Tobacco Control and Health Advocacy in the European Union: Understanding Effective Coalition-Building.

INTRODUCTION: Coalitions of supporters of comprehensive tobacco control policy have been crucial in achieving policy success nationally and internationally, but the dynamics of such alliances are not well understood. METHODS: Qualitative semi-structured, narrative interviews with 35 stakeholders involved in developing the European Council Recommendation on smoke-free environments. These were thematically analyzed to examine the dynamics of coalition-building, collaboration and leadership in the alliance of organizations which successfully called for the development of comprehensive European Union (EU) smoke-free policy. RESULTS: An alliance of tobacco control and public health advocacy organizations, scientific institutions, professional bodies, pharmaceutical companies, and other actors shared the goal of fighting the harms caused by second-hand smoke. Alliance members jointly called for comprehensive EU smoke-free policy and the protection of the political debates from tobacco industry interference. The alliance's success was enabled by a core group of national and European actors with long-standing experience in tobacco control, who facilitated consensus-building, mobilized allies and synchronized the actions of policy supporters. Representatives of Brussels-based organizations emerged as crucial strategic leaders. CONCLUSIONS: The insights gained and identification of key enablers of successful tobacco control advocacy highlight the strategic importance of investing into tobacco control at European level. Those interested in effective health policy can apply lessons learned from EU smoke-free policy to build effective alliances in tobacco control and other areas of public health.

Research and comprehensive cancer control coalitions.

The goal of cancer control research is "to generate basic knowledge about how to monitor and change individual and collective behavior and to ensure that knowledge is translated into practice and policy rapidly, effectively, and efficiently" (Division of Cancer Control and Population Sciences in Cancer control framework and synthese rationale, 2010). Research activities span the cancer control continuum from prevention to early detection and diagnosis through treatment and survivorship (Division of Cancer Control and Population Sciences in Cancer control framework and synthese rationale, 2010). While significant advancements have been made in understanding, preventing and treating cancer in the past few decades, these benefits have yielded disproportionate results in cancer morbidity and mortality across various socioeconomic and racial/ethnic subgroups (Ozols et al in J Clin Oncol, 25(1):146-1622, 2007). It has been a high priority since the beginning of the Comprehensive Cancer Control (CCC) movement to utilize research in the development and implementation of cancer plans in the states, tribes and tribal organizations, territories and US Pacific Island Jurisdictions. Nevertheless, dissemination and implementation of research in coalition activities has been challenging for many programs. Lessons learned from programs and coalitions in the implementation and evaluation of CCC activities, as well as resources provided by national partners, can assist coalitions with the translation of research into practice.

The Sorry Works! Coalition: making the case for full disclosure.

BACKGROUND: The Sorry Works! Coalition, an organization of doctors, lawyers, insurers, and patient advocates, is dedicated to promoting full disclosure and apologies for medical errors as a "middle-ground solution" in the medical liability crisis. If a standard of care was not met (as shown by a root cause analysis) in a bad outcome or adverse event, the providers (and their insurer) should apologize to the patient/family, admit fault, provide an explanation of what happened and how the hospital will ensure that the error is not repeated, and offer compensation. The Sorry Works! protocol is based on the disclosure program developed at the Department of Veterans Affairs Hospital in Lexington, Kentucky. GOALS: The coalition's goals are to (1) educate all stakeholders in the medical liability debate, (2) serve as an organizing force for the full-disclosure movement, and (3) advocate for legislative incentives, including pilot programs. OVERCOMING CULTURAL AND LEGAL OBSTACLES: In large part, the coalition's educational efforts are intended to overcome cultural and legal barriers to full disclosure, which often represent emotional, knee-jerk responses within the medical, insurance, and legal communities. Perhaps the greatest hurdle of all is the culture of the medical profession; considerable changes are needed if doctors are to enjoy the benefits of Sorry Works! and other full-disclosure programs. CONCLUSION: Sorry Works! entails changing the culture of medicine, medical risk management, and the associated insurance and legal support structure.

Cancer coalitions and cancer politics.

OBJECTIVES: To review the evolution of formal and informal coalitions and their involvement in cancer politics and policy. DATA SOURCES: Organizational and political experience. CONCLUSIONS: Cancer has gone through several stages of growth, from single institutions seeking specific favorable treatment, to competitive coalitions. With more than 850 cancer organizations and associations representing the various cancer constituencies, the practicalities of politics demand some consensus and cooperation remains a significant challenge. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must be aware of the various cancer coalitions and have an understanding of how many organizations work together for the improvement of cancer care.

[Cancer networks]. / Actualité des réseaux de cancérologie.

The complexity of legislation and the obstacle race run by all promoters in search of approval and funding for their projects could have greatly hindered the development of healthcare networks in France, or at least discouraged many promoter. Yet social and health professionals, along with certain healthcare service staff, considered these networks highly useful for decompartmentalising the French healthcare system. They would favour patient-oriented projects. It is not a surprise that the number of networks in the field of oncology is expanding rapidly, with more than 60 projects registered by public authorities by the end of 1999. Cancers are chronic diseases which often bring into play the patient's vital prognosis, as well as psychological and social consequences - sometimes dreadful - for patients and their relatives. Cancer patient management calls for a multidisciplinary approach in elaborating the therapeutic project and providing psychological support. Continuity and consistency of care require a partnership between different care providers from different specialities, with different medical practice and environments - hospital or home care, public or private practice. Though so much information has become available in the medical literature, quality of care demands that each healthcare professional keeps fully aware of the latest diagnostic or therapeutic findings and techniques in his/her field. Certain cancer networks have become a place where care providers and establishments can share methods and medical practice. Network promoters and members have thus been able to regain control over the functioning and the future of their profession. Patients have also obtained a place in decisions concerning their own health. Setting up healthcare networks will certainly shake up the tranquil system which the WHO has reported as the world's best health care system at the dawn of this century. However, this will also probably contribute to maintaining this excellence.