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Article
Publication date: 1 March 2006

Brenda Leese, Phil Heywood, Victoria Allgar, Reg Walker, Aamra Darr and Ikhlaq Din

Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary…

Abstract

Purpose

Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative.

Design/methodology/approach

A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses.

Findings

PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue.

Originality/value

The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

Details

Journal of Health Organization and Management, vol. 20 no. 2
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 15 January 2021

Tre Wentling, Carrie Elliott, Andrew S. London, Natalee Simpson and Rebecca Wang

Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to…

Abstract

Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to and experiences of “sex-specific” cancer screenings (SSCS) (e.g., breast and prostate exams, Pap smears) in the North American healthcare system.

Design/Methodology/Approach: We analyze data from semistructured interviews with a diverse sample of 35 transgender-identified adults. Based on thematic narrative analysis, we explore four themes in relation to embodiment: discrimination; discomfort and hyperawareness of genitalia; strategic reframing and active management; and SSCS health care encounters as positive and gender affirming.

Findings: In relation to SSCS, transgender individuals experience discrimination, do emotion work, and actively manage situations to obtain needed health care, and sometimes forego care because barriers are insurmountable. Health care providers' responses to transgender embodiment can disrupt health care encounters, but they can also facilitate access and create opportunities for affirmation, agency, advocacy, and new forms of interaction. Embodiment- and gender-affirming interactions with health care providers, which varied by gender, emerged as key influences on participants' experiences of SSCS.

Research Limitations/Implications: Our sample primarily includes binary gender-identified individuals, and while our interview guide covered many topics, the SSCS question did not explicitly reference testicular exams.

Practical Implications: Cancer prevention and detection Cancer prevention and detection require health care professionals who are prepared for differently embodied persons. Preventive cancer screenings are not “sex-specific”; they are relevant to individuals with medically necessary needs regardless of gender identity or embodiment.

Social Implications

Originality/Value: Few medical sociologists have focused on transgender embodiment. Findings enhance our understanding of how transgender embodiment and minority stress processes influence access to needed SSCS.

Details

Sexual and Gender Minority Health
Type: Book
ISBN: 978-1-83867-147-1

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Article
Publication date: 3 November 2020

Yasemın Özyer and Safiye Yanmış

This review, which was created specifically for cancer care by reviewing the literature, was prepared to provide suggestions for determining the current difficulties in…

Abstract

Purpose

This review, which was created specifically for cancer care by reviewing the literature, was prepared to provide suggestions for determining the current difficulties in cancer care during COVID-19 outbreak and managing these difficulties. It is thought that this review can contribute to the identification of deficiencies related to the subject, to create interest in this issue in our country and in the world and to guide patients in the care during the COVID-19 pandemic process.

Design/methodology/approach

The literature search was carried out using the following electronic seven databases. Search terms used included: “COVID-19”, “management of cancer care” and “cancer care”. Articles meeting the following criteria were included in the current review: articles published in English, articles published in peer-reviewed journals and articles and guidelines published in 2020, articles suggesting management of cancer care during the COVID-19 outbreak.

Findings

The findings suggest that new guidelines need to be created to assess the level of problems in cancer treatment and in hospital, to respond appropriately with the best available resources during COVID-19 outbreak.

Originality/value

This paper seeks to provide suggestions for determining the current difficulties in cancer care during COVID-19 outbreak and managing these difficulties. By doing so, it is believed the suggestions presented will contribute significantly to the quality of cancer care during COVID-19 outbreak.

Details

International Journal of Emergency Services, vol. 10 no. 1
Type: Research Article
ISSN: 2047-0894

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Article
Publication date: 9 October 2017

Loyd S. Pettegrew

Health care organizational research should pay greater attention to the specific settings where health is practiced. An ethnographic account of humor, ritual and defiance…

Abstract

Purpose

Health care organizational research should pay greater attention to the specific settings where health is practiced. An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center. A thick description of the setting and interaction among center staff and patients is offered in an attempt to establish why qualitative research of health care settings is so important. Findings are compared to Ellingson’s work on health care setting. Humor, ritual and defiance have therapeutic value and deserve greater attention in cancer treatment centers and health care organizations more broadly. The paper aims to discuss these issues.

Design/methodology/approach

An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center through thick description.

Findings

This study reinforces the literature on the value of institutionalizing humor and ritual to improve patients’ experience in cancer care given the dominance of large public institutions, most easily accessed by academic researchers. Suncoast Coast Radiation Center’s “institutionalized humor” is an important finding that should be examine further. Scholarship can also illuminate the use of ritual in settings where health care is practiced.

