Aims and objectives: To explore endometrial cancer patients’ perceptions of the disease and the influence of favourable prognoses on their experiences.Background: Endometrial cancer is associated with favourable prognoses, which may imply that patients experience distress to a lesser extent than other cancer patients with less positive treatment outcomes. However, most people with cancer report reduced quality of life and, despite endometrial cancer being prevalent worldwide, experiences of the disease have been little explored.Design: Ethnographic fieldwork with participant observations and interviews.Methods: Observations during clinical consultations at two Danish hospitals and interviews with women with endometrial cancer (n = 18) over a period of 6 months. The article adheres to the COREQ guidelines for reporting qualitative research.Results: We identify how patients consider cancer in general very likely to be fatal, while clinicians in contrast characterise endometrial cancer specifically as “good” because of favourable prognoses. We employ the concept of bricolage to illustrate how bits and pieces of biomedical knowledge and statistical evidence become intertwined with patients’ past experiences and subjective ways of knowing, suggesting that patients’ perceptions of endometrial cancer as a disease are somewhat dynamic.Conclusions: Public stories and everyday life experiences of cancer provide a central framework for illness perceptions. As a result, patients retain the idea of a close connection between cancer and death, while also adopting the notion of endometrial cancer as “good”. This influenced how women responded to treatment and care. Framing endometrial cancer as “good” is not always helpful, as the impact of a cancer diagnosis per se is rarely favourable.Relevance to clinical practice: In providing women with endometrial cancer with optimal support through diagnosis and treatment, clinicians should attend to the complexity of patients’ illness understandings and be aware that assuring patients of a good prognosis not always has the expected impact.

Background: Vocational school students exhibit significant risk behaviors in terms of poor diet, frequent use of nicotine products, inadequate fruit and vegetable intake, low levels of physical activity, and poor mental health. This makes vocational students vulnerable to the development of noncommunicable diseases. Therefore, effective health promotion programs targeting vocational students are required. Objective: The Danish study “Data-driven and Systems Approach to Health Promotion Among Vocational Students” (Data Health) aims to develop, implement, and evaluate a systems approach to support vocational schools, municipalities, and local communities in implementing locally relevant health promotion actions among and for vocational students. This paper describes the Data Health program and how implementation and preliminary effectiveness will be evaluated. Methods: The Data Health program offers an iterative 5-step process to develop changes in the systems that shape health behavior and well-being among vocational students. The program will be implemented and evaluated in 8 Danish vocational schools in 4 municipalities. The implementation of the process and actions will be explored using a systems-based evaluation design that assesses contextual differences and the mechanisms through which the program leads to changes in the systems. Preliminary effectiveness at the individual level (students’ self-reported health behavior and well-being) and organizational level (school organizational readiness reported by school staff) will be assessed using a quasi-experimental design, and cross-sectional data will be collected at all 8 schools simultaneously 4 times during the 2-year study period. Results: This study was launched in 2021, and data collection is expected to be completed in June 2024. The first results are expected to be submitted for publication in January 2024. Conclusions: We expect that the Data Health study will make significant contributions to complex intervention research by contributing to the paucity of research studies that have used systems approaches in school settings. The study will also provide evidence of successful elements for systems change and effectiveness to determine whether a national scale-up can be recommended. Trial Registration: ClinicalTrials.gov NCT05308459; https://clinicaltrials.gov/study/NCT05308459 International Registered Report Identifier (IRRID): DERR1-10.2196/52571

Early diagnosis and rapid treatment are deemed essential in relation to cancer. In 2007, Denmark implemented accelerated cancer patient pathways with predetermined time frames to reduce waiting time. In this article, based on fieldwork with observations at two hospitals and ethnographic interviews, we examine temporal experiences of the cancer patient pathway for endometrial cancer of the uterus at stage I. Results show that while the cancer patient pathway helps suspend thoughts of death it also brings a sense of timely confusion and concerns about whether disease has spread. This ambivalence is linked to a political discourse of cancer in general as acute and a clinical, biomedical framing of endometrial cancer in particular as “good” due to its slow growth. We demonstrate how women customize their temporal experiences to accelerate or decelerate time and argue that waiting is not necessarily a passive state. We emphasize the need for professionals to be aware that the cancer patient pathway time and subjective patient time are not always synchronized.

Background: Telemedicine may advance endometriosis care, but few initiatives are integrated in outpatient follow-up. A novel telemedicine approach—tele-patient-reported outcome measures (telePROM)—includes an endometriosis-specific questionnaire and phone and video consultations combined with text messaging (chat) with a multidisciplinary endometriosis team. This study explores how healthcare professionals experience telePROM and its integration in clinical practice. Methods: A qualitative study guided by interpretive description methodology. Data were generated through observations and focus group interviews conducted between January 2023 and March 2024 at a referral centre for endometriosis within a university hospital. A purposive sample of ten healthcare professionals comprising physicians, nurses and a medical secretary participated in the focus group interviews. Inductive analysis was inspired by interpretive description and carried out through an iterative process involving four steps, leading to the development of final themes and interpretation. Results: Three themes were identified from analysis: (1) Balancing Personalised Care With Increased Clinical Complexity; (2) Changing Professional Boundaries in a Digitally Supported Care Model; and (3) System Friction and Flexibility when Integrating TelePROM. Conclusions: Telemedicine improved endometriosis care by supporting patient-initiated and personalised consultations. However, sustainable, effective, and safe integration of telemedicine appears to require clinical experience, interdisciplinary collaboration, and supervision. Text communication (chat) proved to be an important element to ensure collection of additional information to complement patient-reported outcomes and it is essential for patient triage; yet it is rarely described in the literature. Ensuring organisational resilience during the digital transformation of healthcare requires ongoing training of healthcare professionals’ communicative and digital competences and may necessitate restructured technical support, including designated telemedicine experts in clinical practice to eliminate technical disruptions. These initiatives may contribute to and support the future implementation of telemedicine in healthcare.

Patient-Reported Outcome (PRO) measures supported by a severity algorithm may serve as a decision aid for triage and consultation in follow-up of patients with endometriosis. In a new follow-up regime, patients filled out an endometriosis-specific questionnaire (EQ) at home before outpatient consultation (tele-Patient-Reported Outcome Measures; telePROM). A severity algorithm was assigned patients' answers using a color code thereby reflecting the need of clinical attention. Our study aimed to assess the test-retest reliability of the severity algorithm and of the single items as well as to evaluate the face- and content validity of the EQ. The study was carried out in a referral endometriosis clinic at a Danish University Hospital. The validation was based on an initial version of the EQ, which was adjusted simultaneously with its severity algorithm, to meet the purpose of this study. Reliability was assessed by a test-retest setting of the questionnaire including patients with endometriosis, ≥ 18 years and Danish speaking. Kappa statistics and interclass correlation analyses were applied to assess test-retest reliability. Face- and content validity was explored by focus group interviewing of patients. In total, 14 patients answered the questionnaire twice. Results indicate that the EQ demonstrated substantial reliability in three out of five domain indicators in the severity algorithm and 65% of items with kappa values above 0.60. Further, focus-group interview of five patients resulted in adding an open-ended question regarding important issues to discuss at the consultation. TelePROM in outpatient follow-up of endometriosis is feasible as patients viewed the questionnaire relevant for their clinical follow-up. Yet, due to the small sample size results should be interpreted with caution. Further validation of the EQ is recommended.