Is a larger specialist nurse workforce in cancer care associated with better patient experience? Cross-sectional study

Objectives: To assess whether variation in the provision of cancer specialist nurses in England is associated with variation in positive experiences of care by patients undergoing treatment for cancer.Design: Cross sectional study using routinely collected national survey data.Setting: English acute hospital NHS trusts.Participants: Patients with a primary diagnosis of cancer who attended hospital as an inpatient or outpatient day case in the first three months of 2010in 158 NHS trusts who responded to a national survey (n=67,713, response rate 67%).Main Outcome Measures: Patient perceptions of coordination of care, quality of information provision, emotional support and support for symptom management. Results: Patients of trusts that had the fewest patients per specialist nurse were more likely to report that people treating and caring for them worked well together (adjusted odds ratio 1.08, 95% Confidence Interval 1.01 - 1.15 p=0.02), and enough emotional support during ambulatory treatment (1.15, 1.01 - 1.32 p=0.04) but were no more likely to report being given the right amount of information (0.96, 0.88 –to 1.05 p=0.38) when compared to patients in trusts with the most patients per specialist nurse. Breast cancer patients undergoing chemotherapy in the trusts with fewer patients per specialist nurse were more likely to report good support for control of side effects from chemotherapy (1.34, 1.02 to1.75, p=0.03).Conclusions: Cancer patients’ experiences of care coordination and emotional support are better in trusts with more specialist nurses. The absolute differences are small and further research must investigate whether particular roles or service configurations are associated with better experience