Standards of care
To support the provision of care and support for people with secondary breast cancer, Breast Cancer Care developed Standards of care for people with secondary breast cancer.
These standards were developed in conjunction with people living with secondary breast cancer, healthcare professionals and other relevant stakeholders, and relate to three key areas: information and support, treatment and care, and palliative and supportive care.
Providing excellent care that meets these standards involves both individual and team development. This section is designed to help you understand or articulate:
- the benefits of specialist nursing support for people with secondary breast cancer
- the skills and knowledge needed to deliver this specialist support, and
- some of the roles that can deliver or enable this specialist support
Appropriate skills, knowledge and specialist nursing experience can bring a wealth of benefits to patient care, enabling individuals to maintain as good a quality of life as possible. Developing and maintaining personal professional skills and knowledge is therefore a key factor for specialist nurses who are part of this service provision.
The benefits of specialist nursing
The benefits of the specialist nurse have been well documented, and include the combination of improved one-to-one yet highly specialised care, with efficiencies and cost savings likely where specialist nurses can be freed from routine and non-specialist nursing work.
The National Cancer Patient Experience Surveys across the UK also demonstrate that people affected by cancer across many different tumour sites value the support and input of a breast cancer clinical nurse specialist (CNS). Patients who have been allocated a CNS are more positive about their experience of care, and the CNS is often viewed as playing a valuable role in decision making and as a trusted source of information.
Through our work at Breast Cancer Care, we recognise the types of benefits that skilled CNSs caring for those with secondary breast cancer can bring.
- Patients are supported to make decisions relating to treatment and care.
- Patients are supported to access symptom control to maximise their quality of life.
- Patients know who to contact to access out-of-hours support.
- Patients are less likely to spend lengthy periods in hospital.
- Patients are given information and support to distinguish potential disease progression and the side effects of treatment.
- Patients are informed of health and social care services available to them.
- Patients understand the benefits of hospice and palliative care.
- Family and carers are well informed about secondary breast cancer and are supported accordingly.
Breast Cancer Care’s Secondary. Not Second rate report on nursing care highlighted the issues and challenges faced by breast care teams when trying to provide specialist and skilled nursing support to their patients to improve quality of life and emotional wellbeing from the point of diagnosis.
Essential knowledge and skills
The skills and knowledge required by a CNS supporting those with metastatic breast cancer emerged quite clearly in the work of the Secondary Breast Cancer Taskforce (2008).
- Specialist knowledge of metastatic breast cancer, treatment and the illness trajectory.
- Specialist oncology knowledge.
- Understanding of the implications of living with a chronic illness.
- Understanding of the psychosocial, spiritual/existential impact of metastatic breast cancer on the patient and their family.
- Palliative care knowledge.
- Knowledge of local and national support services for metastatic breast cancer patients.
- Knowledge of current clinical research and trials.
- Knowledge of end-of-life care guidance.
- Knowledge of national and local information and support for patients’ families.
- Ability to support patients in decision making.
- Ability to case-manage complex care, acting as a coordinator for patient care and liaising with all health/social care and other professionals involved in patient care.
- Advanced communication skills.
- Managing conversations with family members including children.
- Advanced assessment skills.
- Ability to discuss long-term illness issues, palliative care and end-of-life issues.
- Ability to provide information to the patient using a number of different models and tools.
- Ability to identify patients who may require individual counselling.
- Ability to be the patient’s advocate.
- Ability to support patients with a self-management approach to their care
- Ability to demonstrate resilience whilst managing their caseload
- Group facilitation skills.
There is more information on developing key competencies and accessing relevant training in Developing and Maintaining Core Competencies.
Our recent report, Setting the standard of care: current best practice in secondary breast cancer highlighted a number of common features in breast care teams that are able to offer excellent support and nursing care for secondary breast cancer patients.
The service remit of teams usually includes:
- provision of information on diagnosis and treatment options
- psychological support
- advice on symptom control and liaison with specialist palliative care
- a link between hospital and community services
- signposting and referral to other agencies, for example, welfare and benefits advice
These are breast care teams who:
- take a pro-active approach to providing patients with important information, support and care
- maximise resources through nurse-led care and stratification of patient follow-up based on level of need
- work collaboratively with supportive care teams to ensure a wider, holistic level of support for the patient
- have innovative outreach models such as satellite sites, hub and spoke models and mobile units as well as links to community services
- undertake ongoing education and training
While the features may be common, different structures and roles may work to deliver these in different settings.
Specialist nursing roles
Since specialist nursing roles vary, patients may meet different specialist nurses according to the hospital trust who provide their care. However, many roles generally include:
- coordinating and providing continuity of care
- applying specialist knowledge and skills
- coordinating complex care
- meeting information needs and empowering patients
- preventing unscheduled hospital admissions
- supporting patients in clinical decision-making
A small number of NHS organisations in England have a non-nurse support worker for people with secondary breast cancer as highlighted in the Secondary. Not Second rate report on nursing care.
Generally working alongside one or more CNSs for secondary breast cancer, support workers might provide some emotional support, signpost patients to other support agencies and help to coordinate appointments and scans, and ensuring that multidisciplinary team discussions take place when necessary.
Staff in all the sites we visited as part of our Secondary, Not Second rate nursing care report were supportive of the idea that responsibility for the overall care coordination plan for some patients could be taken on by a non-nursing support worker role. This role would need strong administrative and communication skills, along with a good understanding of the local services available and how to access them. This is particularly important in light of current workloads for many CNSs, and evidence that care coordination is an important driver of improved patient experience for this patient group.
- Sample job descriptions adapted from public roles on NHS Jobs website:
- Secondary, not Second rate. Part four: nursing care
- R M Partners (formerly the London Cancer Alliance) developed a framework containing three different options in order to provide consistent, high-quality patient care and support across all the hospitals within the Alliance. Download LCA Service framework
- The Christie, Manchester
- Edinburgh Breast Unit, Western General Hospital
- Velindre Cancer Centre, Cardiff