund Icke-kardiell bröstsmärta (Non-cardiac chest pain - NCCP) är ett vanligt problem och utgör ungefär hälften av alla besök på akutmottagningen relaterade till bröstsmärta. Patienter som besväras av NCCP upplever ofta hjärtrelaterad ångest då de tolkar smärtan som hjärtspecifik, trots att ingen livshotande hjärtsjukdom konstaterats. Hjärtrelaterad ångest leder ofta till att de undviker fysisk aktivitet eller sociala situationer på grund av rädsla för att förvärra symtom eller uppleva komplikationer, vilket påverkar livs-kvaliteten negativt. Kognitiv beteendeterapi (KBT) har visat sig vara effektiv för att hantera psykisk ohälsa såsom ångest och depression. KBT är en strukturerad process som hjälper patienter att identifiera och omstrukturera sina negativa tankar, få en korrigerad och mer realistisk uppfattning om sina symtom och lära sig att hantera sina tankar om bröstsmärtan. Trots sin effektivitet är KBT resurskrävande och därför kan internetbaserad kognitiv beteendeterapi (iKBT) vara ett alternativ eftersom den ökar tillgängligheten och är mer kostnadseffektiv jämfört med traditionell KBT. Dock saknas det forskning kring effekten av denna behandlingsform för patienter med NCCP och hjärtrelaterad ångest. Dessutom är digitala vård-teknologier fortfarande relativt okända inom kliniska miljöer, särskilt på akutmottagningar, och en framgångsrik implementering av digitala behandlingsformer, såsom iKBT beror till stor del vårdpersonalens acceptans och integration av digital vård i klinisk praxis. Syfte Det övergripande syftet med denna avhandling var att utvärdera kort- och långsiktiga effekter av ett sjuksköterskelett iKBT-program på psykisk ohälsa hos patienter med NCCP, samt att utforska deras erfarenheter av att delta i iKBT-programmet. Dessutom syftade studien till att beskriva sjukvårdpersonals uppfattningar om digital vård inom akut- och hjärtsjukvården för patienter med NCCP. Metod Denna avhandling består av två kvantitativa och två kvalitativa stud, Funding: The Kamprad Family Foundation and Region Östergötland

Aims and Objective To explore the experiences of patients with non-cardiac chest pain and cardiac anxiety regarding participation in an internet-delivered cognitive behavioural therapy program. Background Non-cardiac chest pain is common and leads to cardiac anxiety. Internet-delivered cognitive behavioural therapy may be a possible option to decrease cardiac anxiety in these patients. We have recently evaluated the effect of an internet-delivered cognitive behavioural therapy program on cardiac anxiety. Design An inductive qualitative study using content analysis and the COREQ checklist. Methods Semi-structured interviews with 16 Swedish patients, who had participated in the internet-delivered cognitive behavioural therapy program. Results Three categories were found. The first, Driving factors for participation in the internet-delivered cognitive behavioural therapy program described the impact of pain on their lives and struggle that led them to participating in the program. The second, The program as a catalyst described that the program was helpful, trustworthy and useful and the last category, Learning to live with chest pain described the program as a tool for gaining the strength and skills to live a normal life despite chest pain. Conclusions The program was experienced as an opportunity to return to a normal life. The program was perceived as helpful, trustworthy and useful, which helped the participants challenge their fear of chest pain and death, and gain strength and new insights into their ability to live a normal life. Relevance to Clinical Practice A tailored internet-delivered cognitive behavioural therapy program delivered by a nurse therapist with clinical experience of the patient group is important to improve cardiac anxiety. Patient or Public Contribution Patients or the general public were not involved in the design, analysis or interpretation of the data of this study, but two patients with experience of non-cardiac chest pain were involved, Funding Agencies|Kamprad Family Foundation [ISV-2018-00033]; Region Ostergotland [RO-938360]

Background: Patients with recurrent episodes of noncardiac chest pain (NCCP) experience cardiac anxiety as they misinterpret the pain to be cardiac related and avoid physical activity that they think could threaten their lives. Psychological interventions, such as internet-delivered cognitive behavioral therapy (iCBT), targeting anxiety can be a feasible solution by supporting patients to learn how to perceive and handle their chest pain. Objective: This study aims to evaluate the effects of a nurse-led iCBT program on cardiac anxiety and other patient-reported outcomes in patients with NCCP. Methods: Patients with at least two health care consultations because of NCCP during the past 6 months, and who were experiencing cardiac anxiety (Cardiac Anxiety Questionnaire score >= 24), were randomized into 5 weeks of iCBT (n=54) or psychoeducation (n=55). Patients were aged 54 (SD 17) years versus 57 (SD 16) years and were mainly women (32/54, 59% vs 35/55, 64%). The iCBT program comprised psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments. The primary outcome was cardiac anxiety. The secondary outcomes were fear of bodily sensations, depressive symptoms, health-related quality of life, and chest pain frequency. Intention-to-treat analysis was applied, and the patients were followed up for 3 months. Mixed model analysis was used to determine between-group differences in primary and secondary outcomes. Results: No significant differences were found between the iCBT and psychoeducation groups regarding cardiac anxiety or any of the secondary outcomes in terms of the interaction effect of time and group over the 3-month follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen d=0.31). In the iCBT group, 36% (16/44) of patients reported a positive reliable change score (>= 11 points on the Cardiac Anxiety Questionnaire), and thus an improvement in cardiac anxiety, compared with 27% of (13/48) patie, Funding Agencies|Kamprad Family Foundation [ISV-2018-00033]

Aims and objectives To investigate patients’ experiences of being involved in their care in the emergency department (ED). Background Previous research shows that when patients experience involvement during care visits, this increased their trust in the care, gave a sense of control and promoted their autonomy. Design A qualitative descriptive design with semi‐structured interviews, using the "Consolidated criteria for reporting qualitative research" (COREQ) checklist. Methods Using convenience sampling, semi‐structured interviews were conducted with 16 patients in the ED. Results The study identified four categories: attention and inattention; communication and understanding; varying levels of participation; and inefficient and inaccessible care. The results show that patients expected to be treated with respect and to be involved in an open dialogue about their care. Patients’ experiences of participation were related to their sense of control. Conclusions Based on the results of the study, the authors found that factors such as dialogue, information, attention and participation affected the patients’ involvement during the ED visit. Experiences of involvement and control were linked to patients’ experiences of care and of patients as individuals. Relevance to clinical practice Healthcare providers’ awareness of the importance of paying attention to the patient as an individual, and of the need for simple, continuous communication could facilitate patient involvement in own care.