Patient experiences with collaborative practices between primary and specialized care in Norwegian cancer pathways: a qualitative study

Increased complexity and specialization of cancer care and treatments are posing significant challenges for patients navigating different levels and professions in the healthcare system. This shift necessitates coordinated care and collaboration across various healthcare providers. The study explores patient experiences with collaborative practices in clinical cancer pathways (CCPs) and examine their implications for a new initiative in Norwegian cancer care known as Cancer pathway - Home (CPH), which seeks to integrate primary care and core palliative care principles into clinical cancer pathways. A qualitative, descriptive design was employed, utilizing semi-structured interviews with 14 patients with cancer who participated in clinical cancer pathways. Our informants were recruited through healthcare professionals and local cancer associations. Data was analyzed using thematic analysis to identify themes and ideal types related to patient perspectives on collaborative practices. Participants articulated a necessity for collaboration that addressed both the disease and the patient with the disease. Some participants felt like “packages” in a fragmented system, while others experienced more holistic, patient-centered care, particularly in rehabilitation settings. We propose a typology of four collaborative practices in Norwegian cancer pathways derived from the patient-perspective: ‘fragmented collaboration’, ‘complementary contributions’, ‘team-based collaboration’, and ‘co-navigated, patient-centered collaboration’. Our patient-derived typology, ranging from ‘fragmented collaboration’ to ‘co-navigated, patient-centered collaboration,’ reveals a clear requirement for more integrated and holistic approaches to cancer care across the continuum of cancer pathways. Patients consistently emphasized the importance of collaboration that addressed both their clinical and psychosocial needs. The Cancer pathway – Home (CPH) initiative aligns with more patient-centered models and shows promise to enhance patient experiences by promoting structured collaboration, improving equity, and coordinating medical and psychosocial support. Addressing persistent challenges in collaboration across primary and specialist care is essential to overcoming fragmentation and realizing the full potential of integrated cancer care.