Exploration of the role of specialist nurses in the care of women with gynaecological cancer: a systematic review.

Background: The needs of women with gynaecological cancer are significant and in some ways unique compared with those of other cancer types. Specialist nurses provide tailored care for women with gynaecological cancer yet their role varies across sectors and states and is not guided by competency standards and minimum educational requirements like their specialist breast nurse counterparts. There is a need to synthesise evidence evaluating the effectiveness of specialist nurses in the gynaecological-oncology setting. Aim: The main aim of this systematic review was to evaluate interventions by specialist nurses in their role of caring for women with gynaecological cancer. Three specific review questions were addressed that considered: the effect of specialist nurse interventions on quality of life, satisfaction with care and psychological outcomes; the most effective interventions categorised according to four main domains of care; and the effect of varied timing in the continuum of care, duration, intensity and modes of delivery of specialist nurse interventions on outcomes. Method: Both randomised controlled trials (RCTs) and non-randomised studies (NRS) testing interventions by specialist nurses in the gynaecological-oncology setting were included in this review. Nine major databases were searched and studies were assessed against set inclusion criteria. Included studies were critically appraised and a risk of bias assessment performed to evaluate quality.Data were extracted independently by three reviewers.Data were insufficiently similar to enable meta- analysis. Results: Nine studies (6 RCTs and 3 NRS) were included in the systematic review. Assessment of the risk of bias revealed that the quality of the RCTs was mixed and highlighted the inherent flaws of non-randomised study designs. Results for the RCTs and NRS were reported separately to enable distinction between evidence levels. Studies varied greatly in the type of intervention provided and the tools used to measure outcomes, contributing to mixed results. Strong positive results were recorded in the three studies measuring satisfaction with care.Seven of the nine included studies reported at least one positive interventional effect on outcomes of interest. Conclusions: The review demonstrated some positive effects of interventions by specialist nurses for women with gynaecological cancer, though these must viewed in conjunction with the assessment of evidence quality. This systematic review has contributed to our understanding of the patient-centred aspects of the specialist nurse role and further research is required to evaluate the role overall.