Couldn’t care less?

The integrated breast cancer pathway as a case for nursing ethics

Birgitta Haga Gripsrud, Ellen Ramvi, Bjørn Ribers

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

The integrated cancer pathways are national standards for treatment trajectories, aiming to contribute to rapid clinical assessment and initiation and streamlining of medical treatment for patients with a suspected cancer diagnosis in Norway. In this article we engage in a critical reading of a case – “the integrated breast cancer pathway” (2015/2016). We build our case, firstly by acknowledging the well-known psychosocial needs and experiences of breast cancer patients, and secondly through analyses and interpretations of how recent shifts in Norwegian healthcare policy and clinical guidelines establish imperatives for professionals’ practice within what the Ministry of Health and Care Services has promoted as “the patient’s health service” (2015). Through our reading of the integrated breast cancer pathway, we have identified care as a non-existent concept in the guideline. The guideline’s descriptions of the role and responsibilities of health professionals in relation to the patient’s psychosocial needs, are mainly of their duty to “inform” and “communicate”. Underlying this emphasis, seems to be the assumption that communication is a transparent process, presupposing a universally resourceful, resilient and rational breast cancer patient and a straight-talking clinician. Why are care and caring absent in the integrated breast cancer pathway? We discuss this question in relation to structural conditions for modern breast cancer treatment, which appear to diminish the space and time for developing and sustaining relations between patients and clinicians. We also discuss wider ideological issues implied by neoliberal effects on Norwegian healthcare policy discourse, which may have impacted on the language of cancer care in a way that appears to challenge established professional ethical codex for medicine and nursing quite profoundly. We conclude the article by indicating the concern of our case for nursing ethics, as we suggest the psychosocial implications for patients, professionals and next of kin of an emerging ‘careless’ policy in a welfare state, which has a stated ambition to become an international role model for “good patient trajectories”.
Original languageEnglish
JournalJournal of Psycho-Social Studies
ISSN1478-6737
Publication statusIn preparation - 2019

Cite this

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abstract = "The integrated cancer pathways are national standards for treatment trajectories, aiming to contribute to rapid clinical assessment and initiation and streamlining of medical treatment for patients with a suspected cancer diagnosis in Norway. In this article we engage in a critical reading of a case – “the integrated breast cancer pathway” (2015/2016). We build our case, firstly by acknowledging the well-known psychosocial needs and experiences of breast cancer patients, and secondly through analyses and interpretations of how recent shifts in Norwegian healthcare policy and clinical guidelines establish imperatives for professionals’ practice within what the Ministry of Health and Care Services has promoted as “the patient’s health service” (2015). Through our reading of the integrated breast cancer pathway, we have identified care as a non-existent concept in the guideline. The guideline’s descriptions of the role and responsibilities of health professionals in relation to the patient’s psychosocial needs, are mainly of their duty to “inform” and “communicate”. Underlying this emphasis, seems to be the assumption that communication is a transparent process, presupposing a universally resourceful, resilient and rational breast cancer patient and a straight-talking clinician. Why are care and caring absent in the integrated breast cancer pathway? We discuss this question in relation to structural conditions for modern breast cancer treatment, which appear to diminish the space and time for developing and sustaining relations between patients and clinicians. We also discuss wider ideological issues implied by neoliberal effects on Norwegian healthcare policy discourse, which may have impacted on the language of cancer care in a way that appears to challenge established professional ethical codex for medicine and nursing quite profoundly. We conclude the article by indicating the concern of our case for nursing ethics, as we suggest the psychosocial implications for patients, professionals and next of kin of an emerging ‘careless’ policy in a welfare state, which has a stated ambition to become an international role model for “good patient trajectories”.",
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Couldn’t care less? The integrated breast cancer pathway as a case for nursing ethics . / Gripsrud, Birgitta Haga; Ramvi, Ellen; Ribers, Bjørn.

In: Journal of Psycho-Social Studies, 2019.

Research output: Contribution to journalJournal articleResearchpeer-review

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