Continuous, comprehensive and crucial care: The role of the CNS in the metastatic castration-resistant prostate cancer patient pathway

Abstract

Several treatment options are now available to men with metastatic castration-resistant prostate cancer (mCRPC). While survival rates for mCRPC continue to improve, patients are faced with increasingly complex treatment pathways and decisions. The clinical nurse specialist (CNS) plays a crucial role in navigating patients with mCRPC through their treatment pathway and fulfils a number of key responsibilities, including providing holistic care and support to patients and their families, educating and communicating with them in a timely and effective manner, and liaising with other healthcare professionals to seamlessly coordinate patient treatment. However, increasing patient caseloads and administrative duties are leaving CNSs with little time to fulfil their supportive role. Additional resources are needed in order to both promote and preserve this supportive role, thus ensuring that mCRPC patients receive the best possible care.

What can patient-reported experience measures tell us about the variation in patients’ experience of prostate cancer care? A cross-sectional study using survey data from the National Prostate Cancer Audit in England

“…Improved patient experience is evidently dependent on a suitable level of appropriately trained staffing, but high staff workloads and increased time pressures make it more difficult to give patients all the time they might need, and this may differ between hospitals. Both physical and staffing resources are currently at a premium50–52 and these capacity issues may not be helping in supporting better patient centred-care 53…”

“…Increasing the number of Clinical Nurse Specialists available is particularly important so that they have enough time to spend with each patient. They play a pivotal role in helping patients to navigate their diagnosis and treatment,47 53 54 and their involvement in conveying information and giving time to answer questions has been shown to have an important contribution to overall satisfaction with care 6 47. They are not always available, however: a recent organisational survey found 83% of NHS hospitals across England and Wales report having at least one CNS in all prostate cancer clinics at present 15 33…”

“…Both physical and staffing resources are currently at a premium 50–52 and these capacity issues may not be helping in supporting better patient centred-care. 53 …”

“…Both physical and staffing resources are currently at a premium [50][51][52] and these capacity issues may not be helping in supporting better patient centred-care. 53 Increasing the number of Clinical Nurse Specialists available is particularly important so that they have enough time to spend with each patient. They play a pivotal role in helping patients to navigate their diagnosis and treatment, 47 53 54 and their involvement in conveying information and giving time to answer questions has been shown to have an important contribution to overall…”

Patients' and partners' experiences with prostate cancer and advanced practice nurse counselling

“…Even though nurse support programmes vary according to time, focus, and nurses' skill and grade levels, patients with PCa, who receive counselling from a specialized nurse, highly value the additional information concerning treatment and support options. Such counselling acts as an incentive to contact the nurse at any time, enabling the patient to experience holistic care from diagnosis to aftercare 23–29 …”