Experiences and perspectives of patients and clinicians in nurse-led clinics in an oncological setting: A sequential multi-methods study

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Purpose: The aim is to explore patient satisfaction with nurse-led consultations and the health care professionals’ experiences on the expanded scope of nursing practice. Methods: A sequential multi-methods study is comprised of a study-specific questionnaire to patients with gynecological- or breast cancer followed by a survey among the involved physicians. Finally, two focus group interviews explored the perspectives of clinical nurse specialists. Results: Study participants were patients (n = 109), physicians (n = 12) and clinical nurse specialists (n = 10). Patients expressed that their concerns and questions were addressed, and even sensitive and very personal issues were discussed. They reported that they were able to follow self-management strategies to cope with side effects (89.8%) and emotional reactions (68.8%). The clinical nurse specialists described how they sought to embrace a person-centred approach in the consultations. The expanded scope of nursing practice resulted in enhanced feelings of professionalism. The physicians appreciated the clinical nurse specialists’ skills and competencies and were comfortable referring patients to nurse-led consultations. Conclusions: Nurse-led consultations are in a pivotal position to establish a culture for person-centred nursing practice. We recommend developing a strategy for implementation of nurse-led consultations and to clarify and align expectations between the involved. Nurse-led consultations have the potential to offer quality-of-care and increase clinical nurse specialists’ professional identity and job satisfaction.

TidsskriftEuropean Journal of Oncology Nursing
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
In the present study physician responses were of a dual nature. On the one hand, they acknowledged that nurse-led consultations freed up their time and resulted in their professional skills being used more efficiently, providing the hospital with an organisational advantage, but on the other hand ultimately leaving the physicians to handle more complex and time-consuming cases in the outpatient clinic. Nurse-led consultations are often highlighted for their ability to ease work pressure on medical consultants (Kerr et al., 2021), but other studies have shown that their workload has become more stressful due to the additional supervision and training required for CNS (Evans et al., 2021). This creates a challenge since CNS may need to discuss patient cases during the day, though they are reluctant to disturb the physician, and the outpatient clinic's current setup does not support inter-professional discussion.The physicians mainly assessed CNS skills and knowledge positively, and all of them felt comfortable about referring patients to nurse-led consultations, which is in contrast to Farrell et al. (2017), who identified resistance among physicians toward using nurse-led consultations. Farrell et al. (2017) also described that referrals were based on the relationship between CNS and the physician. This was not the case in our study suggesting that physicians in our study afforded CNS sufficient professional respect. CNS in our study appreciated that there was solid, respectful interdisciplinary cooperation, which has been shown to have a genuine impact on the role and autonomy of CNS in facilitating nurse-led consultations (Farrell et al., 2017). The physicians thought CNS were skillful, but CNS felt they had an immense responsibility to not overlook anything serious, e.g., a critical lab test, and this pressure was even greater if the patient did not follow a standard regimen. As a result, CNS relied on guidelines to support their clinical practice. Concern about making mistakes is a topic that similar studies of nurse-led consultations, to our knowledge, have not yet examined. Nurse-led consultations created new challenges for CNS, e.g., how to find time to discuss patient cases with physicians and whether patients’ pre-consultation knowledge of the time frames influences the actual consultation time and/or patient related outcome. Based on our study and research (Lindfors et al., 2019) we recommend to provide the patient on the specific time frame for consultations to clarify and align expectations (Fortin VI AH et al., 2012), just as prioritising interprofessional discussion, a highly valued process, is warranted to ensure that CNS provide optimal patient care.Nursing research grant, Department of Oncology, Copenhagen University Hospital, Rigshospitalet.

Funding Information:
Nursing research grant, Department of Oncology, Copenhagen University Hospital, Rigshospitalet .

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© 2022 The Authors

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