Providing Coordinated Cancer Care—A Qualitative Study of Norwegian Cancer Coordinators’ Experiences of Their Role

Healthcare professionals' perceptions of dignity-preserving care for older home-dwelling women with incurable cancer in Norway

Municipal end-of-life care for older home-dwelling patients with cancer is a complex matter requiring healthcare professionals (HCPs) to recognize gender differences in a social, historical and organizational context. A qualitative approach was chosen to explore and identify HCPs value-based principles and organizational conditions promoting dignity-preserving care practice for these women. HCPs recognized the importance of sheltering the women's identity, their sense of being home and acknowledged their personal preferences as value-based principles, whereas creating a flexible culture of care, establishing a functional professional collaboration and developing individualized plans of care, were crucial organizational conditions influencing the practice of dignity-preserving care.

Adapting and Going the Extra Mile: A Qualitative Study of Palliative Care in Rural Northern Norway From the Perspective of Healthcare Providers

BACKGROUND

Despite significant developments in palliative care in recent decades, we still find important differences in access to and delivery of care in rural Norway.

OBJECTIVE

The aim of this study was to explore what healthcare professionals consider necessary to provide equality in care for palliative patients in rural areas.

METHODS

A qualitative approach with focus group discussions and individual interviews with 52 health professionals was used, starting with 5 uniprofessional focus groups of general practitioners and nurses/cancer nurses, followed by 5 interprofessional groups and 6 individual interviews. Interview transcripts were analyzed thematically.

RESULTS

We found local variations in organization, competence and access to palliative care, and challenging geographical conditions. It was essential to be proactive, flexible and willing to go the extra mile, but this may conceal the need for a stronger focus on competence and organization of palliative care. Access to written guidelines and practical tools was important, as was forming palliative teams for particular situations.

CONCLUSIONS

Palliative care needs strengthening in rural areas, and increased competence for all healthcare professionals is vital to increase equality in care. Geographical conditions require locally adapted solutions. Access to guidelines and interprofessional collaboration are essential.

IMPLICATIONS FOR PRACTICE

Rural palliative care needs in Norway are improving, as exemplified by at least 1 cancer nurse assigned to each local authority, and access to guidelines and palliative tools and interprofessional collaboration.

"A limited focus on cancer rehabilitation"-A qualitative study of the experiences from Norwegian Cancer Coordinators in Primary Health Care

OBJECTIVE

The facilitation of complex cancer rehabilitation interventions in primary health care has become of growing importance to meet the bio-psycho-social needs of cancer survivors. However, the delivery of cancer rehabilitation is debated and services are underutilised. Cancer coordinators (CCs) provide patients with coordinated services throughout the trajectory. Little is known about CCs' rehabilitation-focused tasks. This study's objective was to explore Norwegian CCs' experiences with cancer rehabilitation interventions in primary health care.

METHODS

Data were obtained via two focus group interviews with 12 participants, analysed using thematic analysis and discussed using Salutogenesis, a theory for health promotion.

RESULTS

The analysis revealed three themes: (a) "A missing link" to cancer rehabilitation in primary health care, (b) Aiming to put cancer rehabilitation "in the spotlight," (c) The need to build a system for rehabilitation service delivery.

CONCLUSION

CCs experience a lacking focus on and missing systems for cancer rehabilitation in primary health care. CCs aim to improve local practices by advocating patients' needs and educating professionals. CCs must be supported via education and training in system-level work, an increased policy focus and resources for cancer rehabilitation. More research is required into how CCs may facilitate cancer rehabilitation in primary health care.

Scope of Practice, Role Legitimacy, and Role Potential for Cancer Care Coordinators

Objective:

The cancer care coordinator (CCC) role has become a priority in providing coordinated, patient-centered, supported care for patients, and their families experiencing cancer. The CCC role exists with heterogeneity across tumor streams, clinical disciplines, and institutions. This study explored CCCs perceptions and experiences of their role, scope of practice, and potential for future role development.

Methods:

This research used a mixed methods design. Focus groups and individual interviews were conducted with a purposive sample of 16 CCCs from two tertiary public teaching hospitals in Melbourne, Australia. A thematic analysis approach was used. A quantitative record of relative time spent on tasks was also collected.

Results:

Three major themes were identified: (1) Perceptions of role legitimacy, (2) Structure and funding of the role determines scope of practice, and (3) Reflections on the potential for the role. Variability was evident in predominant tasks undertaken, integration into the unit, level of patient contact, and regard from other professional colleagues. Variability appears to relate to employment time assigned to the role, and history and structure of the role.

Conclusions:

The findings underline the need when establishing and reviewing CCC roles for explicit attention to be given to the reporting, integration, structural, and collegiate support for the role as this will profoundly influence its success.