Supportive Care in Cancer

, Volume 16, Issue 12, pp 1343–1352 | Cite as

A mixed-method evaluation of nurse-led community-based supportive cancer care

  • D. M. HowellEmail author
  • J. Sussman
  • J. Wiernikowski
  • N. Pyette
  • D. Bainbridge
  • M. O’Brien
  • T. Whelan
Original Paper


Goals of work

The study purpose was to evaluate a nurse-led supportive care clinical case management program in the community using multi-methods to delineate care processes prior to outcome evaluation.

Materials and methods

Multiple data sources including program service records, chart reviews and interviews with nurses and key interdisciplinary informants were used to identify population served (coverage and reach), processes of care (implementation), and providers’ perceptions of the effectiveness of the nurse-led program (reaction).

Main results

The program provided care to over 700 cancer patients in a 1-year period. Nurse-led support interventions were focused on direct care inclusive of teaching/coaching for symptom management, counseling and support, and mobilization of services through system navigation based on an initial comprehensive assessment of supportive care needs.


Nurse-led models of supportive care have the potential to reduce unmet supportive care needs, improve continuity of care, and overall health-related quality of life that should be tested in future trials.


Supportive care Community Evaluation Nursing Case management 



This research was supported by the Ministry of Health and Long Term Care in Ontario, Canada through the Supportive Care Research Unit, Juravinski Cancer Centre, Hamilton, Ontario. We also acknowledge the time provided by the ICCN nurses and other participants who contributed to our understanding of the ICCN model of care.


