title: Assessing patient outcomes and cost-effectiveness of nurse-led follow-up for women with breast cancer - have relevant and sensitive evaluation measures been used?
abstract: OBJECTIVE
  To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost-effectiveness.
  
  
  BACKGROUND
  As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients' satisfaction with the model of physician-led follow-up.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005-2013. The quality of appraisal assessment was inspired by the GRADE system.
  
  
  RESULTS
  The results show that there are many different instruments used when evaluating nurse-led follow-up, which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses, and the results are hard to interpret.
  
  
  CONCLUSIONS
  Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients' information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness.
  
  
  CONCLUSIONS
  Results from well-conducted evaluation studies of nurse-led services based on theory are needed so that relevant interventions can be implemented in clinical practice. There is a need to in future studies include cost-effectiveness analyses to compare nurse-led services with other types of follow-up.
authors.affiliation: School of Health and Education, University of Skövde, Skövde, Sweden.|Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Browall
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Forsberg
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.|Breast and Sarcoma Unit, Karolinska University Hospital, Radiumhemmet, Sweden.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Wengström
mesh_terms: D000554:Ambulatory Care Facilities; D001943:Breast Neoplasms / Q000191:economics / Q000451:nursing*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000191:economics / Q000451:nursing*; D009736:Nursing Process; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D057184:Practice Patterns, Nurses'
keywords: Quality of Life; breast cancer; cost-effectiveness; nurse-led follow-up; psychosocial support; symptoms