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

Publication date: Available online 13 February 2019Source: Social Science & MedicineAuthor(s): Sarah Wright, Mary Porteous, Diane Stirling, Oliver Young, Charlie Gourley, Nina HallowellAbstractChanges 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 ...
Source: Social Science and Medicine - Category: Psychiatry & Psychology Source Type: research