An evidence-based specialist breast nurse role in practice: a multicentre implementation study

Self-assessment of a breast care nursing model within a Breast Unit: learning process and keys to improving breast care

AIM AND OBJECTIVES

To assess the adherence of a nursing care model in a multidisciplinary breast cancer unit in a tertiary hospital to the recommended competencies and quality indicators.

BACKGROUND

Aligning the competencies of the breast care nurse with international recommendations for this role helps better fulfil patient needs, increases satisfaction and ensures continuity of care.

DESIGN

Cohort study.

METHODS

Breast care nursing was assessed in all patients treated at the Functional Breast Unit from 1 July 2016 to 30 June 2017. Patients were followed for 1 year. Sociodemographic, clinical and pathological data, treatments performed and nursing interventions were collected. The strobe checklist has been used to report this study.

RESULTS

We analysed nursing interventions carried out in 382 patients attended over 1 year in a multidisciplinary breast cancer unit. All patients with early disease had contact with the nurse at different times during their primary treatment. Only 58% of patients with advanced disease had contact with the nurse during their first year of illness. Moreover, first contact with the nurse was delayed by more than a week from diagnosis, the interval recommended by international guidelines.

CONCLUSION

The nursing care model meets the core competencies defined for the breast care nurse in patients with early breast cancer, but the first visit should be organised earlier, and follow-up should extend beyond completion of primary treatment.

RELEVANCE TO CLINICAL PRACTICE

This study evaluated the breast care nurse model in one breast cancer unit according to international guidelines. Nursing care adhered to most guideline requirements in patients with early breast cancer, but not in those with advanced disease. New models of care need to be developed for women with advanced breast cancer in order to achieve true patient-centred care.

PATIENT OR PUBLIC CONTRIBUTION

No contribution from the patient or the public because the data collected was entered into the clinical history by the health professionals of the Breast Unit as part of their usual clinical practice.

Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia

Background

International consensus guidelines recommend patients with metastatic breast cancer have access to a nurse experienced in the treatment of metastatic breast cancer. This study aimed to explore women’s experiences of supportive care from breast care nurses, including their perspectives on the role breast care nurses currently play in providing support to people with metastatic breast cancer.

Methods

Multiple semi-structured qualitative interviews with 38 women with metastatic breast cancer in Australia. Data relating to nursing care were extracted and analysed using thematic analysis.

Results

Three themes were identified: (1) feeling that supportive care needs are unrecognised; (2) confusion about role and relevance of breast care nurse to those with metastatic breast cancer; (3) care from metastatic breast care nurses (when available) was appreciated, valued and beneficial. Participants’ experiences differed in relation to ease of access to, amount of contact with, and level of care provided by breast care nurses. Contact and care ranged from little or none to comprehensive and ongoing. A key system-level challenge was that the diversity of diagnostic and treatment pathways for metastatic breast cancer meant that no systematic means existed to support routine or regular contact between breast care nurses and participants. Participants who did report having access to a specialised metastatic breast care nurse placed considerable value on the care received. For these participants, care from the breast care nurse extended and complemented care from the oncologist and included much needed psychosocial and practical support. For these participants, the breast care nurse assumed the role of key contact and care coordinator and was valued for their availability, accessibility and responsiveness. High levels of trust developed between patient and breast care nurse.

Conclusions

Findings indicate that there may be gaps and inequities in supportive care in Australia for people diagnosed with metastatic breast cancer, a finding that supports earlier reports of limited access to breast care nurses for people with metastatic breast cancer in Australia. The specialised metastatic breast care nurse could potentially play a key role in addressing the high level of unmet supportive care needs and improve continuity of care for these patients.

The effects of case management for breast cancer patients: A protocol for systematic review and meta-analysis

BACKGROUND

Female breast cancer is the most common cancer nowadays, and its treatment has a significant impact on patients both physically and psychologically. Many randomized trials have proved that case management (CM) can effectively care for patients. However, there is a lack of systematic scientific evaluation, so this systematic evaluation aims to explore the impact of CM on breast cancer patients.

