title: Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study.
abstract: BACKGROUND
  Managed cancer networks are widely promoted in national cancer control programs as an organizational form that enables integrated care as well as enhanced patient outcomes. While national programs are set by policy-makers, the detailed implementation of networks is delegated at the service delivery and institutional levels. It is likely that the capacity to ensure more integrated cancer services requires multi-level governance processes responsive to the strengths and limitations of the contexts and capable of supporting network-based working. Based on an empirical case, this study aims to analyze the implementation of a mandated cancer network, focusing on governance and health services integration as core concepts in the study.
  
  
  METHODS
  This nested multi-case study uses mixed methods to explore the implementation of a mandated cancer network in Quebec, a province of Canada. The case is the National Cancer Network (NCN) subdivided into three micro-cases, each defined by the geographic territory of a health and social services region. For each region, two local health services centers (LHSCs) are selected based on their differences with respect to determining characteristics. Qualitative data will be collected from various sources using three strategies: review of documents, focus groups, and semi-directed interviews with stakeholders. The qualitative data will be supplemented with a survey that will measure the degree of integration as a proxy for implementation of the NCN. A score will be constructed, and then triangulated with the qualitative data, which will have been subjected to content analysis. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify governance patterns similarities and differences and degree of integration in contexts.
  
  
  CONCLUSIONS
  This study is designed to inform decision-making to develop more effective network implementation strategies by thoroughly describing multi-level governance processes of a sample of settings that provide cancer services. Although the study focuses on the implementation of a cancer network in Quebec, the rich descriptions of multiple nested cases will generate data with a degree of generalizability for health-care systems in developed countries.
authors.affiliation: Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada. dominique.tremblay2@usherbrooke.ca.|Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada. dominique.tremblay2@usherbrooke.ca.
authors.forename: Dominique
authors.initials: D
authors.lastname: Tremblay
authors.affiliation: École nationale d'administration publique, 4750 Henri-Julien Avenue, 5th Floor, H2T 3E5, Montreal, Quebec, Canada.
authors.forename: Nassera
authors.initials: N
authors.lastname: Touati
authors.affiliation: Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.|Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
authors.affiliation: Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.|Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.affiliation: Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, G1V 0A6, Quebec, Quebec, Canada.|Centre de recherche du CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6, Quebec, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Roch
authors.affiliation: École nationale d'administration publique, 4750 Henri-Julien Avenue, 5th Floor, H2T 3E5, Montreal, Quebec, Canada.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Denis
authors.affiliation: Institut national d'excellence en santé et en services sociaux, 2535, boulevard Laurier, 5e étage, Quebec, G1V 4M3, Quebec, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Candas
authors.affiliation: Institut national de santé publique du Québec, 190 Crémazie Blvd. East, 2nd Floor, H2P 1E2, Montreal, Quebec, Canada.
authors.forename: Danièle
authors.initials: D
authors.lastname: Francoeur
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017598:Efficiency, Organizational; D017144:Focus Groups; D006801:Humans; D009369:Neoplasms; D015397:Program Evaluation; D011792:Quebec; D012947:Social Work; D011795:Surveys and Questionnaires
keywords: Cancer; Case study; Governance; Health-care integration; Implementation; Mixed methods; Network