Non‐medical prescribing in prostate cancer care: a case study reflection

Abstract

There are approximately 54 000 nurse and midwife prescribers across the United Kingdom (UK), with 19 000 nurse independent and supplementary prescribers. Prostate cancer specialist nurses are ideally suited to implement advanced levels of practice in non‐medical prescribing, but little has been detailed in the literature about the prescribing practice in this clinical context. This paper set out to critically review evidence‐based recommendations for Prostate Cancer Specialist Nurses using a case study reflection to contextualize the role of non‐medical prescribing. A structured literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL), and a grey literature search in google, to identify studies employing a qualitative and/or quantitative methods. National (UK) and European clinical guidelines and legislative frameworks were also included. Methodological evaluation was conducted and evidence‐based recommendations were integrated into a narrative synthesis. A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective prescribing practice, and optimizes supportive care delivery. A reflective case study has illuminated the key features necessary to maximize the success of non‐medical prescribing in prostate cancer care and captures the importance of good working relationships. While different practice models will emerge, the Prostate Cancer Model of Consultation may facilitate a structured framework for safe practice, embedded in effective communication strategies. Non‐medical prescribers must be committed to continual professional development, and prescribe safely within individual competencies and scope of professional practice. There is a pressing need for further research to evaluate prescribing practices with a particular focus on the nature of influencing factors on prescribing decisions, cost‐effectiveness and a more detailed understanding of how team working and inter‐team referral affects prescribing decisions between the Multidisciplinary Team (MDT) members.

Knowledge gaps in prostate cancer treatment between physicians and clinical nurse specialists

“…Furthermore, this may impact on the ability of those nurses involved in non-medical prescribing, who need to be aware of the full range of contemporary clinical and non-clinical factors that influence prescribing practice (Paterson and Nabi, 2017) Much has been written about the benefits of MDTs, including the breakdown of old-fashioned demarcations and the delivery of the best and most cost-effective outcomes for patients when health-care professionals work together and take a holistic but unified approach to patient treatment and well-being. Even if a clinician's recommendation is the most influential factor in the treatment of the majority of prostate cancer patients, any disharmony in messaging between physicians and nurses will only generate uncertainty and disquiet, impacting the patient's experience and confidence that they are receiving the best possible care.…”

“…Even if a clinician's recommendation is the most influential factor in the treatment of the majority of prostate cancer patients, any disharmony in messaging between physicians and nurses will only generate uncertainty and disquiet, impacting the patient's experience and confidence that they are receiving the best possible care. Furthermore, this may impact on the ability of those nurses involved in non-medical prescribing, who need to be aware of the full range of contemporary clinical and non-clinical factors that influence prescribing practice (Paterson and Nabi, 2017) Much has been written about the benefits of MDTs, including the breakdown of old-fashioned demarcations and the delivery of the best and most cost-effective outcomes for patients when health-care professionals work together and take a holistic but unified approach to patient treatment and well-being.…”