Nurse-led models of chemotherapy care: mixed economy or nurse–doctor substitution?

Fitzsimmons, Deborah, Hawker, Sheila E., Simmonds, Peter, George, Steve L., Johnson, Colin D. and Corner, Jessica L. (2005) Nurse-led models of chemotherapy care: mixed economy or nurse–doctor substitution? Journal of Advanced Nursing, 50 (3), 244-252. (doi:10.1111/j.1365-2648.2005.03387.x).

Abstract

Aim: This paper reports a study exploring the perspectives of people affected by cancer (service users) and health care professionals' about current medical consultant-led services and the acceptability of a proposed nurse-led ambulatory chemotherapy service.

Background: A number of studies have evaluated a nurse-led model of cancer care delivery but little work has been undertaken in chemotherapy settings. Furthermore, many of these studies give little information on how the perspective of users was incorporated in the design and evaluation of these services.

Methods: Service users (n = 26) and health care professionals (n = 22) were recruited across the South East of England. A qualitative study was undertaken… Using a semi-structured interview schedule, participants were asked to give their perceptions of current chemotherapy services and the potential of a nurse-led service. A thematic analysis of data was undertaken.

Findings: This paper focuses on the theme of the current and future context of a chemotherapy service. Three sub-themes were identified: contextualizing roles, defining therapeutic outcomes, and demonstrating effectiveness. All interviewees saw this role as different but complementary to the role of medical staff. There were mixed opinions from service users and professionals on the acceptability of nurse-led chemotherapy provision. In defining potential outcomes of nurse-led care, service users described benefits in terms of service and economic outcomes. Professionals saw additional benefits in terms of patient-based outcomes. Professionals and service users expressed the need for appropriate education of nurses for this role and rigorous evaluation of any new service before widespread implementation.

Conclusions: Understanding the perspective of users is imperative when re-designing cancer nursing services. Implementation of nurse-led models in chemotherapy services should be preceded by staff education and followed by systematic evaluation.

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