1. Investigating complex interventions - Changing perspective and methods along the way Rikke Dalsted PhD-fellow, MA Sociology, Reg Nurse 16 th Nordic Congress of general practice Copenhagen 13-16 May 2009

2. Investigating cooperation  PhD-project “Cooperation in cancer treatment. A research and discussion about patient trajectories”  Aim: Investigate how cooperation is happening between patient and healthcare professionals, and how the existing cooperation can be a point of departure in further development of coherent patient trajectories

3. Central concepts  Cooperation: A collective process where ways of working together are seen as social and historical created (Brown & Duguid 1991)  Patient trajectory: The total organization of actions that happens in trajectory of the patients illness and the influence the action have on the involved people (Strauss et al. 1997)

4. Methods - until now  12 individual interviews with patients  2 focus group with the patients’ GPs  1 focus group with clinic staff  1 focus group with hospital doctors  2 focus groups with nurses at hospital  1 focus group with home care nurses Fall 2007- fall 2008

5. Preliminary results  Significant part of informal relations Not described or seen as significant Patients active part  Lack of coherence in patient trajectories Shifting treatment from organization or ward Communication profession to profession Lack of inter-organizational thinking

6. Conclusion  Level of research developed – preliminary results unknown  Research design readjusted and need for additional methods

7. Methods – Next step  Observational study Informal relations Work practice of all health care professionals Interconnection of work Patient trajectories – further investigation

8. Discussion  Is it possible to know the “active” component? Cancer treatment as complex intervention Reciprocal impact of multiple factors Patient trajectory – total organization of actions  Is it possible to create a “on fits all” model for investigating complex interventions? The need for flexibility

9. Rikke Dalsted PhD-fellow, MA Sociology, Reg, Nurse The Research Unit for General Practice, Copenhagen rikke.dalsted@gpract.ku.dk 16 th Nordic Congress of general practice Copenhagen 13-16 May 2009