Research limitations/implications

This study is limited to a particular research setting which is a private, concierge care radiation oncology treatment center in the Southeastern USA.

Practical implications

Cancer care centers should consider carefully institutionalizing humor and ritual into their daily practices. Further, patient defiance should be reinterpreted not as a patient deficiency but as a therapeutic coping mechanism by patients.

Social implications

While nearly half of cancer care in the USA is offered in private, for-profit institutions, the vast majority of the understanding of cancer care comes only from non-profit and government-run institutions. Shining a light of these neglected cancer care settings will add to the understanding and the ability to improve the care offered to patients.

Originality/value

This is the first health ethnography in a concierge care, cancer care treatment setting. It tests the proposition that humor, ritual and defiance play an important role in a private concierge cancer care organization.

Details

Journal of Organizational Ethnography, vol. 6 no. 3
Type: Research Article
ISSN: 2046-6749

Keywords

Content available
Article
Publication date: 24 March 2021

Syaribah Noor Brice, Paul Harper, Tom Crosby, Daniel Gartner, Edilson Arruda, Tracey England, Emma Aspland and Kieran Foley

The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of…

Abstract

Purpose

The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies.

Design/methodology/approach

The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature.

Findings

The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency.

Originality/value

As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 18 September 2018

Katherine S. Virgo, Chun Chieh Lin, Amy Davidoff, Gery P. Guy, Janet S. de Moor, Donatus U. Ekwueme, Erin E. Kent, Neetu Chawla and K. Robin Yabroff

To examine associations by gender between cancer history and major health insurance transitions (gains and losses), and relationships between insurance transitions and…

Abstract

Purpose

To examine associations by gender between cancer history and major health insurance transitions (gains and losses), and relationships between insurance transitions and access to care.

Methodology

Longitudinal 2008–2013 Medical Expenditure Panel Survey data were pooled yielding 2,223 cancer survivors and 50,692 individuals with no cancer history ages 18–63 years upon survey entry, with gender-specific sub-analyses. Access-to-care implications of insurance loss or gain were compared by cancer history and gender.

Findings

Initially uninsured cancer survivors were significantly more likely to gain insurance coverage than individuals with no cancer history (RR: 1.25; 95% CI: 1.08–1.44). Females in particular were significantly more likely to gain insurance (unmarried RR: 1.16; 95% CI: 1.06–1.28; married RR: 1.09; 95% CI: 1.02–1.16). Significantly higher rates of difficulty accessing needed medical care and prescription medications were reported by those remaining uninsured, those who lost insurance, and women in general. Remaining uninsured, losing insurance, and male gender were associated with lack of a usual source of care.

Research implications

Additional outreach to disadvantaged populations is needed to improve access to affordable insurance and medical care. Future longitudinal studies should assess whether major Affordable Care Act (ACA) provisions enacted after the 2008–2013 study period (or those of ACA’s replacement) are addressing these important issues.

Originality

Loss of health insurance coverage can reduce health care access resulting in poor health outcomes. Cancer survivors may be particularly at risk of insurance coverage gaps due to the long-term chronic disease trajectory. This study is novel in exploring associations between cancer history by gender and health insurance transitions, both gains and losses, in a national non-elderly adult sample.

Details

Gender, Women’s Health Care Concerns and Other Social Factors in Health and Health Care
Type: Book
ISBN: 978-1-78756-175-5

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Book part
Publication date: 12 August 2014

Tony Huzzard, Andreas Hellström, Svante Lifvergren and Nils Conradi

This chapter presents a framework for an action research based intervention to develop and transform sustainable healthcare in a regional context. The framework is…

Abstract

Purpose

This chapter presents a framework for an action research based intervention to develop and transform sustainable healthcare in a regional context. The framework is illustrated by the case of the Regional Cancer Centre (RCC) West in western Sweden.

Design/methodology/approach

The framework draws upon and develops Pettigrew’s context–content–process model of strategic change and applies it to the unfolding narrative of the change effort. The empirical focus is the activities of a learning platform consisting of the RCC leadership, senior cancer physicians designated as process owners and an action research team. Data were collected from documents, observations of the learning platform, notes from meetings and interviews. Outcome data were obtained via the self-reporting of the physicians.

Findings

The learning platform established the capability for wide ranging development and quality improvement on the 23 cancer pathways as well as some support activities around principles of patient-centred care. A clear result is greater inter-organisational collaboration between care professionals as well as the introduction of new medicines, clinical methods, joint learning activities and new forms of measurement and monitoring of care practices. All of the improved measures are sustained.

