DISCUSSION, RECOMMENDATIONS AND CONCLUSION

Introduction

The study presented throughout the pages of this dissertation has moved through multiple settings and stages. Reflecting back on my original impetus, I expressed an interest in joining an ongoing dialogue concerning the lived experiences of cancer, care, and work in the Ontario health care context. I chose ELLICSR as the site through which to engage in this dialogue endeavouring to answer the question: How does ELLICSR facilitate women's work, for which women and in what ways? The women chose additional sites of focus: the hospital, the home, the community, and for some, the paid workplace – situating their interview responses and

photographic images within these particular fields of practice. In these instances, I was reminded of the boundless nature of cancer and its consequences as well as the work it necessitates. As women’s accounts of ELLICSR refracted into discussions of hospital, home, community, and workplace I was reminded that ELLICSR does not operate in a vacuum and that women’s stories of care and work extended far beyond the confines of this space alone. As women recounted their experiences of care and work within and between these fields, important tensions and conflicts emerged. In line with feminist political economy and critical ethnography, I sought to pursue these tensions and conflicts further as they related to the topics of work and care.

In Manuscript One: ““It’s Hard Work:” Re-conceptualizing ‘Work’ in the Cancer Context”, I adopted a feminist political economy conceptualization of the notion of work as consisting of paid and unpaid tasks that require intent, time, effort, and skill (Smith, 2005 as cited in Sinding et al., 2011). I pursued the theme of work from this perspective as it unfolded in relation to 12 women’s experiences with cancer and care. The findings of this manuscript contributed to a foundational understanding of: the far reaching impact of cancer; the limits of the medical model in attending to the vast care and support needs of women living with this illness; and the various gendered consequences and equity concerns that emerge when care is commodified, when the responsibilization of care provision shifts to individuals and their homes, and/or when inadequate care supports are provided to help individuals and their families to manage the vast

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burdens of illness. In illuminating and engaging these tensions and conflicts, I enlivened the various roads that bring women with cancer to spaces like ELLICSR.

In Manuscript Two: “Putting Psychosocial Care on the Prescription Pad: The Successes and Challenges of Integrating Psychosocial Care into Routine Cancer Care Practice”, I explored notions of care in the context of a changing health care milieu marked by conflicting care commitments between health policy (with an increasing emphasis on the need for chronic care) and health care structures (which remain entrenched in acute care operations). Within this manuscript, I endeavoured to better understand the care experiences of women in the context of this changing health care milieu, the impact of ELLICSR in framing these care experiences, and the extent to which ELLICSR is integrated into the everyday clinical care practices of the hospital. The findings revealed that not only do long cited unmet care needs remain but suggest that access to good quality care may be even more challenging in the context of current policy changes. The findings further revealed that ELLICSR’s holistic and collective orientation to care delivery helped to fill many of the care gaps that patients experienced through conventional health care channels. Despite the perceived benefit of this space and its alignment with proposed policy changes, the findings of this study highlighted the challenges of implementing an

alternate, and more collective-oriented model of care, in a structure that is predominated by a “funding system that remunerates acute medical care and favours hospital services that are brief, biomedical, and episodic” (Daly, 2012, p.93). As such, in an ironic twist, the findings of this study revealed that ELLICSR’s alignment with policy promises is what reinforces the very precarity of this space.

Reflecting on the findings of these manuscripts and in consideration of the tensions and

contradictions that emerged within and between them, a topsy-turvy health care climate is more clearly revealed. This topsy-turvy environment closely resembles the Looking Glass World described in Louis Carroll’s novel Through the Looking Glass, and What Alice Found There (Carroll, 1871). The Looking Glass is the mirror that permits Alice entry into a world both clear and recognizable, yet turned sideways – a backward reflection of the world in which she resides. This parallels women’s own experiences as they journeyed from a state of health to illness but also provides an appropriate metaphor for the tensions in care that surfaced throughout this dissertation; where care was provided in ways that opposed, and sometimes, evaded policy

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promises as well as women’s own care philosophies and needs. Feminist political economy contends that the tensions that underlie care policies and practices must be recognized and resolved (or balanced) in order for effective equity-promoting strategies to be developed

(Armstrong & Braedley, 2013; Smele & Seeley, 2013). As such, in what follows I organize the major findings of this study according to the two key overarching tensions that emerged

throughout this dissertation: 1. policy directions and health care settings; and, 2. medicalized discourses of self-management and the practicalities of women’s everyday lives. In identifying and unpacking these tensions, feminist political economy provides a lens through which to view the topsy-turvy landscape of cancer care policy and practice and to illuminate the implications for women’s health, care, and work.

Major Findings