Nursing Articles

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see a specialist nurse, they experienced gaps in their care,

in particular, a lack of time to talk things over post-diagnosis,

and a lack of immediate access to advice and support

over the course of their care.

Importantly, patients' accounts highlight the unique features

of the specialist nurse role, which make it possible

for specialist nurses to contribute to patients' positive

experiences of care. Firstly, patients described the availability

of the specialist nurse, in terms of the amount of

time the specialist nurse was able to spend with them in

contrast with other medical staff such as consultants, and

the possibility of patient-initiated contact with the specialist

nurse. This concurs with Boxhall and Dougherty's

study [15] in which patients valued the extra time available

to them with specialist nurses compared to doctors.

The second unique aspect of the specialist nurse role was

that specialist nurses were seen as being in a position to

liaise between the medical system and the patient. This

included providing or restating information about diagnosis

and treatment in terms which were clearly understandable

to the patient, and acting as an advocate for the

patient to facilitate the care process. These two key aspects

of care have been advocated as important to the specialist

nurse role [16], and this study indicates that these aspects

of the role are recognised and valued by patients

The unique nature of the specialist nurse role, with their

level of availability to the patient and their position at the

interface between the patient and the health system, was

seen as enabling specialist nurses to address specific

patient needs. Some of these needs could not be met by

professionals in different roles, as other roles do not share

the unique characteristics of the specialist nurse role (for

example, consultants are not able to offer patients their

time for unlimited periods). Taken together, the findings

of the questionnaire survey and the qualitative interviews

suggest that specialist nurses make a unique and valuable

contribution to patient experience of prostate cancer care.

There are several limitations to the work reported here

which should be noted. Firstly, the questionnaire survey

was not a randomised controlled study of an intervention,

and there is a risk of selection bias. It is possible that

patients who did and did not see a specialist nurse differed

on factors which were not measured as part of the study.

For example, patients who did not see a specialist nurse

may have felt less need for nurse input, or may have had

more or less advanced disease. This may have had an

impact on the study findings, given that only 12.8% of

participants had not seen a specialist nurse. However it is

notable that the groups did not differ in terms of treatment

type or health status. Those who did not see a specialist

nurse were older than those who did, and it is

possible that some of the participants who did not see a

specialist nurse may have been given their diagnosis prior

to the widespread input of specialist nurses in care. The

survey involved a relatively small number of patients in

three hospitals, and responders to the survey were predominantly

White British. In addition there were considerable

numbers of missing responses on some questions.

Although the response rate to the survey was relatively

high, the 40% of invited patients who did not respond to

the survey may differ systematically to those who did

respond, for example, they may be older, or have more

advanced disease. Hence the generalisability of the survey

results may be limited. The interviews reported here did

not systematically explore the role of the specialist nurse;

rather this was an issue raised spontaneously by patients,

and the analysis is limited to the issues raised by patients.

Also, the sampling frame for interviews did not aim specifically

to sample those who did and did not see a specialist

nurse. The studies do not make a distinction between

different types of specialist nurse (e.g. urology specialist

nurse and prostate cancer specialist nurse). Nevertheless,

the quantitative and qualitative components of the study

present complementary findings that together demonstrate

the benefits reported by patients of specialist nurses.

Conclusion

In conclusion, this study indicates that specialist nurses

play an important and unique role in prostate cancer care,

and have a positive impact on patient experience. It is

essential that specialist nurses are supported in their

unique role, and that their input is not threatened by

financial and organisational pressures.

Competing interests

The author(s) declare that they have no competing interests.

Authors' contributions

The authors contributed to the article as follows: CT, PS

and RB designed the study. CT, PS and SA collected the

data. CT analysed the data with input from PS, SA and RB.

CT drew up the draft manuscript and PS, SA and RB contributed

to producing the final version.

Acknowledgements

The study was funded by the NHS Service Delivery and Organisation

National R&D Programme (SDO/77/2004). We would like to thank the

men, and their carers, who participated in this research, and the members

of staff at participating hospitals who helped with recruitment. We would

also like to thank Raj Gill for transcribing the patient interviews.

References

1. National Audit Office: Tackling Cancer: Improving the Patient Journey