Originality/value

Whilst there is no shortage of rhetoric on patient-centred care, the reality is that in complex healthcare systems solutions such as process-oriented approaches often fail. This case presents a model and an approach that eschews clear visions for change and instead places an emphasis on dialogue, participation, professional autonomy and collaborative communities as means for achieving the patient-centred ideal. The case also shows the value of seeing sustainable health systems as being grounded on practitioner–scholar collaboration that combines practical knowing with scientific knowledge.

Details

Reconfiguring the Ecosystem for Sustainable Healthcare
Type: Book
ISBN: 978-1-78441-035-3

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Article
Publication date: 10 August 2020

Judith Fletcher-Brown, Diane Carter, Vijay Pereira and Rajesh Chandwani

Knowledge is a key success factor in achieving competitive advantage. The purpose of this paper is to examine how mobile health technology facilitates knowledge management…

Abstract

Purpose

Knowledge is a key success factor in achieving competitive advantage. The purpose of this paper is to examine how mobile health technology facilitates knowledge management (KM) practices to enhance a public health service in an emerging economies context. Specifically, the acceptance of a knowledge-resource application by community health workers (CHWs) to deliver breast cancer health care in India, where resources are depleted, is explored.

Design/methodology/approach

Fieldwork activity conducted 20 semi-structured interviews with frontline CHWs, which were analysed using an interpretive inductive approach.

Findings

The application generates knowledge as a resource that signals quality health care and yields a positive reputation for the public health service. The CHW’s acceptance of technology enables knowledge generation and knowledge capture. The design facilitates knowledge codification and knowledge transfer of breast cancer information to standardise quality patient care.

Practical implications

KM insights are provided for the implementation of mobile health technology for frontline health-care professionals in an emerging economies context. The knowledge-resource application can deliver breast cancer care, in localised areas with the potential for wider contexts. The outcomes are valuable for policymakers, health service managers and KM practitioners in an emerging economies context.

Social implications

The legacy of the mobile heath technology is the normalisation of breast cancer discourse and the technical up-skilling of CHWs.

Originality/value

First, this paper contributes three propositions to KM scholarship, in a public health care, emerging economies context. Second, via an interdisciplinary theoretical lens (signalling theory and technology acceptance model), this paper offers a novel conceptualisation to illustrate how a knowledge-resource application can shape an organisation’s KM to form a resource-based competitive advantage.

Details

Journal of Knowledge Management, vol. 25 no. 3
Type: Research Article
ISSN: 1367-3270

Keywords

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Article
Publication date: 15 June 2015

Isabelle Brault, Jean-Louis Denis and Terrence James Sullivan

Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The…

Abstract

Purpose

Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation.

Design/methodology/approach

The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario’s cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations.

Findings

From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives.

Practical implications

To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers.

Originality/value

This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

Details

Journal of Health Organization and Management, vol. 29 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 8 April 2014

Tim Shaw, Deborah McGregor, Sue Sinclair, Robert Sutherland, Ana Munro and Jackie Ross

Cancer care is complex and an integrated cancer pathway involves many health professionals in a variety of care settings using many skills. The widely distributed and…

Abstract

Purpose

Cancer care is complex and an integrated cancer pathway involves many health professionals in a variety of care settings using many skills. The widely distributed and heterogeneous nature of the cancer workforce raises significant challenges with respect to professional development. Cancer Learning is a government-funded initiative designed to provide access to a wide range of quality online learning resources for all health care professionals involved in the care of cancer patients and their families. The purpose of this paper is to discuss these issues.

Design/methodology/approach

A multi-phase project, led by a consortium of national stakeholders in cancer care, informed the design, build, and deployment of Cancer Learning; an online, evidence based, information and learning portal to support professional development of health professionals across the continuum of cancer care in Australia. An action research approach allowed for an iterative process of ongoing dynamic evaluation and improvement of this workforce improvement resource.

Findings

The National Government Agency, Cancer Australia's Cancer Learning online hub has been supporting the professional development requirements of cancer care professionals since the site deployment in 2007. Since launch, site usage continues to grow and evaluations have been positive. Time constraints of health professionals continue to be a major barrier to sustained online learning participation.

Originality/value

This research recount of the development and implementation of an Australia first national online learning initiative highlights the rigorous approach undertaken for the delivery of a quality evidence-based resource for the professional development of all health professionals involved in the delivery of cancer care.

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