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The role of cancer coordinators in improving collaboration in cancer care at local levels following the coordination reform

Moshina, Nataliia
Master thesis
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URI
https://hdl.handle.net/10642/2251
Date
2014
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Abstract
The present study is devoted to one area of change in the Norwegian cancer care associated

with the Coordination Reform implemented in 2012. More specifically, my aim has been

to shed light on the role cancer coordinators play in cancer care provision at local levels.

This underlies both the theoretical presentation and the empirical study undertaken. Cancer

coordinator positions were initiated in many municipalities following the Coordination

Reform, as part of a trial project implemented by the Norwegian Cancer Society. The main

objectives of these positions were to facilitate an increased coordination of cancer care at

local levels, to optimize the level and timeliness of care for patients, their next-of-kin and

health personnel serving this population in municipalities. As such, implementing cancer

coordinator positions was a means to improve the provision of care and assistance for

cancer patients and their families in municipalities and to enhance the development and

maintenance of adequate collaboration between various municipal and non-municipal

health care professionals, organizations, services and institutions to ensure the best

possible practice in the area of cancer care (Kreftforeningen 2013). This thesis investigates

the theoretical backgrounds for the cancer coordinator initiative and describes the impact

of cancer coordinators’ activity on the provision of patient-centered care and cancer care

coordination, as viewed by the cancer coordinators themselves.

Utilizing a post-New Public Management framework in the theoretical examination allows

me to shed light on the explicit and more implicit backgrounds for the implementation of

cancer coordinators in municipalities, and to analyze various outcomes as expressed by

cancer coordinators in light of this theoretical approach. As the implementation of cancer

coordinator positions is inherently interconnected with the Coordination Reform, I have

included a brief discussion of this reform from the same theoretical perspective.

Post-New Public Management ideas are characterized by processes aimed to enhance both

horizontal and vertical coordination, resulting in greater cross-sectoral collaboration and

integration and focuses on value-based management and pro-active leadership (Ling 2002;

Alford 2002; Pollitt 2003; Stoker 2006; O’Flynn 2007; Christensen and Lægreid 2007).

The quantitative study has demonstrated that the implementation of the cancer coordinator

trial project in several Norwegian municipalities has had a positive impact on the provision

of patient-centered care and cancer care coordination, as viewed by the cancer coordinators themselves. In particular, the majority of cancer coordinators reported that they had good

or very good communication with cancer patients and were capable of meeting cancer

patients’ needs, ensuring a positive impact of their activities on the patients’ life situation.

Furthermore, cancer coordinators commonly used home-visits as a means of

communication with cancer patients and their next-of-kin. Cancer coordinators participated

in supervision and education of cancer patients and their families in the municipality at

least monthly. The majority of cancer coordinators denoted very good or good

collaboration with palliative care and cancer care nurses, oncological outpatient

departments, palliative care departments, nursing homes and cancer coordinators of other

municipalities and/or representatives of the Norwegian Cancer Society. Moreover, cancer

coordinators initiated and maintained collaborative actions with several concerned parties

in the municipalities by means of attending or arranging joint meetings at least monthly.

On the other hand, this study also revealed organizational and communication difficulties

within the area of cancer care, which need to be considered and resolved to further improve

the level of care and cancer care coordination. In particular, cancer coordinators denoted

that it was sometimes quite difficult or even not possible to communicate and collaborate

on cancer patients with general practitioners, NAV, schools and/or kindergartens. In

addition, the majority of cancer coordinators reported that better collaboration with general practitioners about new and existing cancer patients, as well as better interaction with

hospitals and municipal services, could make their work more effective.

Comparisons of the results from this empirical analysis with the results of studies

conducted in similar areas in national and international contexts indicate the presence of

common features, particularly with regard to the difficulties in maintaining an appropriate

level of coordination. A comparison of the obtained results with the results of the

evaluation report of the Norwegian Cancer Society shows that the results of the present

study are in line with those reported by the Norwegian Cancer Society.

Cancer coordinators have been shown to provide enhanced patient-centered care for cancer

patients and maintain cancer care coordination at local levels. However, the process of

cancer care coordination among services, institutions and organizations is considered

complicated and has been shown to exceed the resources available to cancer coordinators.

As a consequence, cancer coordinators’ interaction and collaboration with several health

care and municipal services need to be improved.
Description
Master i sosialt arbeid
Publisher
Oslo and Akershus University College

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