METHODS

PubMed, Embase, Cochrane Library, Scopus, CINAHL were searched. Chinese repositories included China National Knowledge, Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database. We will also search unpublished literature at ClinicalTrials.gov. Randomized controlled trials were collected from them. The literature will be screened according to inclusion and exclusion criteria, and 2 researchers will extract the literature independently. The primary outcome indicator for this study will be patient satisfaction. Statistics were performed using RevMan 5.4 software. The quality of each outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

This study will provide the most recent evidence for evaluating the impact of CM on breast cancer patients.

CONCLUSION

To evaluate the impact of CM on patients with breast cancer.

REGISTRATION NUMBER

DOI:10.17605/OSF.IO/ZJKHX.

Specialist breast care nurses for support of women with breast cancer

BACKGROUND

Interventions by specialist breast cancer nurses (SBCNs) aim to support women and help them cope with the impact of the disease on their quality of life.

OBJECTIVES

To assess the effects of individual interventions carried out by SBCNs on indicators of quality of life, anxiety, depression, and participant satisfaction.

SEARCH METHODS

In June 2020, we searched MEDLINE, Embase, CENTRAL (Trials only), Cochrane Breast Cancer Group's Specialist Register (CBCG SR), CINAHL, PsycINFO, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of interventions carried out by SBCNs for women with breast cancer, which reported indicators of quality of life, anxiety, depression, and participant satisfaction.

DATA COLLECTION AND ANALYSIS

The certainty of the evidence was evaluated using the GRADE approach. A narrative description of the results including structured tabulation was carried out.

MAIN RESULTS

We included 14 RCTs involving 2905 women. With the exception of one study (women with advanced breast cancer), all the women were diagnosed with primary breast cancer. Mean age ranged from 48 to 64 years. Psychosocial nursing interventions compared with standard care for women with primary breast cancer Eight studies (1328 women, low-quality evidence) showed small improvements in general health-related quality of life or no difference in effect between nine weeks and 18 months. Six studies (897 women, low-quality evidence) showed small improvements in cancer-specific quality of life or no difference in effect between nine weeks and 18 months. Six studies (951 women, low-quality evidence) showed small improvements in anxiety and depression between nine weeks and 18 months. Two studies (320 women, low-quality evidence) measured satisfaction during survivorship; one study measured satisfaction only in the intervention group and showed high levels of satisfaction with care; the second study showed equal satisfaction with care in both groups at six months. Psychosocial nursing interventions compared with other supportive care interventions for women with primary breast cancer Two studies (351 women, very-low quality evidence) measured general health-related quality of life. One study reported that psychological morbidity reduced over the 12-month period; scores were consistently lower in women supported by SBCNs alone compared to support from a voluntary organisation. The other study reported that at six months, women receiving psychosocial support by either SBCNs or psychologists clinically improved from "higher levels of distress" to "lower levels of distress". One study (179 women, very-low quality evidence) showed no between-group differences on subscales at all time points up to six months measured using cancer-specific quality of life questionnaires. There were significant group-by-time changes in the global quality of life, nausea and vomiting, and systemic therapy side effects subscales, for women receiving psychosocial support by either SBCNs or psychologists at six months. There were improvements in other subscales over time in both groups. Systemic therapy side effects increased significantly in the psychologist group but not in the SBCN group. Sexual functioning decreased in both groups. Two studies (351 women, very-low quality evidence) measured anxiety and depression. One study reported that anxiety subscale scores and state anxiety scores improved over six months but there was no effect on depression subscale scores in the SBCN group compared to the psychologist group. There was no group-by-time interaction on the anxiety and depression or state anxiety subscales. The other study reported that anxiety and depression scores reduced over the 12-month post-surgery period in the SBCN group; scores were consistently lower in women supported by SBCNs compared to support from a voluntary organisation. SBCN-led telephone interventions delivering follow-up care compared with usual care for women with primary breast cancer Three studies (931 women, moderate-quality evidence) reported general health-related quality of life outcomes. Two studies reported no difference in psychological morbidity scores between SBCN-led follow-up care and standard care at 18 to 24 months. One trial reported no change in feelings of control scores between SBCN-led follow-up care and standard care at 12 months. Two studies (557 women, moderate-quality evidence) reported no between-group difference in cancer-specific quality of life at 18 to 24 months. A SBCN intervention conducted by telephone, as a point-of-need access to specialist care, did not change psychological morbidity compared to routine clinical review at 18 months. Scores for both groups on the breast cancer subscale improved over time, with lower scores at nine and 18 months compared to baseline. The adjusted mean differences between groups at 18 months was 0.7 points in favour of the SBCN intervention (P = 0.058). A second study showed no differences between groups for role and emotional functioning measured using cancer-specific quality of life questionnaires in a SBCN-led telephone intervention compared with standard hospital care, both with and without an educational group programme at 12 months. At 12 months, mean scores were 78.4 (SD = 16.2) and 77.7 (SD = 16.2) respectively for SBCN-led telephone and standard hospital follow-up. The 95% confidence interval difference at 12 months was -1.93 to 4.64. Three studies (1094 women, moderate-quality evidence) reported no between-group difference in anxiety between 12 and 60 months follow-up. One of these studies also measured depression and reported no difference in depression scores between groups at five years (anxiety: RR 1.8; 95% CI 0.6 to 5.1; depression: RR 1.7 95% CI 0.4 to 7.2). Four studies (1331 women, moderate-quality evidence) demonstrated high levels of satisfaction with SBCN-led follow-up care by telephone between 12 and 60 months. Psychosocial nursing interventions compared with usual care for women with advanced breast cancer One study (105 women, low-quality evidence) showed no difference in cancer-specific quality of life outcomes at 3 months.

