IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v225y2019icp26-33.html
   My bibliography  Save this article

Negotiating jurisdictional boundaries in response to new genetic possibilities in breast cancer care: The creation of an ‘oncogenetic taskscape’

Author

Listed:
  • Wright, Sarah
  • Porteous, Mary
  • Stirling, Diane
  • Young, Oliver
  • Gourley, Charlie
  • Hallowell, Nina

Abstract

Changes in the nature and structure of healthcare pathways have implications for healthcare professionals' jurisdictional boundaries. The introduction of treatment focused BRCA1 and 2 genetic testing (TFGT) for newly diagnosed patients with breast cancer offers a contemporary example of pathway change brought about by technological advancements in gene testing and clinical evidence, and reflects the cultural shift towards genomics. Forming part of an ethnographically informed study of patient and practitioner experiences of TFGT at a UK teaching hospital, this paper focuses on the impact of a proposal to pilot a mainstreamed TFGT pathway on healthcare professionals' negotiations of professional jurisdiction. Based upon semi-structured interviews (n = 19) with breast surgeons, medical oncologists and members of the genetics team, alongside observations of breast multidisciplinary team meetings, during the time leading up to the implementation of the pilot, we describe how clinicians responded to the anticipated changes associated with mainstreaming. Interviews suggest that mainstreaming the breast cancer pathway, and the associated jurisdictional reconfigurations, had advocates as well as detractors. Medical oncologists championed the plans, viewing this adaptation in care provision and their professional role as a logical next step. Breast surgeons, however, regarded mainstreaming as an unfeasible expansion of their workload and questioned the relevance of TFGT to their clinical practice. The genetics team, who introduced the pilot, appeared cautiously optimistic about the potential changes. Drawing on sociological understandings of the negotiation of professional jurisdictions our work contributes a timely, micro-level examination of the responses among clinicians as they worked to renegotiate professional boundaries in response to the innovative application of treatment-focused BRCA testing in cancer care – a local and dynamic process which we refer to as an ‘oncogenetic taskscape in the making’.

