Clinical trials play an important role in advancing therapeutic and preventive care with many current modalities resulting from prior research. While prior research has described barriers to participation in therapeutic clinical trials, much less in known about barriers related to participation in trials aimed at prevention, prostate cancer prevention in particular. Physicians have been shown to play a critical role in access to trials; however, less is known about the individual and structural factors that influence their participation in prostate cancer prevention trials. This research provides rich ethnographic detail within the context of an ongoing trial. Research participants included physician/investigators who were either directly (serving as a co-investigator) or peripherally (referring patients for participation) involved in prostate cancer prevention intervention clinical trial (PCPICT), as well as those who were considered for participation but declined. Methods included open ended semi-structured interviews, participant-observation and a survey. Participants were recruited via direct inquiry, email and/or letter regarding participation. The results of this study show that individual and structural factors intersect, influencing both the willingness and ability of physician/investigators to participate or refer patients for participation in a prostate cancer prevention intervention clinical trial. Individual factors such as explanatory views on prevention, notions of risk and uncertainty, shared decision-making and duality of roles appear to have a greater influence on the willingness of physicians to participate while structural factors such as staffing, other resources and time are more influential in regards to the ability to participate. This research served as a critical first step towards providing an in-depth understanding of the individual and structural factors that influence a physician's participation in this type of trial. It builds from prior work where a better understanding of barriers and identification of successful strategies to overcome them was a noted void. The researcher identifies areas where additional research would be beneficial and provides applied recommendations for those considering the design of future cancer prevention intervention projects.

Metaphorically, the idiom “you cannot have your cake and eat it too” describes fundamental tensions at the heart of today’s organizations. Engaging tensions may seem implausible or even impossible. However, there exists evidence, given the increasingly complex environment, that both are vital to organizational success. To succeed, therefore, requires that organizations be able to manage, embrace, and transcend tensions. Consequently, the overall purpose of this thesis is to advance our understanding of tensions in general, and in creativity-based contexts in particular. The purpose is achieved through five self-contained yet complementary papers. The conceptual parts, which resulted in three papers, include a literature review on tensions, from which inspirations and ideas from different disciplines have been drawn in order to add value to the literature specifically addressing tensions. In parallel with this conceptual work, I explore tensions (a paradox, to be specific) in a specific context (architecture), an effort that results in two papers. Consequently, in the conceptual work, I focus on what “could be,” while in the empirical work I focus on “what is.” The findings highlight that first, theorizing about tensions calls for conceptual clarity. This was accomplished by identifying and then assembling core features that scholars use to conceptualize tensions. In doing so, the thesis contributes to the ways in which tensions are “represented” by reducing confusion and by making the assumptions behind tensions clear. Second, the thesis establishes that dealing with tensions productively requires a shift from thinking (and doing) based on a contingency approach towards contemporary approaches. Given the nature of the empirical context and the challenges therein, a true shift of this order necessitates framing tensions as paradoxes. In the same vein, the thesis indicates the need to rethink the central question; currently, that question is predominantly “how can we accommodate both A and B?” Given the nature of the empirical context, the question can be shifted to “why not C?” Doing so breaks away from focusing on the existing competing options and turns the focus towards something new. Moreover, dealing with tensions through this lens prevents neutralizing them and settling for a bland halfway point between one extreme and the other. Third, the thesis challenges the taken-for-granted assumption in the literature that dealing with tensions as paradoxes necessitates temporal compromise, separation, or resolution. In the thesis, I argue that dealing with paradoxes is possible without separating. This is so because simultaneously engaging paradoxes allows organizations to tap their energy and opens up new possibilities. In this case, the thesis contributes to the literature by empirically studying architectural firms. This empirical study shows that dealing with paradoxes requires an intricate interplay between what I call paradoxical mindsets and practices—which comprise organization members’ emotions, cognition, and behaviors—and organizational conditions that embed such mindsets and practices into the organization’s system. Fourth, the thesis makes a point that not all tensions require an action move. Accordingly, the thesis establishes that dealing with paradoxes may not necessarily entail action moves but rather a space to engage in dialogue so as to connect opposites, move outside of them, and situate them in a new relationship. In doing so, the presence of tension is appreciated and complementarity is sought. That is, the challenge is to be able to embrace paradoxes and not to resolve them. The thesis concludes that although it is challenging to tap the power of paradoxes, it is not impossible. This thesis shows that this goal can be accomplished by accepting that paradoxes are normal, and then seeking to transcend them. In so doing, organizations can unleash the “slices of genius” in their members.