Grassroots inter-professional networks: the case of organizing care for older cancer patients.

Purpose The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives. Design/methodology/approach This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions. Findings This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking. Practical implications Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts. Originality/value The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these "grass-root" initiatives engender and how they are consolidated.

Factors influencing cancer specialists' decision to collaborate with geriatricians in treating older cancer patients.

BACKGROUND: the collaboration between geriatricians and cancer specialists holds significant potential for improving care outcomes for older cancer patients. The realisation of this collaboration partly depends on cancer specialists involving geriatricians in caring for their older patients. Yet only a few studies have focused on understanding the reasons for cancer specialists' choice to involve or not involve geriatricians in this care. OBJECTIVE: this study shed some light on the challenges of collaboration between geriatricians and cancer specialists. It describes the case of a hospital that established a clinic staffed by geriatricians to assist cancer treatment teams. The focus of this article is to identify and explain the patterns of referrals of cancer specialists to this clinic. RESULTS: our study suggests that the referral practices of cancer specialists are considerably influenced by their specialty. The cancer specialists who find more applied value from geriatric assessments tend to refer their patients to geriatricians. Medical oncology is the sub-specialty that struggles the most in practically using information from the assessments to adjust their treatment. Cancer specialists who regularly referred to the clinic were the ones who thought that geriatricians had a unique contribution to patient care with their assessments and also with their intervention in palliative and psychosocial care. These specialists were usually from surgery and radiation oncology. CONCLUSIONS: ageing confers an increased risk of developing cancer. Providing adequate care to older cancer patients is still a challenge. Our study opens the 'black box' of collaboration between two important groups of professionals who may intervene in this care.