Suggested Citation

  • Wright, Sarah & Porteous, Mary & Stirling, Diane & Young, Oliver & Gourley, Charlie & Hallowell, Nina, 2019. "Negotiating jurisdictional boundaries in response to new genetic possibilities in breast cancer care: The creation of an ‘oncogenetic taskscape’," Social Science & Medicine, Elsevier, vol. 225(C), pages 26-33.
    • Handle: RePEc:eee:socmed:v:225:y:2019:i:c:p:26-33
    DOI: 10.1016/j.socscimed.2019.02.020
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953619300875
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2019.02.020?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Robins, Rosemary & Metcalfe, Sylvia, 2004. "Integrating genetics as practices of primary care," Social Science & Medicine, Elsevier, vol. 59(2), pages 223-233, July.
    2. van der Geest, Sjaak & Finkler, Kaja, 2004. "Hospital ethnography: introduction," Social Science & Medicine, Elsevier, vol. 59(10), pages 1995-2001, November.
    3. Miller, Fiona Alice & Giacomini, Mita & Ahern, Catherine, 2008. "Contending visions in the evolution of genetic medicine: The case of cancer genetic services in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 67(1), pages 152-160, July.
    4. Anteby, Michel & Chan, Curtis K. & DiBenigno, Julia, "undated". "Three Lenses on Occupations and Professions in Organizations: Becoming, Doing, and Relating," Working Paper 324041, Harvard University OpenScholar.
    5. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
    6. Arribas-Ayllon, Michael, 2016. "After geneticization," Social Science & Medicine, Elsevier, vol. 159(C), pages 132-139.
    7. Allen, Davina, 2009. "From boundary concept to boundary object: The practice and politics of care pathway development," Social Science & Medicine, Elsevier, vol. 69(3), pages 354-361, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rauscher, Emily A. & Dean, Marleah & Campbell-Salome, Gemme & Barbour, Joshua B., 2019. "“How do we rally around the one who was positive?” Familial uncertainty management in the context of men managing BRCA-related cancer risks," Social Science & Medicine, Elsevier, vol. 242(C).
    2. Dowrick, Anna & Kelly, Moira & Feder, Gene, 2020. "Boundary spanners: Negotiating connections across primary care and domestic violence and abuse services," Social Science & Medicine, Elsevier, vol. 245(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Skovgaard, Anna Louise & Jørgensen, Marianne Johansson & Tjørnhøj-Thomsen, Tine & Høybye, Mette Terp, 2022. "Discharge readiness as an infrastructure: Negotiating the transfer of care for elderly patients in medical wards," Social Science & Medicine, Elsevier, vol. 312(C).
    2. Waring, Justin J. & Bishop, Simon, 2010. "Lean healthcare: Rhetoric, ritual and resistance," Social Science & Medicine, Elsevier, vol. 71(7), pages 1332-1340, October.
    3. Malcolm, Dominic & Scott, Andrea, 2011. "Professional relations in sport healthcare: Workplace responses to organisational change," Social Science & Medicine, Elsevier, vol. 72(4), pages 513-520, February.
    4. Biswas, Debashish & Hossin, Raduan & Rahman, Mahbubur & Bardosh, Kevin Louis & Watt, Melissa H. & Zion, Mazharul Islam & Sujon, Hasnat & Rashid, Md Mahbubur & Salimuzzaman, M. & Flora, Meerjady S. & Q, 2020. "An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions," Social Science & Medicine, Elsevier, vol. 260(C).
    5. Topo, Päivi & Iltanen-Tähkävuori, Sonja, 2010. "Scripting patienthood with patient clothing," Social Science & Medicine, Elsevier, vol. 70(11), pages 1682-1689, June.
    6. Cupit, Caroline, 2022. "Public health in the making: Dietary innovators and their on-the-job sociology," Social Science & Medicine, Elsevier, vol. 305(C).
    7. Kapil Babu Dahal, 2022. "Engrained with modernity: commodification, medicalisation, and cross-border medical travel for health care in Nepal," Palgrave Communications, Palgrave Macmillan, vol. 9(1), pages 1-9, December.
    8. Evans, Sarah & Scarbrough, Harry, 2014. "Supporting knowledge translation through collaborative translational research initiatives: ‘Bridging’ versus ‘blurring’ boundary-spanning approaches in the UK CLAHRC initiative," Social Science & Medicine, Elsevier, vol. 106(C), pages 119-127.
    9. Per Magnus Mæhle & Ingrid Kristine Small Hanto & Sigbjørn Smeland, 2020. "Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz," IJERPH, MDPI, vol. 17(24), pages 1-32, December.
    10. Salhi, Bisan A., 2020. "Who are Clive's friends? Latent sociality in the emergency department," Social Science & Medicine, Elsevier, vol. 245(C).
    11. Varley, Emma, 2010. "Targeted doctors, missing patients: Obstetric health services and sectarian conflict in Northern Pakistan," Social Science & Medicine, Elsevier, vol. 70(1), pages 61-70, January.
    12. Evans, Joshua D. & Crooks, Valorie A. & Kingsbury, Paul T., 2009. "Theoretical injections: On the therapeutic aesthetics of medical spaces," Social Science & Medicine, Elsevier, vol. 69(5), pages 716-721, September.
    13. Kurt Sandholtz & Daisy Chung & Isaac Waisberg, 2019. "The Double-Edged Sword of Jurisdictional Entrenchment: Explaining Human Resources Professionals’ Failed Strategic Repositioning," Organization Science, INFORMS, vol. 30(6), pages 1349-1367, November.
    14. Steven J. Kahl & Brayden G. King & Greg Liegel, 2016. "Occupational Survival Through Field-Level Task Integration: Systems Men, Production Planners, and the Computer, 1940s–1990s," Organization Science, INFORMS, vol. 27(5), pages 1084-1107, October.
    15. M. Teresa Cardador, 2017. "Promoted Up But Also Out? The Unintended Consequences of Increasing Women’s Representation in Managerial Roles in Engineering," Organization Science, INFORMS, vol. 28(4), pages 597-617, August.
    16. Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.
    17. Hall, Edward, 2005. "The 'geneticisation' of heart disease: a network analysis of the production of new genetic knowledge," Social Science & Medicine, Elsevier, vol. 60(12), pages 2673-2683, June.
    18. Maslen, Sarah & Harris, Anna, 2021. "Becoming a diagnostic agent: A collated ethnography of digital-sensory work in caregiving intra-actions," Social Science & Medicine, Elsevier, vol. 277(C).
    19. Gilbert, Patrick & Laporte, Marie-Eve, 2022. "War and peace in hospitals: Humans, objects and paradoxes," Journal of Business Research, Elsevier, vol. 141(C), pages 253-263.
    20. Jessica Edlom, 2022. "The Engagement Imperative: Experiences of Communication Practitioners’ Brand Work in the Music Industry," Media and Communication, Cogitatio Press, vol. 10(1), pages 66-76.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:225:y:2019:i:c:p:26-33. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.