Key points are not available for this paper at this time.
Traditionally a patient's colorectal cancer (CRC) journey from diagnosis to treatment to follow-up has been led by surgeons. In recent years the Colorectal Unit at The Royal Adelaide Hospital has instituted a dedicated Colorectal Cancer Nurse Consultant (CCNC) to help manage a patient's care following diagnosis and treatment of non-metastatic CRC. The CCNC coordinates surveillance and serves as the primary point of contact for patients. Whilst studies have demonstrated improved patient follow-up through CCNC involvement in care,1 literature exploring patient perspectives on the value of CCNC support is limited. As such, the purpose of this study was to evaluate patient-reported satisfaction with CCNC coordinated care, focusing on the early follow-up period. The survey utilized a Likert scale for questions 2–9, with ratings of 'excellent', 'very good', 'good', 'fair', 'poor', 'unsure' or 'not applicable'. Data were collated and analysed with summary descriptive statistics and a thematic qualitative analysis. A total of 475 surveys were sent with 285 responses (60% response rate). 53% of patients first met the CCNC prior to their operation. This was either in the outpatient department, the technical suites or on the ward prior to surgery. The Likert scale responses to Questions 2–9 are shown in Table 1. Over 90% of responders rated the colorectal cancer nurse's ability to coordinate their care, facilitate investigations and provide information to both the patient and their families as 'very good' or 'excellent'. A further 74% of responders rated the professional conduct of the colorectal cancer nurse as 'excellent', and 90% rated the convenience of having the colorectal cancer nurse as the single point of contact as 'very good' or 'excellent'. Additionally, 86% of the patients rated their ability to contact the CCNC when needed as 'very good' or 'excellent'. A thematic analysis showed that patients felt the care provided was excellent, well-supported and professional in the delivery. Common comments from patients related to appreciation of attention to emotional needs, a perceived reduction in stress and disease burden, and instilling of confidence during the treatment process. This study based on patient satisfaction survey data collected over a 10-year period at a single tertiary centre has demonstrated that colorectal cancer survivors highly value the care delivered by a colorectal cancer nurse. Nurse-led care was prevalent from diagnosis through to follow up, and key aspects of the model favoured by patients included effective information delivery, the consistency and availability of a single point of contact and professionalism of the service. Positive outcomes have been observed in nurse-led follow up for a variety of cancers, including lung,2 breast3 and gynaecological.4 In regards to colorectal cancer specifically, a previous Australian study by Moloney et al. identified 97.4% compliance with surveillance in a nurse-led programme, along with high patient satisfaction with the follow up provided.1 In addition to potential recurrence detection benefits, it is recognized that nurse-led models for cancer follow up may be advantageous in meeting the unique needs of cancer survivors, including psychological and social support.5 Indeed, the thematic analysis from this study highlighted benefits of emotional support, reducing disease burden and inspiring confidence. Furthermore, many patients valued the readily available phone contact provided by the colorectal cancer nurse, which is particularly encouraging when applied to the recent pandemic challenges facing healthcare. Nurse-led care for CRC patients would be expected to provide colorectal surgeons with greater capacity to devote time to reviewing new patients, and the financial benefits that could also be derived from a nurse-led model of care would be of interest. 'Additionally, further investigation of patient perceptions regarding nurse-led involvement in extended follow up is also necessary. Feelings of abandonment and struggles with bowel function and reduced quality of life have been identified in patients with colorectal and anal cancer,6 and a Danish study has demonstrated the successful implementation of a nurse-led clinic for supporting patients beyond the early post-operative period. In this model, not only did nurses provide front-line consultation and support, but they were also pivotal in the appropriate escalation of care to specialized services'.7 Strengths of this study include the number of patients included over a prolonged time frame, and the consistency of a single colorectal cancer nurse being assessed. The survey results have provided valuable, patient perspective data to support nurse-led models for care in CRC. Whilst a response rate of 60% was still reasonable, non-response bias may have been present in this study. Follow up studies exploring patient perceptions of remote models of nurse-led care would be particularly useful in the current pandemic context. Patient satisfaction survey data demonstrates that colorectal cancer survivors highly value the care delivered by a CCNC as their single point of contact. This further supports the concept of increasing levels of nurse led coordination and follow-up in colorectal cancer survivorship. Wilson Petrushnko: Conceptualization; data curation; formal analysis; investigation; methodology; writing – original draft; writing – review and editing. Joanne Perry: Conceptualization; data curation; methodology; writing – review and editing. Zachary Bunjo: Data curation; formal analysis; methodology; writing – original draft; writing – review and editing. Ryash Vather: Conceptualization; investigation; supervision; writing – review and editing. Mark Lewis: Conceptualization; investigation; supervision; writing – review and editing. Tarik Sammour: Conceptualization; investigation; methodology; supervision; writing – review and editing.
Petrushnko et al. (Mon,) studied this question.