Dimensions of Proximity: An Actionable Framework to Better Understand Integrated Practices in Cancer Networks

Dominique Tremblay; Nassera Touati; Susan Elizabeth Usher; Johanne Cournoyer

doi:10.5334/ijic.6434

Figures & Tables

The National Cancer Network in Quebec 1998–2020.

Table 1

Dimensions of proximity and illustrative examples in cancer care.

DIMENSIONS OF PROXIMITY	ILLUSTRATIVE EXAMPLES IN CANCER CARE
Geographic proximity can be objective (metric distance) or subjective (perceived) [18]. It involves face-to-face or virtual interactions among permanently or temporarily (i.e. meetings) co-located actors that enable information exchange [19].	Acknowledging the impact of traveling time and cost on professional coordination and as a contributor to access inequalities for cancer patients in rural or remote areas Co-locating clinicians in a Comprehensive Cancer Center to advance integrated care, and considering the potential impact on inter-organizational transitions along the cancer continuum Considering (for both clinicians and patients) the spatial dilemmas involved in establishing hierarchies of services according to complexity of cancer type
Relational proximity involves trust and mutual respect between actors [20] that recognizes their interdependencies	Facilitating the quality and quantity of communication Supporting professional positions in the integrated network and commitment to the cancer care continuum Improving the feeling of individual attachment to the local and national cancer network
Cognitive proximity entails shared mental models of a situation [14] which is useful in interdisciplinary teamwork and transitions between cancer and primary care teams	Making sense of notions of “Cure” and “Care” beyond disciplinary knowledge Recognizing tensions between PLC experience and clinical expertise in patient-centered care Providing interdisciplinary training on the goals and processes of teamwork
Organizational proximity describes routines and processes that reduce the transaction costs of interactions within or between organizations [21]	Aligning organizational structures among different independent organizations (e.g. hospital, primary care, home care, non-profit community organizations) and coordinating interdependencies Establishing multiple levels of network governance (national, regional, local)
Institutional proximity touches on the roles, norms, culture and values of a field [14, 17, 21]	Facilitating top-down and bottom-up linkages between national cancer priorities and communities of practice Supporting a consultative committee structure Shifting from vertical government “prescription” to forms of collaborative governance
Technological proximity refers to the tools that help actors interact and understand each other [21], and support knowledge exchange and interactions [14, 18, 21].	Transforming the perception of space using virtual communication technologies Sharing knowledge during virtual tumor board and interdisciplinary team meetings to support treatment decision-making and shared goals. Using eHealth to improve patient–provider communication (symptom and toxicity assessment and management, optimising patient engagement)

Dimensions of proximity as mechanisms underpinning integrated practices.

Table 2

Characteristics of participating sites and key informants.

CHARACTERISTIC	SITE 1	SITE 2	SITE 3
Geography	Rural+Semi-urban+Urban	Urban	Rural+Semi-Urban
Territory (Km2)	1,391	88	15,074
Population on territory	420,000^a	446,800^a	424,856^b
Mandate	Community	Academic	Community
Number of network organizations	19 (2 CH, 7 CLSC, 10 GMF/UMF)	11 (3 CH, 6 CLSC, 12 GMF/UMF)	71 (5 CH, 26 CLSC, 39 GMF/UMF)
Cancer services provided	Radiotherapy: Yes Integrated cancer centre: Yes	Radiotherapy: No Integrated cancer centre: No	Radiotherapy: Yes^c Integrated cancer centre: Yes
Key informants/sites
Clinicians	6^d	5^d	5
Managers	3	3	3^d
PLC representatives	1	1	1
Non-profit Org. leaders	0	0	2
Total/sites	11	9	11
Key informants/QCN	7

[i] LEGEND: ^a: Population in 2020; ^b: Population in 2018; ^c: Integrated cancer centre and radiotherapy facility opened in January 2019; ^d: Key informants involved at two levels.

CH: Centre hospitalier (Hospital); CLSC: Centre local de services communautaires (Local community service centre); GMF: Groupe de médecine familiale (Family medicine group); UMF: Unité de médecine familiale universitaire (Academic family medicine unit); QCN: Quebec cancer network.

Dimensions of Proximity: An Actionable Framework to Better Understand Integrated Practices in Cancer Networks

Figures & Tables

Figure 1

Table 1

Figure 2

Table 2

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