Clinical Nurse Specialists counselling cancer patients

Clinical nurse specialists (CNS’s) play a pivotal role in the care of women receiving treatment for ovarian cancer. As doctors in specialist training rotate through services, CNS’s can frequently be the most consistent face of the care team and often have the best opportunity to develop a good understanding of individual patients’ knowledge about their disease, their concerns for their future health and that of their families.   They are therefore ideally placed to discuss BRCA testing with their patients and provide them with the information necessary to make an informed decision about whether to proceed with such testing.

Natalie Percival (and others’) new paper, published in the BJN, “The integration of BRCA testing into oncology clinics” gives the perspective of clinical nurse specialists and their experience of how a new gene testing pathway for ovarian cancer patients was implemented within their cancer service.  (This innovative, streamlined and patient centric pathway is fully described in our paper published in Scientific Reports, and summarised elegantly by Ed Yong in The Atlantic.)

The BJN paper describes the experience of a pilot programme for implementation of the new care pathway, in which 300 women with ovarian cancer were counselled and consented for BRCA testing, 108 of which were counselled by CNS’s.   All clinicians involved in the programme, including the CNS’s, were required to work through online training modules before they attempted to speak to patients and obtain consent for BRCA testing.  They were also all aware that at any time they could refer patients to the genetic team, should they feel that was necessary.

The CNS’s were surveyed about their experience of this addition to their role and responses were universally positive about:

  • the helpfulness and effectiveness of the training modules,
  • consenting for BRCA testing being appropriate for the role of CNS’s working in cancer care team,
  • the value of BRCA testing for their patients
  • feeling well supported by back-up from the genetics team.

One nurse expressed concern about the additional time required to counsel and obtain consent for gene testing, but the others all felt that they were able to incorporate this even within very busy clinics.

Overall the nurses found discussions about BRCA testing with cancer patients a natural extension of their role and found that they were well placed to deliver the service through the continuity of care they provide and their more extensive knowledge of individual’s personal and family circumstances.

First author on the paper, Natalie Percival, also shares her thoughts in this recent video about the testing pathway.

Providing access to BRCA testing through routine oncology appointments is now standard of care at Royal Marsden Hospital.

The MCG programme hugely appreciates the efforts clinical nurse specialists are making towards the goal of making more genetic testing available for more cancer patients.