Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care
Abstract Background How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the d...
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2020
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crspringernat:10.1186/s12913-020-4893-4 2023-05-15T17:45:14+02:00 Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care Hultstrand, Cecilia Coe, Anna-Britt Lilja, Mikael Hajdarevic, Senada Västerbotten Läns Landsting The Strategic Research Program in Care Sciences JC Kempe's foundation 2020 http://dx.doi.org/10.1186/s12913-020-4893-4 http://link.springer.com/content/pdf/10.1186/s12913-020-4893-4.pdf http://link.springer.com/article/10.1186/s12913-020-4893-4/fulltext.html en eng Springer Science and Business Media LLC http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ CC-BY BMC Health Services Research volume 20, issue 1 ISSN 1472-6963 Health Policy journal-article 2020 crspringernat https://doi.org/10.1186/s12913-020-4893-4 2022-01-04T15:21:29Z Abstract Background How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). Methods Participant observations of patient-provider encounters ( n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. Results One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. Conclusions Patients and GPs seem to be mutually dependent on each other and both patients’ expertise and GPs’ medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients’ needs as to standardized routines as CPPs. Article in Journal/Newspaper Northern Sweden Springer Nature (via Crossref) BMC Health Services Research 20 1 |
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Springer Nature (via Crossref) |
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English |
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Health Policy |
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Health Policy Hultstrand, Cecilia Coe, Anna-Britt Lilja, Mikael Hajdarevic, Senada Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care |
topic_facet |
Health Policy |
description |
Abstract Background How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). Methods Participant observations of patient-provider encounters ( n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. Results One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. Conclusions Patients and GPs seem to be mutually dependent on each other and both patients’ expertise and GPs’ medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients’ needs as to standardized routines as CPPs. |
author2 |
Västerbotten Läns Landsting The Strategic Research Program in Care Sciences JC Kempe's foundation |
format |
Article in Journal/Newspaper |
author |
Hultstrand, Cecilia Coe, Anna-Britt Lilja, Mikael Hajdarevic, Senada |
author_facet |
Hultstrand, Cecilia Coe, Anna-Britt Lilja, Mikael Hajdarevic, Senada |
author_sort |
Hultstrand, Cecilia |
title |
Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care |
title_short |
Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care |
title_full |
Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care |
title_fullStr |
Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care |
title_full_unstemmed |
Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care |
title_sort |
negotiating bodily sensations between patients and gps in the context of standardized cancer patient pathways – an observational study in primary care |
publisher |
Springer Science and Business Media LLC |
publishDate |
2020 |
url |
http://dx.doi.org/10.1186/s12913-020-4893-4 http://link.springer.com/content/pdf/10.1186/s12913-020-4893-4.pdf http://link.springer.com/article/10.1186/s12913-020-4893-4/fulltext.html |
genre |
Northern Sweden |
genre_facet |
Northern Sweden |
op_source |
BMC Health Services Research volume 20, issue 1 ISSN 1472-6963 |
op_rights |
http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ |
op_rightsnorm |
CC-BY |
op_doi |
https://doi.org/10.1186/s12913-020-4893-4 |
container_title |
BMC Health Services Research |
container_volume |
20 |
container_issue |
1 |
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1766148080207396864 |