RESUMO
AIMS: To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. METHODS: A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. RESULTS: We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self-management requires a trustful PWD-HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self-manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence-based guidelines are important but can detract from personalised care. CONCLUSION: We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals.
Assuntos
Atitude do Pessoal de Saúde , Diabetes Mellitus Tipo 2/terapia , Objetivos , Pessoal de Saúde/normas , Pesquisa Qualitativa , Telemedicina/métodos , Humanos , Grupo Associado , Apoio SocialRESUMO
PURPOSE: Breast cancer-related lymphedema is a common and debilitating side effect of cancer treatment. This randomized trial compared the effect of progressive resistance- or aerobic-based exercise on breast cancer-related lymphedema extent and severity, as well as participants' muscular strength and endurance, aerobic fitness, body composition, upper-body function, and quality of life. METHODS: Women with a clinical diagnosis of stable unilateral, upper-limb lymphedema secondary to breast cancer were randomly allocated to a resistance-based (n = 21) or aerobic-based (n = 20) exercise group (12-wk intervention). Women were assessed preintervention, postintervention, and 12 wk postintervention, with generalized estimating equation models used to compare over time changes in each group's lymphedema (two-tailed P < 0.05). RESULTS: Lymphedema remained stable in both groups (as measured by bioimpedance spectroscopy and circumferences), with no significant differences between groups noted in lymphedema status. There was a significant (P < 0.01) time-group effect for upper-body strength (assessed using four to six repetition maximum bench press), with the resistance-based exercise group increasing strength by 4.2 kg (95% confidence interval [CI] = 3.2-5.2) postintervention compared with 1.2 kg (95% CI = -0.1 to 2.5) in the aerobic-based exercise group. Although not supported statistically, the aerobic-based exercise group reported a clinically relevant decline in number of symptoms postintervention (-1.5, 95% CI = -2.6 to -0.3), and women in both exercise groups experienced clinically meaningful improvements in lower-body endurance, aerobic fitness, and quality of life by 12-wk follow-up. DISCUSSION: Participating in resistance- or aerobic-based exercise did not change lymphedema status but led to clinically relevant improvements in function and quality of life, with findings suggesting that neither mode is superior with respect to lymphedema effect. As such, personal preferences, survivorship concerns, and functional needs are important and relevant considerations when prescribing exercise mode to those with secondary lymphedema.