Most patients used IBTs every day. Overall, patients advocated for an extended use of IBT in oncology. Differences in perceived ease of use corresponding to age and socioeconomic status have to be addressed.

BackgroundModern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge coordination, although this is seen as a sensitive phase of clinical pathway.PurposeThe purpose of this study was to identify and quantify the categories of activities performed by nurse navigators for hospital discharge coordination.MethodsPatients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to identify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; procedure performed) and then analyzed.ResultsQualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls analyzed. The callers were patients or their relatives (38 %), private nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physicians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %).ConclusionsThe majority of requirements are related to organizational issues (e.g., navigation, lack of information, appointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.

La recherche de l’efficience et la concentration sur les besoins du patient et sur sa satisfaction sont au cœur des conceptions actuelles en termes de qualité et d’organisation des services de santé. On constate, en effet, une relative consolidation des approches organisationnelles dites Patient-Centred Care (ex. CCM, DM, Case management, population management ) pour une prise en charge structurée des patients atteints de maladies chroniques et une réelle volonté de leur mise en place dans le domaine de la santé. Cette évolution se prolonge au niveau du pilotage des systèmes de santé à travers le New Public Management – NPM. Une forte pression pèse ainsi sur les professionnels (professionnels du soin et gestionnaires) appelés à assurer une plus grande efficacité en termes d’activités et une plus grande efficience en termes d’usage des moyens. Les deux évolutions vont dans le sens d’une plus grande place accordée à la personnalisation des prises en charge, à la différenciation des prestations et à la prise en compte de la satisfaction des bénéficiaires des services publics. Toutefois, sans être antinomiques, les deux évolutions sous-tendent des ressorts et des mécanismes divergents, voire paradoxaux.