AUTHORS' CONCLUSIONS

Evidence suggests that psychosocial interventions delivered by SBCNs for women with primary breast cancer may improve or are at least as effective as standard care and other supportive interventions, during diagnosis, treatment and survivorship. SBCN-led telephone follow-up interventions were equally as effective as standard care, for women with primary breast cancer.

Current organization of specialist pulmonary hypertension clinics: results of an international survey

Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow-up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online February-December 2015 and was advertised at international PH nurse meetings and through international PH organizations to their corresponding clinics. In total, 126 healthcare professionals from 32 countries responded. According to respondents, 54% of clinics managed >200 patients, of whom 49% had a pulmonary arterial hypertension (PAH) diagnosis, on average. In terms of staff, 66% had a dedicated program administrator, 35% had one full-time nurse coordinator/practitioner/specialist, and 57% had a nurse attend outpatient clinic alongside a physician. Crucially, not all centers had a nurse in their team. The role of a nurse coordinator/practitioner/specialist varied with 51% taking patient histories/examinations and 66% managing outpatients. In 34% of clinics, nurses were involved in their own research. Protocols were available for PH therapies (81%), management of heart failure (37%) and pain (26%), and referring patients who did not have PAH/chronic thromboembolic PH back to their specialist (62%). Not all clinics are meeting all of the standards outlined in the latest guidelines with key areas of improvement being level of support from/for nurses, clear protocols, and referral pathways.

Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation

Continuity of care is integral to the quality and safety of care provided to people with cancer and their carers. Further evidence is required to examine the contribution Nurse Cancer Care Coordinator (NCCC) roles make in improving the continuity. The aim of the present study was to clarify the assumptions underpinning the NCCC roles and provide a basis for ongoing evaluation. The project comprised a literature review and a qualitative study to develop program logic. The participants who were purposively sampled included policy makers, practitioners, patient advocates, and researchers. Both the literature and participant reports found that NCCC roles are diverse and responsive to contextual influences to coordinate care at the individual (patient), organisational, and systems levels. The application of the program logic for the development of NCCC roles was explored. The conceptualisation of NCCC roles was also examined in relation to Boundary Spanning and Relational Coordination theory. Further research is required to examine how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research, policy and practice, and makes explicit existing assumptions to provide a platform for further development and evaluation of these roles.

The clinical nurse specialist in chronic diseases

BACKGROUND/RATIONALE

The number of individuals with chronic illness is growing at an astonishing rate because of the rapid aging of the population and the increased longevity of persons with chronic conditions. Nurses in clinical nurse specialist (CNS) roles are well positioned and ideally suited to meet the needs of a growing population with chronic diseases; yet, to date, there has been no critical review of the CNS in chronic diseases.

PURPOSE/OBJECTIVES

This article provides a critical review of the literature in order to better define and understand the CNS related to patients living with chronic illnesses (cardiovascular and oncology).

