Kirshbaum, Marilyn (2003) Commentary: A patient-focused evaluation of breast care nurse specialist services in North Wales. Clinical Effectiveness in Nursing, 7 (2). p. 103. ISSN 1361-9004

Breast care nurse specialists are in a unique position to address many of the needs of individuals throughout screening, diagnosis, treatment and follow-up of breast cancer. This evaluation provides the field of breast cancer care with valuable information about the experiences of patients who have entered the Breast Care Nursing Service (BCNS) through breast screening and symptomatic referrals.

Amongst the findings from the study, attention is drawn to two key pressures that impede optimal effectiveness with the BCNS, namely, responding to the multiple information needs of patients and their families and attending to concerns of patients following treatment.

From the patient’s perspective, the BCNS supplies the majority of information necessary to understand the nature of the disease, treatment options, possible side effects and strategies for psychological adjustment. This is a highly complex task, which requires the breast care nurse to possess well-developed communication skills, expert specialist knowledge and an understanding of the patient’s decision making preferences. An overarching difficulty resides in determining which strategies would be most beneficial to impart sensitively so much information during emotionally significant exchanges.

The provision of consistent, clear, tailored information is regarded as the responsibility of all members of the multidisciplinary team ([NHS Executive, 1996]), but can become blurred when chemotherapy and radiotherapy treatment begins and the patient meets up with other teams of specialists. Patients in this study indicated that information about adjuvant therapies (15%) and side effects (16%) was insufficient. To resolve this information related deficit it appears that a clear consensus on ‘who’ gives ‘what’ information will need to be detailed after enlisting the input from all professional groups involved in an individual’s breast cancer pathway. Written patient information materials can be valuable aides but only when their relevancy is maintained. Further strategies for improving information exchange would be to involve patient experts ( [Department of Health, 2001]) and to review how peer support groups could optimise their contributions.

Follow-up care is often given a low priority, yet respondents in this study have expressed that it is an area of particular concern for them. As increasingly more women are surviving breast cancer ([Peto et al]), there will be greater consumer demand for professional guidance in relation to common quality of life issues such as fatigue, menopausal symptoms and mood disturbances. The BCNS will need to consider how it will be able to provide more attention to breast cancer survivors in light of existing availability and accessibility concerns. It may be that as breast care nursing diversifies into more specific advanced practice roles (e.g., genetic risk assessment, review clinics, psychotherapeutic interventions), the rehabilitation/health promotion role could be enhanced, for which precedence would be given to developing optimum physical and mental health following the acute phases of cancer therapies.

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