Abstract
BackgroundPeople living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems.National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the “missing link” for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system.Methods/designThe study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.
Highlights
People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time
This is why providing safe and high-quality care and services requires a shift from a logic based on autonomy and independence to a logic of interdependence where teamwork allows for the exchange of knowledge and expertise [13] and for shared leadership that goes beyond the invisible walls between professions and organizations, and that includes PLCs [14, 15]
The case study, as a methodological approach, is appropriate when the analysis focuses on the dynamics of interaction between actors involved in an intervention in a given context [76]
Summary
People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time They are affected by the operation of professional and organizational silos. People living with and beyond cancer (PLC) need timely access to proven, coordinated, continuous care focused on their values and preferences [1,2,3]. They must receive care and services, concurrently or over time, from multiple professionals and practitioners working in various locations (ambulatory oncology clinics, hospitalization units, doctors’ offices, CLSCs, homes, palliative care residences) [4, 5]. Organizing in the form of an integrated network centred on PLCs is a logical choice
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