Specialist nurses in multidisciplinary prostate cancer teams

We often hear — from patients themselves and also from spouses and partners — about what they see as a failure of some physicians to address the problems that they want to discuss and a failure to to answer questions that they raise or wish to raise about treatment for prostate cancer. So patients and their spouses may be interested in knowing that they aren’t alone in having that feeling.

The full text of a new paper by Punshon et al. is now available on line in the journal Clinical Nurse Specialist and reports on the experiences of specialist nurses who work on multidisciplinary prostate cancer management teams at hospitals within  the UK’s National Health Service.

The authors surveyed 285 specialized urology and urologic oncology nurses and asked them about both the services they provide and their experience of working in prostate cancer-specific multidisciplinary teams (MDTs) in hospitals in the UK.

Here is what the nurses said about their experiences:

  • 45 percent of respondents stated that they worked in a functional MDT.
  • 34 percent reported that they could constructively challenge all members of the MDT in meetings.
  • 12 percent stated that they worked in a dysfunctional MDT.
  • 3.5 percent reported that the MDT meetings were intimidating from their perspective (implying that they felt it was difficult or impossible for them to raise their points of view and have them heard).
  • Responses to open-ended questions suggested
    • A frequent lack of interest in non-medical concerns by other MDT members
    • Difficulties with constructively challenging decisions or views of physicians within MDT meetings
    • Little opportunity to ensure that patients’ wishes were expressed and addressed.

It appears that many of these nurses still work in  environments where the attitudes and mindsets of some physicians is the driving force, and the knowledge and expertise of others may be routinely ignored.

Apparently the nurses had a variable, but often negative, experience of the MDT.

The “New” Prostate Cancer InfoLink thinks it is high time that the physician community in general was better trained in listening carefully to others (whether it be patients or nurses or others, such as patients’ spouses and partners) and making sure that patients’ non-medical needs are being appropriately addressed.

We are also very conscious that it is often the nurse rather than the doctor who may be able to “hear” the underlying concerns of patients and family members and understand that those underlying concerns need to get addressed. Physicians need to be more aware of this fact and ensure that nursing personnel can bring such issues to the attention of the treating physician(s) — especially in the MTD setting, where the whole point is to try to ensure that the individual patient is given the best possible guidance based on the insights of the entire clinical team, as opposed to just one or two dominant personalities.

8 Responses

  1. In my 50 years experience in medical care as a provider and now as a patient, nothing has changed in urology. It remains male dominated and a classic surgical approach: fix it but let’s not talk about feelings.

    Women in medicine have made it a kinder, gentler world in primary care. Primary Care doctors are trained to talk and in most cases listen.

    From an Old Curmudgeon Pediatrician (and 19 year prostate cancer patient)

  2. A fear born out in practice, albeit anecdotally, is that some specialist nurses who are nurse practitioners may on occasion assume authority and make decisions beyond their training; I have seen this happen.

    Some NPs are excellent, others lacking. If a patient is uncomfortable seeing an NP, they should have no qualms in requesting their appointments are taken by a physician.

  3. Dear Rick:

    Which would you rather have, a nurse who listened to you and tried to help you or a doctor who thought he had all the answers and wasn’t listening to you at all?

    Of course there are imperfect nurses and nurse practitioners, just as there are quite certainly poor doctors (however good their training).

  4. The problem lies with the NPs who think they have all the answers when they don’t — even if they take the time with you. Anecdotally, I have seen the ramifications.

    We suggest to our men not to take any major treatment decisions based on the sole advice of an NP. We believe NPs are fine for routine appointments — not for decision making ones.

    And if you have a doctor who does not take the time, then you need to tell that doctor or change him. In most instances it actually works if you stand up to your doctor — you are your best advocate, and let the doctor see that.

  5. Dear Rick:

    You seem to be missing the entire point of the commentary above and the article on which it is based.

    No one is suggesting that any nurse or any NP should be making major treatment decisions about prostate cancer on his or her own. The whole point of having MDTs is that those decisions should be made by the team as a whole, and clearly the physicians are going to be the team leaders. However, what is the point of having MDTs if the doctor or doctors running them aren’t even willing to listen to (let alone “hear”) the input from nurses and nurse practitioners who are invited members of those teams and who may have spent considerable time with the patients and are trying to represent the best interests of those patients at the MDTs. The patients aren’t at these MDT meetings, so they can’t be their own advocate at such meetings.

  6. Unfortunately, even when concerns are heard, it feels like it’s impossible to change the outcome. Life is forever altered. Too often, couples move apart, unable to ever fix things. One or both ends up in the loneliest place in the world. Such a mean cancer.

  7. Mike: I am not missing the point — I clearly understand there is a role for specialist nurses and NP’s; however it should be limited and often it is not.

    On the contrary, you are missing this point! How many appointments have you attended taken by NPs etc? How many men have you counseled who are frustrated by the fact they do not get to speak with their doc for multiple appointments on end — only the NP!

    All too often the doctors are too busy or unavailable and appointments get shifted to the NPs and specialist nurses. Rather than the nurses consulting with their whole team, they make decisions independently that are not always well considered and in the best interest of the patients. I speak from practical experience — I have seen it happen too many tines.

    Politically, the docs do not want to upset the NPs/SNs because they take a large burden off their shoulders. And too many patients do not advocate for themselves and go withe the system, frustrated and unhappy!

  8. Rick:

    We aren’t talking about the same thing at all. You are talking about something very different to me, which sounds very like bad organization and poor patient scheduling which leaves both the patients and the NPs/nurses in the lurch because the doctors are over-committed and aren’t available when the patient had expected them to be. Of course that may not be the doctors’ fault. It smells more like an administrative breakdown.

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