| dc.description.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. | en_US |
