Who should follow up cancer patients? Nurse specialist based outpatient care and the introduction of a phone clinic system.
The objective of this study was to pilot and evaluate a nurse based follow-up system for oncology patients in terms of feasibility and impact on outpatient oncology practice. We identified clinical situations with a defined range of clinical problems, which were set out on a proforma (Appendix) for a nurse consultation. Following a period of training, surveillance during radiotherapy was transferred to a nurse 'on treatment clinic' and a defined point of post-treatment follow-up to a nurse 'phone clinic'. The effectiveness of the nurse based follow-up was assessed by a prospective analysis of the consultation records. The impact on clinical practice was assessed in the form of audit of the clinic work-load before and after introduction of the nurse follow-up service. The patient assessment by the nurse specialist was satisfactory and covered the range of problems encountered. Medical referral by the nurse specialist was necessary in 3/33 on treatment assessments and 1/61 phone appointments. The medical outpatient work-load was estimated to decrease by 30%. Structured follow-up by a skilled and trained nurse specialist provides excellent support and effective medical surveillance in defined situations in oncology follow-up. Patients appeared satisfied with the arrangement and the pilot study suggested up to 30% reduction in the medical outpatient work-load. The use of 'phone clinics' offers an effective alternative to the conventional outpatient clinic model, while being less costly and more convenient for patients and staff.