Layers in sorting practices: Sorting out patients with potential cancer

Naja Holten Møller, Pernille Bjørn

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    Abstrakt

    In the last couple of years, widespread use of standardized cancer pathways has been seen across a range of countries, including Denmark, to improve prognosis of cancer patients. In Denmark, standardized cancer pathways take the form of guidelines prescribing well-defined sequences where steps are planned and pre-booked in order to manage patient trajectories. They are different from typical medical guidelines because they combine both administrative and clinical
    prescriptions. A key issue related to the enactment of a standardized cancer pathway concerns the decision to initiate a pathway for a particular patient. Due to the limited resources within the Danish healthcare system, initiating cancer pathways for all patients with a remote suspicion of cancer would crash the system, as it would be impossible for healthcare professionals to commit to the
    prescribed schedules and times defined by the standardized pathways. Thus, sorting patients with symptoms of potential cancer becomes an essential activity. In this paper, we investigate the prediagnostic work of sorting patients with symptoms that may potentially be cancer. We identify and
    conceptualize the sorting practices for potential cancer patients in the pre-diagnostic work as being
    structured in layers of the interrelated, iterative practices of constructing, organizing, re-organizing,
    and merging the multiple queues within which each patient is simultaneously situated. We find that
    the ordering of patients in queues is guided by the formal sorting mechanism, but is handled by
    informal sorting mechanisms. We identify two informal sorting mechanisms with large impact on
    the sorting practices, namely subtle categorizing and collective remembering. These informal
    sorting mechanisms have implications for the design of electronic booking systems because they
    show that sorting patients before initiating a standardized cancer pathway is not a simple process of
    deciding on a predefined category that will stipulate particular dates and times. Instead, these
    informal sorting mechanisms show that the process of sorting patients prior to diagnosis is a
    collaborative process of merging multiple queues while continuously deciding whether or not a
    patient’s symptoms point to potential cancer.
    OriginalsprogEngelsk
    TidsskriftComputer Supported Cooperative Work
    Vol/bind20
    Sider (fra-til)123-153
    ISSN0925-9724
    StatusUdgivet - 2011

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