DESCRIPTION OF THE PROJECT/INNOVATION

Using the guidelines of DiCenso et al (2005) for evaluating health services interventions, the literature was appraised in order to identify the characteristics of CNS roles, and the strengths and limitations of research about the effectiveness of CNS in chronic disease management.

IMPLICATIONS

Clinical nurse specialists with master's-level preparation provided high-quality and cost-effective care to patients with chronic diseases. The CNSs had a positive impact on patient, family, and healthcare team outcomes. Further evaluation of the CNS role in the research domain of practice is recommended.

Telephone follow-up after treatment for breast cancer: views and experiences of patients and specialist breast care nurses

AIMS AND OBJECTIVES

To explore the views of patients and specialist breast care nurses on telephone follow-up after treatment for breast cancer.

BACKGROUND

A recent randomised controlled trial demonstrated that nurse-led telephone follow-up led to high levels of patient satisfaction with no physical or psychological detriment. This study aimed to explore in more detail the views of patients randomised to telephone follow-up and the nurses who conducted telephone appointments.

DESIGN

Qualitative.

METHOD

Individual interviews with 28 patients and four specialist breast care nurses. Content analysis was used to analyse the interview data.

RESULTS

Telephone follow-up was convenient for patients and provided continuity of care. Speaking on the telephone was perceived as a more 'normal' activity than attending hospital outpatient clinics. A structured approach was appreciated, instilling feelings of confidence that all questions had been asked and no errors had been made. Specialist nurses emphasised the high level of skill required to deliver the intervention and perceived that the telephone approach was well able to meet the individual needs of patients.

CONCLUSIONS

Positive views on telephone follow-up were reported. An experienced and skilled practitioner, with effective communication skills, is required to deliver the intervention and a period of training is recommended. Nurse-led telephone interventions have a broader applicability to other disease conditions, although more work is needed to develop appropriate interventions and evaluate their effectiveness.

RELEVANCE TO CLINICAL PRACTICE

Nurses at advanced levels of practice are uniquely placed to deliver such complex interventions. However, a period of initial training with effective peer support and channels for ongoing feedback are essential for administering an intervention that relies on audio rather than visual cues.

What does it mean to be an oncology nurse? Reexamining the life cycle concepts

PURPOSE/OBJECTIVES

To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994.

DATA SOURCES

Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995-2009 was obtained from PubMed, CINAHL(R), PsycINFO, ISI Science, and EBSCO Health Source(R): Nursing/Academic Edition databases.

DATA SYNTHESIS

Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring.

CONCLUSIONS

The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries.

IMPLICATIONS FOR NURSING

This review indicates that although the healthcare system has changed significantly in 15 years, nurses' experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

Disparities in access to breast care nurses for breast surgeons: a National Breast Cancer Audit survey

The involvement of a breast care nurse (BCN) in breast cancer treatment can improve the physical and psychological outcomes and provide the continuity of care and better information about the disease and treatment process. This survey examined the current status of BCNs access to determine the extent and how BCNs were accessed by breast surgeons across Australia and New Zealand in different geographical settings or health service sectors. The survey was disseminated in December 2006. Response rate was 91%. The results show that the majority of Australian and New Zealand breast surgeons either work with a BCN in their practice or can access a BCN outside their practice. Patients are more likely to have access to a BCN immediately after diagnosis while around a third of practices have access to a BCN more than once, usually "after diagnosis" and "after surgery". More public practices have direct access to a BCN than private practices, particularly in the metropolitan and regional areas while access to BCN is poor in rural public and private practices. The difference in overall access, either in the practice or external access (Yes or No but can access a BCN), to a BCN between public and private practices is smaller. Access to a BCN was best in metropolitan public practices and worst in rural private practices with one quarter rural private practices had no access to a BCN and no rural patients can access a BCN more than once in private practice. The results of this survey demonstrated some evidence of disparity in access to a BCN which needs to be reduced through more attention and/or extra resources in this area.

Specialist breast care nurses for supportive care of women with breast cancer

BACKGROUND

Breast Care Nurses (BCNs) are now established internationally, predominantly in well resourced healthcare systems. The role of BCNs has expanded to reflect the diversity of the population in which they work, and the improvements in survival of women with breast cancer. Interventions by BCNs aim to support women and help them cope with the impact of the disease on their quality of life.

