The 'link person' - The role of cancer nurse specialists in cancer treatment decisions

Title: The 'link person' - The role of Cancer Nurse Specialist in cancer treatment decisions

Background: The Cancer Nurse Specialist (CNS) role is relatively new in Ireland.  The impact of the CNS on cancer treatment decisions has not been been investigated widely.

Aim and objectives: The TReat study investigated factors influencing cancer treatment decision making  (TDM) from the perspectives of healthcare professionals (HCP) and patients. This analysis focuses on elucidating the role of the Cancer Nurse Specialist (CNS) in TDM.

Methods: In depth qualitative interviews were conducted with 29 CNSs, 15 consultants and 35 cancer patients from 29 hospitals nationwide.  Interviews were transcribed verbatim and content analysis was used to identify main themes.

Analysis and results: CNSs attend the treatment discussions between the consultant and patient.  From this point they considered that they play several key roles in TDM; 1) education (providing information about disease, treatment, side effects), 2) emotional support, 3) they empower and guide patients in making decisions, 4) assess fitness (in physical and social terms) for commencement and maintenance of treatment, 5) actively participate in  multidisciplinary teams, 6) facilitate cancer treatment, thus increasing the treatment options available (organise transport, accomodation and funding if necessary) and 7) they are always available to patients and families.  There was good agreement between the roles identified by CNSs themselves and those identified by consultants and patients. However, CNSs identified a number of limitations to fulfilling their role, including time restraints and a lack of emotional support for them. Some patients reported that they did not have sufficent time with the CNS.     

Recommendations: The CNS role has improved cancer TDM.  However, the limitations identified should be addressed in order to continue to sustain this improvement.