  1. 1.
    Fitch M (2003) Supportive care: rebalancing efforts. In: Sullivan T, Evans W, Angus H, Hudson A (eds) Strengthening the quality of cancer services in Ontario. Cancer Care Ontario, Toronto Ontario, pp 141–163Google Scholar
  2. 2.
    Sanson-Fisher R, Girgis A, Boyes A et al (2000) The unmet supportive care needs of patients with cancer. Cancer 88:226–237PubMedCrossRefGoogle Scholar
  3. 3.
    Ashbury FD, Findlay H, Reynolds B, McKerralehen K (1998) A Canadian survey of cancer patients’ experiences: are their needs being met? J Pain Symptom Manage 6:298–306CrossRefGoogle Scholar
  4. 4.
    Canadian Cancer Society (CCS) (2003) The needs of Ontario cancer patients: an assessment. Canadian Cancer Society (CCS), TorontGoogle Scholar
  5. 5.
    Jacobson PB, Donavan KA, Trask PC, Fleishman SB, Zabora J, Baker F, Holland JC (2005) Screening for psychologic distress in ambulatory cancer patients. American Cancer Society. Published online February 2005 in Wiley Interscience (
  6. 6.
    Carlson LE, Angen M, Cullum J et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304PubMedGoogle Scholar
  7. 7.
    Zabora J, BrintzenhofeSzoc K, Curbow H, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncol 10:19–28CrossRefGoogle Scholar
  8. 8.
    Fitch M (1994) Provincial Cancer Network Supportive Care Work Group: report and recommendations, Submission to Cancer Care Ontario: TorontoGoogle Scholar
  9. 9.
    Canadian Strategy for Cancer Control (2001) Canadian Strategy for Cancer Control Draft Synthesis, Report 10. Ottawa, ON. CanadaGoogle Scholar
  10. 10.
    Brazil K, Whelan T, O’Brien MA, Sussman J, Pyette N, Bainbridge D et al (2003). Coordinating supportive care in the community. Prepared for the Research Divisions, Ontario Ministry of Health and Long Term CareGoogle Scholar
  11. 11.
    Provincial Cancer Network Committee (1995) Recommendations on cancer care in Ontario. Submitted to Ontario Ministry of Health. Provincial Cancer Network Committee, TorontoGoogle Scholar
  12. 12.
    Doll R, Stephen J, Barroetavena MC, Linden W, Poole G, Ng E, Fyles G, Habra M (2003) Patient navigation in cancer care: program delivery and research in British Columbia. Can Oncol Nurs J 13(3):193PubMedGoogle Scholar
  13. 13.
    Goodwin JS, Sattish S, Anderson ET, Nattinger AB, Freeman JL (2003) Effect of nurse case management on the treatment of older women with breast cancer. J Am Geriatr Soc 51:1252–1259PubMedCrossRefGoogle Scholar
  14. 14.
    Whelan T, Grunfeld E, Sussman J, Abelson J, Willan A, Selleck S et al (2003) An evaluation of continuity of cancer care through Regional Supportive Care Networks. Canadian Health Services Research FoundationGoogle Scholar
  15. 15.
    Farber JM, Deschamps M, Cameron R (2002) Investigation and Assessment of the Navigator Role in Meeting the Informational Needs of Women with Breast Cancer in Canada. Ottawa: Canadian Breast Cancer Initiative, Centre for Chronic Disease Prevention and Control, Health Canada 2002Google Scholar
  16. 16.
    Canadian Association of Nurses in Oncology (CANO/ACIO) (2001) Standards of care, roles in oncology nursing and role competencies. Canadian Association of Nurses in Oncology (CANO/ACIO), TorontoGoogle Scholar
  17. 17.
    Douglas HR, Halliday D, Normand C, Corner J, Bath P, Beech N (2003) Economic evaluation of specialist cancer and palliative nursing: Macmillan evaluation study findings. Int J Palliat Nurs 9(10):429–438PubMedGoogle Scholar
  18. 18.
    Sussman J, Howell D, O’Brien MA, Whelan T (2004) An evaluation of the effectiveness of a specialized nurse case management model in coordinating supportive cancer care in the community. Submitted to the Ontario Ministry of Health and Long Term Care, May 14, 2004Google Scholar
  19. 19.
    Howell D, Fitch M, Caldwell B (2002) The impact of Interlink Community Cancer Nurses on the experience of living with cancer. Onc Nurs Forum 29(4):715–723CrossRefGoogle Scholar
  20. 20.
    Howell D, Jackson J (1998) Making cancer bearable: the Interlink Community Cancer Nurses program. Can Oncol Nurs J 8(4):222–228PubMedGoogle Scholar
  21. 21.
    Bunn F (1988) An explanatory study of the role of the Macmillan nurse. King’s College, University of London (unpublished study)Google Scholar
  22. 22.
    Skilbeck J, Seymour J (2002) Meeting complex needs: an analysis of Macmillan nurses’ work with patients. Int J Palliat Nurs 8:574–582PubMedGoogle Scholar
  23. 23.
    Rossi PH, Freeman HE (1993) Evaluation: a systematic approach, 5th edn. Sage, Newbury ParkGoogle Scholar
