The ability of a patient to access physiotherapy directly (patient self-referral), although used widely in the private sector, is not the mechanism in use within the NHS where there exists a system of open access controlled by doctors. This study aimed to develop, implement and investigate a direct access physiotherapy service within a primary care setting in a health district of Scotland. The service was introduced and compared to the existing system of open access over a twelve-month period (1997-1998). Demographic and clinical data was collected relating to two samples: Control Year Group: All GP referrals for a year prior to the study year collected retrospectively. Study Year Group: General practitioner (GP) and direct access (DA) referrals. All patients were followed up one-month after discharge, and the number of associated GP consultations collated together with patient, physiotherapist, general practitioner and service non-user views of physiotherapy generally and direct access specifically. There were similar numbers of referrals (339 vs. 340) with no significant differences with regard to patient age or gender between the Control and Study Year Groups. The Study Year Group however revealed significant differences between DA and GP referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total referrals in comparison to 77.6% GP referrals. DA patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, who were more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care. This group also demonstrated a greater confidence in knowing when to access physiotherapy and were highly supportive of the effectiveness of physiotherapy. DA patients also consulted their general practitioner significantly less often than GP referrals (p = 0.001). Support for direct access was strongly expressed by service users and nonusers, physiotherapists and general practitioners. Direct access to physiotherapy is an example of an innovative, flexible approach to primary care service provision encouraged by current health policy.

Bakgrund: Kolorektalcancer är en av världens vanligaste cancersjukdomarna i världen. Sjuksköterskans roll när en patient får ett diagnosbesked är att stötta, informera och lyssna. Sjuksköterskor upplever dock svårigheter med att bemöta patienter i samband med diagnsobeskedet. Svårigheter sjuksköterskan uppelver är att ge tillräckligt med stöd och information samtidigt som distansen bibehålls till patienten. I omvårdnadsforskningen idag finns stora brister i kunskapen gällande hur diagnosbeskedet påverkar individen. Syfte: Syftet var att belysa patienter upplevelser i samband att diagnostiseras med kolorektalcancer. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Resultat: Resultatet bestod av tio vetenskapliga artiklar och presenterades i tre katergorier: Blandade upplevelser av diagnosen, Behovet av stöd och Behovet av tydlig kommnikation. Vid diagnos upplevde patienter chock, ilska och förnekelse, för att sedan komma till acceptans av sjukdomen. Patienterna konfronterades också med sin egen dödlighet. Resultaet visade även att patienterna upplevde kommunikationen från hälso-och sjukvården väldigt varierande. Stödet från både anhöriga och hälso-och sjukvårdspersonalen var viktig för att orka. Slutsats: Litteraturstudien belyser sårbarheten hos de patienter som får diagnosen kolorektalcancer, vilka tankar och känslor ett allvarligt diagnosbesked väcker. Resultatet kan öka sjuksköterskors kunskap om patienters upplevelser av att diagnostiseras av kolorektalcancer, vilket kan hjälpa dem att ge patienterna ett bättre bemötande. / Background: Colorectal cancer is one of the most common cancer diseases in the world. The nurse´s role when the patient receives the diagnosis is to support, inform and listen. Hoewver, nurses experince difficulties to meet the patients in connection with diagnosis. Difficulties the nurses are experiencing  is to give sufficient support and information and still maintain a distance to the patient. In nursing research today there are major shortcomings in the knowledge regarding how the diagnosis decision affects the indivdual. Aim: THe aim was to highlight patients experiences associated with being diagnosed with colorectal cancer. Method: The study was conducted as a general literature study with an inductive approach. Results: The results consisted of ten scientific articles and were presented in three categories: Mixed experiences of the diagnosis, The need for support and The need for clear communication. At diagnosis, patients experienced schock, anger, and denial, and then to come to acceptance of the disease. Patients were also confronted with there own mortaality. The results also showed that patients experienced communication from the health care system very varied. The support was important of both relatives and the healht care professionals was important for coping. Conclusion: The literature study highlights the vulnerability of patients diagnosed with colorectal cancer, which  thoughts, and feelings a serious diagnosis raises. The result may increase knowledge of patients experiences of being diagnosed with colorectal cancer, and what thoughts and feelings a serious diagnosis raises. Ther result can increase nurses knowledge of patients experiences of being diagnosed with colorectal cancer, whitch can help them provide patients with a better treatment.