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Layers in sorting practices: Sorting out patients with potential cancer

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Layers in sorting practices: Sorting out patients with potential cancer. / Møller, Naja Holten ; Bjørn, Pernille .

In: Computer Supported Cooperative Work, Vol. 20, 2011, p. 123-153.

Research output: Journal Article or Conference Article in JournalJournal articleResearchpeer-review

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@article{5bbfb7b8c0ed4863a9d98e9e70bc30b8,
title = "Layers in sorting practices: Sorting out patients with potential cancer",
abstract = "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 clinicalprescriptions. 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 theprescribed 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 andconceptualize the sorting practices for potential cancer patients in the pre-diagnostic work as beingstructured 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 thatthe ordering of patients in queues is guided by the formal sorting mechanism, but is handled byinformal sorting mechanisms. We identify two informal sorting mechanisms with large impact onthe sorting practices, namely subtle categorizing and collective remembering. These informalsorting mechanisms have implications for the design of electronic booking systems because theyshow that sorting patients before initiating a standardized cancer pathway is not a simple process ofdeciding on a predefined category that will stipulate particular dates and times. Instead, theseinformal sorting mechanisms show that the process of sorting patients prior to diagnosis is acollaborative process of merging multiple queues while continuously deciding whether or not apatient’s symptoms point to potential cancer.",
author = "M{\o}ller, {Naja Holten} and Pernille Bj{\o}rn",
year = "2011",
language = "English",
volume = "20",
pages = "123--153",
journal = "Computer Supported Cooperative Work",
issn = "0925-9724",
publisher = "Springer",

}

RIS

TY - JOUR

T1 - Layers in sorting practices: Sorting out patients with potential cancer

AU - Møller, Naja Holten

AU - Bjørn, Pernille

PY - 2011

Y1 - 2011

N2 - 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 clinicalprescriptions. 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 theprescribed 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 andconceptualize the sorting practices for potential cancer patients in the pre-diagnostic work as beingstructured 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 thatthe ordering of patients in queues is guided by the formal sorting mechanism, but is handled byinformal sorting mechanisms. We identify two informal sorting mechanisms with large impact onthe sorting practices, namely subtle categorizing and collective remembering. These informalsorting mechanisms have implications for the design of electronic booking systems because theyshow that sorting patients before initiating a standardized cancer pathway is not a simple process ofdeciding on a predefined category that will stipulate particular dates and times. Instead, theseinformal sorting mechanisms show that the process of sorting patients prior to diagnosis is acollaborative process of merging multiple queues while continuously deciding whether or not apatient’s symptoms point to potential cancer.

AB - 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 clinicalprescriptions. 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 theprescribed 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 andconceptualize the sorting practices for potential cancer patients in the pre-diagnostic work as beingstructured 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 thatthe ordering of patients in queues is guided by the formal sorting mechanism, but is handled byinformal sorting mechanisms. We identify two informal sorting mechanisms with large impact onthe sorting practices, namely subtle categorizing and collective remembering. These informalsorting mechanisms have implications for the design of electronic booking systems because theyshow that sorting patients before initiating a standardized cancer pathway is not a simple process ofdeciding on a predefined category that will stipulate particular dates and times. Instead, theseinformal sorting mechanisms show that the process of sorting patients prior to diagnosis is acollaborative process of merging multiple queues while continuously deciding whether or not apatient’s symptoms point to potential cancer.

M3 - Journal article

VL - 20

SP - 123

EP - 153

JO - Computer Supported Cooperative Work

JF - Computer Supported Cooperative Work

SN - 0925-9724

ER -

ID: 32650536