  24. 24.
    Flanagan JC (1954) The critical incident technique. Psychol Bull 51:327–358PubMedCrossRefGoogle Scholar
  25. 25.
    Norusis MJ (2002) SPSS 11.0 guide to data analysis. Prentice Hall, Upper Saddle River, NJGoogle Scholar
  26. 26.
    Neuendorf KA (2001) The content analysis handbook. Cleveland State University, Cleveland, USAGoogle Scholar
  27. 27.
    Lincoln YS, Guba EG (1985) Naturalistic inquiry. Sage, Beverly Hills, CA:Google Scholar
  28. 28.
    Glaser BG, Strauss AL (1967) Discovery of grounded theory: strategies for qualitative research. Aldine, ChicagoGoogle Scholar
  29. 29.
    Delbecq AL, VandeVen AH (1971) A group process model for problem identification and program planning. J Appl Behav Sci 8:466–491CrossRefGoogle Scholar
  30. 30.
    Alter C, Murty S (1997) Logic modeling: a tool for teaching critical thinking in social work practice. J Soc Work Educ 33:85–102Google Scholar
  31. 31.
    Skarstein J, Aass N, Fossa SD, Skovland E, Dahl AA (2000) Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res 49:27–34PubMedCrossRefGoogle Scholar
  32. 32.
    Wen KY, Gustafson DH (2004) Needs assessment for cancer patients and their families. Health Qual Life Outcomes 2:11–23PubMedCrossRefGoogle Scholar
  33. 33.
    Simpson JSA, Carlson LE, Trew M (2001) Impact of a group psychosocial intervention on health care utilization by breast cancer patients. Cancer Pract 9(1):19–26PubMedCrossRefGoogle Scholar
  34. 34.
    Chiles JA, Lambert MJ, Hatch AL (1999) The impact of psychological interventions on medical cost offset: a meta-analytic review. Clin Psychol: Sci Practice 6(2):204–220CrossRefGoogle Scholar
  35. 35.
    Canadian Cancer Control Strategy, ReBalance Focus Action Group Mission and Mandate, Public Health Agency of Canada, 2005Google Scholar
  36. 36.
    Hollander M, Prince M (2002) The third way: a framework for organizing health related services for individuals with ongoing care needs and their families. Home Care and Pharmaceutical Division, Health Policy and Communications Branch, Health Canada, OttawaGoogle Scholar
  37. 37.
    Stewart S, Pearson S, Horowitz JD (1998) Effects of a home-based intervention among congestive heart failure patients discharged from acute hospital care. Arch Intern Med 158:1067–1072PubMedCrossRefGoogle Scholar
  38. 38.
    Rich MW, Beckham V, Wittenberg C et al (1995) A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333:1190–1195PubMedCrossRefGoogle Scholar
  39. 39.
    Moore S, Corner J, Haviland et al (2002) Following patients with advanced cancer: satisfaction with nurse-led care. BMJ 325:1145–51PubMedCrossRefGoogle Scholar
  40. 40.
    Faithfull S, Corner J, Leyer L, Huddart R, Dearnaley D (2001) Evaluation of nurse-led follow-up for patients undergoing pelvic radiotherapy. Br J Cancer 85:1853–1864PubMedCrossRefGoogle Scholar
  41. 41.
    McCorkle R, Benoliel JQ, Georgiadou F, Moinpour C, Goodell B (1989a) A randomized clinical trial of home nursing care for lung cancer patients. Cancer 64:1375–1382PubMedCrossRefGoogle Scholar
  42. 42.
    McCorkle R, Strumpf NE, Nuamah IF, Adler DC, Cooley ME, Jepson C et al (2000) A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc 48:1701–1713Google Scholar
  43. 43.
    Suhonen R, Valimaki M, Leino-Kilpi H (2005) Individualized care, quality of life and satisfaction with nursing care. J Adv Nurs 50(3):283–292PubMedCrossRefGoogle Scholar
  44. 44.
    Stewart M, Brown JB, Donner A, McWhinney IR et al (2000) The impact of patient-centered care on outcomes. J Fam Pract 49:796–780PubMedGoogle Scholar
  45. 45.
    Clayton MF, Mishel MH, Belyea M (2006) Testing a model of symptoms, communication, uncertainty, and well-being in older breast cancer survivors. Res Nurs Health 29:18–39PubMedCrossRefGoogle Scholar
  46. 46.
    Haggerty J, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R (2003) Continuity of care: a multidisciplinary review. BMJ 327:1219–1221PubMedCrossRefGoogle Scholar
  47. 47.
    Dumont I, Dumont S, Turgeon J (2005) Continuity of care for advanced cancer patients. J Palliat Care 21(1):49–57PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • D. M. Howell
    • 1
    Email author
  • J. Sussman
    • 2
  • J. Wiernikowski
    • 3
  • N. Pyette
    • 3
  • D. Bainbridge
    • 3
  • M. O’Brien
    • 3
  • T. Whelan
    • 3
  1. 1.Princess Margaret HospitalTorontoCanada
  2. 2.Supportive Cancer Care Research UnitJuravinski Cancer CenterHamiltonCanada
  3. 3.Juravinski Cancer CenterHamiltonCanada

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