OBJECTIVES

To assess the effectiveness of individual interventions carried out by BCN's on quality of life outcomes for women with breast cancer.

SEARCH STRATEGY

We searched the Cochrane Breast Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (15 January 2007). We also searched MEDLINE (1966 to September 2006), CINAHL (1982 to September 2006), EMBASE (1980 to September 2006), British Nursing Index (1984 to September 2006), CancerLit (1961 to September 2006), PsycInfo (1967 to September 2006), Library and Info Science Abstracts (LISA) (1969 to September 2006), Dissertation Abstracts International (only available 2005 to September 2006). We contacted authors as appropriate.

SELECTION CRITERIA

Randomised controlled trials assessing the effects of interventions carried out by BCN's on quality of life outcomes, for women with breast cancer.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed relevant studies for inclusion and undertook data extraction and quality assessment of included studies.

MAIN RESULTS

We incuded five studies, categorised into three groups. Three studies assessing psychosocial nursing interventions around diagnosis and early treatment found that the BCN could affect some components of quality of life, such as anxiety and early recognition of depressive symptoms. However, their impact on social and functional aspects of the disease trajectory was inconclusive. Supportive care interventions during radiotherapy was assessed by one study which showed that specific BCN interventions can alleviate perceived distress during radiotherapy treatment, but did not improve coping skills, mood or overall quality of life. One study assessed nurse-led follow-up interventions in which no statistically significant difference was identified for main demographic variables, satisfaction with care, access to medical care or anxiety and depression.

AUTHORS' CONCLUSIONS

There is limited evidence at this time to support the contention that interventions by BCNs assist in the short-term with the recognition and management of psychological distress for women with breast cancer. Further research is required before the impact of BCNs on aspects of quality of life for women with breast cancer can be known.

A nurse is a nurse? A systematic review of the effectiveness of specialised nursing in breast cancer

The effectiveness of specialised nursing in breast cancer has received limited attention. This systematic literature review aims at (i) presenting and discussing role models of specialised nursing in the area of breast cancer and (ii) suggesting avenues for future research in this field. The ten studies included in the review differ with respect to the roles of specialised nurses as well as the measured outcome variables; thus, the comparability and generalisability of results are limited. Nevertheless, the review indicates that specialised nursing in breast cancer may contribute to improved physical and psycho-social well-being. In view of the limited comparability, the authors call for (i) a more uniform definition of models of specialised nursing in breast cancer care, as well as (ii) rigorous confirmatory studies to evaluate their effectiveness. These two aspects are pivotal in providing a reliable basis for future health care strategies.

Are specialist breast nurses available to Australian women with breast cancer?

Despite evidence of benefit, little is know about Australian women's access to and perceptions of specialist breast nurse (SBN) care. The aims of this study were to: explore access to SBNs by Australian women with breast cancer; identify factors associated with receiving systematic SBN care (at least 3 SBN contacts including preoperatively and postoperatively and at follow-up); and explore the impact of systematic SBN care on women's perceptions of treatment and support. A population-based sample of 544 women with early breast cancer was randomly selected through state and territory cancer registries. Participants completed a structured telephone interview. Over half (52%) of the women had no SBN contact and only 11% received systematic SBN care. Factors associated with systematic SBN care were being treated in a public hospital and receiving systemic adjuvant therapy. Women who received systematic SBN care were more likely to report receiving enough support for themselves and their families, and enough information about where to get more support or counseling and the costs of treatment. In conclusion, systematic SBN contact was uncommon in this population-based sample but positively influenced women's perceptions of care, particularly in relation to the provision of support.

The quality of early-stage breast cancer treatment: what can we do to improve?

Early-stage breast cancer is a highly curable disease with well-established protocols, including surgery, and the adjuvant modalities of regional radiation therapy, chemotherapy, and hormonal therapy. Yet, there is clear evidence that these adjuvant modalities are underused significantly. This article reviews the evidence that supports the use of efficacious local and systemic therapies in early-stage breast cancer, reasons for underuse, and interventions that have proven to be effective in ensuring the delivery of appropriate breast cancer care and suggests strategies to improve the quality of breast cancer care.