Exploring the patient-centred contributions of colorectal clinical nurse specialists to multidisciplinary meetings in cancer care
: a mixed methods study

Student thesis: Doctoral ThesisDoctor of Healthcare

Abstract

Background Multidisciplinary teams (MDTs) are considered central to the delivery of high quality cancer care. Some evidence suggests that there is poor participation and limited contribution from the clinical nurse specialist (CNS) whose focus is on patient-centred issues. Aim The main aims were to: 1) explore the CNS contribution to the multidisciplinary team meeting (MDM); and 2) identify the factors that enable and inhibit CNSs from contributing patient-centred information. 
Methods 
Using a sequential mixed methods design Phase 1 consisted of nonparticipant observation of 16 colorectal MDMs across four colorectal teams. Phase 2 consisted of semi-structured interviews with a purposive sample of 18 core colorectal MDT members from the four teams. For Phase 3 the colorectal CNSs attended a focus group to explore and validate proposals to enhance their contributions. The quantitative data were analysed using descriptive statistics and framework analysis was undertaken for the interview data. 
Findings 
In Phase 1 CNSs were observed contributing patient-centred information variably across the four teams with few patient-centred dimensions raised. Phase 2 findings showed variations between the CNS and other MDT members in their perceptions of the role and contribution of the CNS in the MDM. The integrated findings of Phase 1 and 2 showed that there was low participation and minimal contribution of the CNSs across all MDTs due to the perceived low professional status of the CNSs, role conflict and ambiguity and a meeting culture focused on the ‘tumour’ rather than the ‘person’. Phase 3 indicated support for three proposals: 1) agreed clarity on the role of the CNS in the MDM; 2) systematising of the CNS opinion in the MDM and; 3) training in team dynamics. 
Conclusion 
There are problems with CNSs fulfilling their role within the context of the cancer MDT meeting. Potential strategies for enhancing their contribution on patient-centred issues should be tested and implemented.
Date of Award1 Jun 2016
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorGlenn Robert (Supervisor), Claire Taylor (Supervisor) & Cath Taylor (Supervisor)

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