When the patient trajectory moves in: The psychosocial organization of trajectories for cancer

Abstract:

This research project will examine the potential benefits and challenges in new trajectories for cancer patients receiving home-based outpatient treatment. The change from in-hospital activities to at-home treatments can benefit patients by providing a better balance between family, social, and working life and the time they spend in the hospital. However, at the same time it reduces the direct contact with hospital staff and requires a new role for patients as being ‘responsible’ for a part of their own treatment. In 2015, at-home treatment of acute leukemia at Rigshospitalet was developed through an innovation project named “Home-based chemo”, which attained great success (Torpegaard, 2016). However, the treatment change also includes a number of organizational challenges, as it requires a large investment of time for hospital staff to educate patients on how to use a chemotherapy pump, which increases the need for scheduling ‘learning sessions’ in an organizational setting that is already under time-pressure. There is also a significant change in the coherence of patient trajectories, with the changeover from patients being hospitalized for many days, to the professionals meeting them sporadically. The purpose of this project is to address the psychosocial challenges that arise from the organization of patient trajectories with at-home treatment and to present a new understanding of how professionals and patients can meet these challenges by engaging in ’trajectory work’ (Strauss, Fagerhaugh, Suczek, & Wiener, 1997). This project applies a practice-based perspective, which defines patient trajectories by the day-to-day work of both professionals and patients to map, coordinate and articulate the illness- and treatment process (Corbin & Strauss, 1985; Dalsted, Kousgaard, Andersen, & Hølge-Hazelton, 2012). In this understanding, trajectory work describes the process by which patients and professionals can make sense across the boundaries between hospital and home and how conversation tools can contribute positively to this sense-making process (Hargie, Brataas, & Thorsnes, 2009). The research project is conducted as an ethnographic-inspired, qualitative case study at the Department of Hematology at Rigshospitalet, which is a ‘front runner’ in the development of home-based treatment techniques.