Grassroots inter-professional networks: the case of organizing care for older cancer patients

Factors That Affect Knowledge-Sharing Behaviors in Medical Imaging Departments in Cancer Centers: Systematic Review

BACKGROUND

Knowledge management plays a significant role in health care institutions. It consists of 4 processes: knowledge creation, knowledge capture, knowledge sharing, and knowledge application. The success of health care institutions relies on effective knowledge sharing among health care professionals, so the facilitators and barriers to knowledge sharing must be identified and understood. Medical imaging departments play a key role in cancer centers. Therefore, an understanding of the factors that affect knowledge sharing in medical imaging departments should be sought to increase patient outcomes and reduce medical errors.

OBJECTIVE

The purpose of this systematic review was to identify the facilitators and barriers that affect knowledge-sharing behaviors in medical imaging departments and identify the differences between medical imaging departments in general hospitals and cancer centers.

METHODS

We performed a systematic search in PubMed Central, EBSCOhost (CINAHL), Ovid MEDLINE, Ovid Embase, Elsevier (Scopus), ProQuest, and Clarivate (Web of Science) in December 2021. Relevant articles were identified by examining the titles and abstracts. In total, 2 reviewers independently screened the full texts of relevant papers according to the inclusion and exclusion criteria. We included qualitative, quantitative, and mixed methods studies that investigated the facilitators and barriers that affect knowledge sharing. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles and narrative synthesis to report the results.

RESULTS

A total of 49 articles were selected for the full in-depth analysis, and 38 (78%) studies were included in the final review, with 1 article added from other selected databases. There were 31 facilitators and 10 barriers identified that affected knowledge-sharing practices in medical imaging departments. These facilitators were divided according to their characteristics into 3 categories: individual, departmental, and technological facilitators. The barriers that hindered knowledge sharing were divided into 4 categories: financial, administrative, technological, and geographical barriers.

CONCLUSIONS

This review highlighted the factors that influenced knowledge-sharing practices in medical imaging departments in cancer centers and general hospitals. In terms of the facilitators and barriers to knowledge sharing, this study shows that these are the same in medical imaging departments, whether in general hospitals or cancer centers. Our findings can be used as guidelines for medical imaging departments to support knowledge-sharing frameworks and enhance knowledge sharing by understanding the facilitators and barriers.

Tenacious team, precarious patient: A phenomenological inquiry into interprofessional collaboration during ICU resuscitations

AIMS

The study aims to explore the lived experiences of interprofessional collaboration among ICU nurses, doctors, and respiratory therapists in managing resuscitations in the ICUs.

DESIGN

Descriptive phenomenological design, underpinned by Husserl's philosophy.

METHODS

ICU nurses, doctors and respiratory therapists who have experience in managing resuscitations with the interprofessional team were recruited through purposive sampling from April to December 2019. Sixteen ICU professionals participated in individual, semi-structured, in-depth interviews which were audio recorded, and transcribed verbatim. Findings were analysed using Colaizzi's 7-step analysis.

RESULTS

The essence of interprofessional collaboration during resuscitations can be described in four main themes. 'Ruminating about professional boundaries' signifies how ICU professionals acknowledged the roles and boundaries that surrounded their scope of practice during resuscitations. 'Rallying the interprofessional team' illustrates how the interprofessional team rapidly band together amongst the aid and hindrance of contextual enablers and inhibitors. 'Responding to interprofessional conflicts' depicts how intra- and interprofessional tensions can occur during resuscitations that can impact patient safety. 'Reaching collective leadership' proposes enhanced resuscitation care through the collective leadership of the interprofessional team.

CONCLUSION

Resuscitations represent a precarious turn of events for the critically ill patient where the interprofessional team undergoes a cyclic sequence of teamwork and conflict while attempting to drive the resuscitation into a positive outcome. As ICU professionals attempt to optimise interprofessional collaboration during resuscitations, findings call for enhanced team training initiatives encompassing the interprofessional team, with an emphasis on collective leadership.

IMPACT

ICU professionals experience of interprofessional collaboration during resuscitations is poorly understood. By understanding their lived experience, targeted interventions to improve interprofessional collaboration can be conceptualised and implemented. Findings will set pace for future evaluation research on interprofessional collaboration and patient outcomes during resuscitations.

Personalised treatment for older adults with cancer: The role of frailty assessment

It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.

Implementation of geriatric assessment in oncology settings: A systematic realist review

Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.

Healthcare professionals' perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care

OBJECTIVE

The purpose of this study is to describe the pre-requisites and realisation of interprofessional collaboration as perceived by healthcare professionals working in the cancer care setting and to produce knowledge to support the development of collaborative practices.

METHODS

This study employed a descriptive survey design. The data were collected in one Finnish cancer centre between May and October 2018 from nurses, physicians and other healthcare professionals using an electronic survey (n = 350). The survey focused on the pre-requisites of interprofessional collaboration (appreciation and competence) and its realisation in cancer care. The data were analysed using descriptive and interferential statistics.

RESULTS

The pre-requisites of interprofessional collaboration were perceived as good and the collaboration was well realised in the cancer centre. The perceptions of pre-requisites and realisation were associated with each other. Male respondents, physicians and professionals belonging to interprofessional teams had more positive perceptions of the pre-requisites and realisation of interprofessional collaboration than others.

CONCLUSION

The findings indicate that the pre-requisites of interprofessional collaboration and its realisation seem to be well implemented in the cancer care setting. However, the ongoing evaluation of interprofessional collaboration requires further attention from healthcare administration and professionals to support the systematic development of collaborative practices.

Collaborative governance as a policy strategy in healthcare

Purpose

The purpose of this paper is to examine the enactment of collaborative governance as a policy strategy in healthcare – in particular its effects in coordinating multiple collaborative initiatives dedicated to improve the performance of health organizations. It studies overarching governance mechanisms that serve as platforms at a meta-level between policy and frontline practice.

Design/methodology/approach

Four collaborative governance arrangements dedicated to improve health outcomes in the Netherlands are analyzed in a comparative case-study design, based on extensive document analysis (n=121) and interviews (n=56) with key stakeholders in the field, including the Dutch Ministry of Health, health organizations and other actors.

Findings

The studied policy-based governance mechanisms for the coordination of multiple micro-level collaborative initiatives function partly as platforms in bringing actors and resources together successfully. They do so, by fostering evolvability (the capacity to generate diversity in emergent ways) in relation to goal-setting and intermediation between actors. Yet, they marginalize open access to participants through high selectivity and deliberate exclusion strategies for certain actors, contrary to a platform logic of action.

Research limitations/implications

While the collaborative governance literature focuses on these dimensions as independent elements, findings reveal both trade-offs and interdependencies between studied dimensions of coordination associated with platforms, that need to be negotiated and managed.

Practical implications

Selectivity and exclusion in collaborative arrangements may negatively affect relational bonds and ties between actors, which challenges the application of collaborative governance as a policy strategy in pursuit of health objectives.

Originality/value

Responding to recent calls in the literature, this study applies ideas from public administration to the field of health organization and management to avert failures in the translation of policy ambitions into health practice.