Impact of specialist prostate cancer nurses on patient reported and health service outcomes: A comparative effectiveness study

The scope of advanced practice nursing roles has expanded, however few adequately powered trials have reported on how such roles impact on patient and health service outcomes. A new prostate cancer specialist nursing (PCSN) service was established in 12 hospitals in Australia providing a unique opportunity to evaluate the impact of advanced nursing roles on patient and health service outcomes. Separate cohorts of men treated for primary or recurrent prostate cancer were assessed at two time points: - (1) six months before implementation; - (2) a six month period following 12 months of service implementation. Patient reported outcomes (PROMs) assessed were care experiences, supportive care needs, severity of prostate cancer specific symptoms, quality of life and decisional regret. Bivariate analyses were conducted to identify covariates to be adjusted for when comparing outcomes. Multiple regression analyses were used. Adjusted covariates were entered in models at the first step, and the group variable (PCSN or no PCSN) entered at the last step. Data were analysed for 302 pre- and 260 post-implementation patients. After adjusting for demographic differences between groups, compared to patients who did not have access to a PCSN(pre-implementation group), patients who did have access to a PCSN (post-implementation group) reported a significantly higher level of symptom severity in relation to urinary incontinence (b = -0.10, p = 0.03) and sexual function (b = -0.10, p = 0.02), but showed significantly lower need in the area of sexuality (b = 0.12, p = 0.03) and had better experiences of in-hospital care (b = -0.15, p = 0.001). Patients’ health related quality of life and level of decisional regret did not differ according to whether they did or did not access a PCSN. While men who had access to a PCSN reported higher symptom severity in areas of urinary and sexual function and no differences were noted between groups in overall quality of life, men who accessed a PCSN