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Peter Vedsted

Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Hans Thulesius, Lund University, Region Kronoberg, Linnaeus University
  • ,
  • Ulrika Sandén, Lund University
  • ,
  • Davorina Petek, Univ Ljubljana, University of Ljubljana, Dept Psychol
  • ,
  • Robert Hoffman, Tel Aviv University (TAU), Tel Aviv
  • ,
  • Tuomas Koskela, Tampere University Hospital and University of Tampere, Tampere, Finland.
  • ,
  • Bernardino Oliva-Fanlo, Department of Primary Health Care
  • ,
  • Ana Luísa Neves, Imperial College London, University of Porto
  • ,
  • Senada Hajdarevic, Umeå University
  • ,
  • Lars Harrysson, Lund University
  • ,
  • Berit Skjodeborg Toftegaard
  • Peter Vedsted
  • Michael Harris, University of Bern, University of Exeter
  • ,
  • Örenäs Research Group

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 Örenäs 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.Key pointsCancer diagnosis is under-researched in primary care, especially theoretically. Thus, inspired by classic grounded theory, we analysed and conceptualised the field:Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians.This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires cognitive task shifting emphasising learning, and digital task shifting involving the use of eHealth and telemedicine.Financial task shifting with cost tracking and reallocation of funds is eventually necessary for successful pluralistic task shifting to happen.

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Primary Health Care
Vol/bind39
Nummer4
Sider (fra-til)486-497
Antal sider12
ISSN0281-3432
DOI
StatusUdgivet - okt. 2021

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