title: Establishing nurse-led active surveillance for men with localised prostate cancer: development and formative evaluation of a model of care in the ProtecT trial.
abstract: OBJECTIVE
  To develop a nurse-led, urologist-supported model of care for men managed by active surveillance or active monitoring (AS/AM) for localised prostate cancer and provide a formative evaluation of its acceptability to patients, clinicians and nurses. Nurse-led care, comprising an explicit nurse-led protocol with support from urologists, was developed as part of the AM arm of the Prostate testing for cancer and Treatment (ProtecT) trial.
  
  
  METHODS
  Interviews and questionnaire surveys of clinicians, nurses and patients assessed acceptability.
  
  
  METHODS
  Nurse-led clinics were established in 9 centres in the ProtecT trial and compared with 3 non-ProtecT urology centres elsewhere in UK.
  
  
  METHODS
  Within ProtecT, 22 men receiving AM nurse-led care were interviewed about experiences of care; 11 urologists and 23 research nurses delivering ProtecT trial care completed a questionnaire about its acceptability; 20 men managed in urology clinics elsewhere in the UK were interviewed about models of AS/AM care; 12 urologists and three specialist nurses working in these clinics were also interviewed about management of AS/AM.
  
  
  RESULTS
  Nurse-led care was commended by ProtecT trial participants, who valued the flexibility, accessibility and continuity of the service and felt confident about the quality of care. ProtecT consultant urologists and nurses also rated it highly, identifying continuity of care and resource savings as key attributes. Clinicians and patients outside the ProtecT trial believed that nurse-led care could relieve pressure on urology clinics without compromising patient care.
  
  
  CONCLUSIONS
  The ProtecT AM nurse-led model of care was acceptable to men with localised prostate cancer and clinical specialists in urology. The protocol is available for implementation; we aim to evaluate its impact on routine clinical practice.
  
  
  BACKGROUND
  NCT02044172; ISRCTN20141297.
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Wade
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Churchill Hospital, Oxford, UK.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Holding
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Churchill Hospital, Oxford, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Bonnington
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Rooshenas
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: C Elizabeth
authors.initials: CE
authors.lastname: Salter
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Tilling
authors.affiliation: Department of Urology, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Speakman
authors.affiliation: Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Simon F
authors.initials: SF
authors.lastname: Brewster
authors.affiliation: Department of Urology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Evans
authors.affiliation: University Department of Oncology, Addenbrooke's Hospital, University of Cambridge, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Churchill Hospital, Oxford, UK.
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Donovan
mesh_terms: D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards; D019468:Disease Management; D018450:Disease Progression; D006296:Health Services / Q000592:standards; D006801:Humans; D008297:Male; D009726:Nurses; D017060:Patient Satisfaction; D010820:Physicians; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D011467:Prostate; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014572:Urology / Q000379:methods; D057832:Watchful Waiting; D000078329:Workforce
chemical_list: D017430:Prostate-Specific Antigen
keywords: UROLOGY