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- Thulesius, Hans, et al.
(författare)
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Pluralistic retasking. Re-thinking cancer diagnostics from a primary care physician perspective. A grounded theory study.
- 2020
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Ingår i: Core values of family medicine: Threats and opportunities. - : WONCA.
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Konferensbidrag (refereegranskat)abstract
- BackgroundCancer diagnostics is heterogeneous depending on disease type, age, gender, socioeconomical and geographical contexts of patients and caregivers.QuestionsHow could cancer be diagnosed in a more timely way from a primary care perspective?MethodsData from 1752 primary care physician (PCP) respondents in 20 countries and 20 Spanish and 7 Swedish PCP interviewees 2013-2019 analysed with classic grounded theory, especially free text responses to “How do you think the speed of diagnosis of cancer in primary care could be improved?”. Secondary analysis of interviews and literature. OutcomesWe call PCP's ideas on improved cancer work-up pluralistic retasking: task shifting among physicians, nurses, assistants and secretaries involving task redistribution, task sharing, task collaboration, changing tasks – cancer fast tracks or cancer screening instead of cancer case finding when appropriate. Cognitive retasking involves both slow rational thinking in algorithms and fast intuitive thinking through gut feelings. Digital retasking bridges time and place by eHealth to reduce “elsewhereism” of experts and power symmetry issues between patient/caregiver. Shrinking gaps between and amongst patients and caregivers requires care restructuring and reallocation of funds. Care refinancing is thus necessary to improve diagnostic timeliness. Good cancer diagnostics needs good time management. Not too early (to avoid overdiagnosis) and never too late.DiscussionPluralistic retasking is a conceptual summary of multiple strategies needed to optimise the timeliness of cancer diagnostics.Take Home Message for PracticeCan I do something differently to diagnose cancer in a more timely way?
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| 2. |
- Thulesius, Hans, et al.
(författare)
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Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 39:4, s. 486-497
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore how cancer could be diagnosed in a more timely way. Design Grounded theory analysis of primary care physicians' free text survey responses to: 'How do you think the speed of diagnosis of cancer in primary care could be improved?'. Secondary analysis of primary care physician interviews, survey responses, literature. Setting Primary care in 20 European orenas Research Group countries. Subjects Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015-2019). Main outcome measures Conceptual explanation of how to improve timeliness of cancer diagnosis. Results Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing - among nurses, physicians, nurse assistants, secretaries, and patients - and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers, and clinicians. Financial task shifting that involves cost tracking followed by reallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early-stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late. Conclusions We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis.
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