title: Hospital-community interface: a qualitative study on patients with cancer and health care providers' experiences.
abstract: BACKGROUND
  Patients with cancer must deal with complex and fragmented healthcare systems in addition to coping with the burden of their illness. To improve oncology treatment along the care continuum, the barriers and facilitators for streamlined oncologic care need to be better understood.
  
  
  OBJECTIVE
  This study sought to gain insight into the hospital-community interface from the point of view of patients with cancer, their families, and health care providers on both sides of the interface i.e., the community and hospital settings.
  
  
  METHODS
  The sample comprised 37 cancer patients, their family members, and 40 multidisciplinary health care providers. Twelve participants were interviewed individually and 65 took part in 10 focus groups. Based on the grounded theory approach, theoretical sampling and constant comparative analyses were used.
  
  
  RESULTS
  Two major concepts emerged: "ambivalence and confusion" and "overcoming healthcare system barriers." Ambiguity was expressed regarding the roles of health care providers in the community and in the hospital. We identified three main strategies by which these patients and their families overcame barriers within the system: patients and families became their own case managers; patients and health care providers used informal routes of communication; and nurse specialists played a significant role in managing care.
  
  
  CONCLUSIONS
  The heavy reliance on informal routes of communication and integration by patients and providers emphasizes the urgent need for change in order to improve coordinating mechanisms for hospital-community oncologic care.
authors.affiliation: Nursing Division, Rambam Health Care Campus, P.O.B. 9602, Haifa 31096, Israel. Electronic address: h_admi@rambam.health.gov.il.
authors.forename: Hanna
authors.initials: H
authors.lastname: Admi
authors.forename: Ella
authors.initials: E
authors.lastname: Muller
authors.forename: Lea
authors.initials: L
authors.lastname: Ungar
authors.forename: Shmuel
authors.initials: S
authors.lastname: Reis
authors.forename: Michael
authors.initials: M
authors.lastname: Kaffman
authors.forename: Nurit
authors.initials: N
authors.lastname: Naveh
authors.forename: Efrat
authors.initials: E
authors.lastname: Shadmi
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy*; D009859:Oncology Nursing / Q000458:organization & administration; D036301:Qualitative Research; D011787:Quality of Health Care
keywords: Cancer patients; Care continuity; Health care system barriers; Hospital–community interface; Oncology health care providers; Qualitative design