title: Are nurse-led chemotherapy clinics really nurse-led? An ethnographic study.
abstract: BACKGROUND
  The number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses' roles in nurse-led clinics.
  
  
  OBJECTIVE
  To explore nurses' roles within nurse-led chemotherapy clinics.
  
  
  METHODS
  A focused ethnographic study of nurses' roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses.
  
  
  METHODS
  Four chemotherapy units/cancer centres in the UK PARTICIPANTS: Purposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations.
  
  
  METHODS
  Non-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation.
  
  
  RESULTS
  61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses' autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses' autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses' roles.
  
  
  CONCLUSIONS
  Four different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses' roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses' autonomy and negatively impact on patient care.
authors.affiliation: Christie Patient Centred Research Group, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: Carole.farrell@christie.nhs.uk.
authors.forename: Carole
authors.initials: C
authors.lastname: Farrell
authors.affiliation: International Observatory on End of Life Care, Lancaster University, UK. Electronic address: c.walshe@lancaster.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Walshe
authors.affiliation: The Hong Kong Polytechnic University, Hong Kong. Electronic address: alex.molasiotis@polyu.edu.hk.
authors.forename: Alex
authors.initials: A
authors.lastname: Molassiotis
mesh_terms: D000884:Anthropology, Cultural; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002173:Cancer Care Facilities / Q000458:organization & administration*; D002983:Clinical Competence; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000451:nursing; D024802:Nurse's Role; D057184:Practice Patterns, Nurses'; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents
keywords: Advanced nursing practice; Cancer; Chemotherapy; Ethnography; Nurse-led clinics; Nurse’s roles; Qualitative research