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'Nurses need to see cancer as everybody's business'

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Four years ago, Diana Greenfield and her colleagues sat down to consider the range of skills now needed when caring for patients living with or beyond cancer.

By drawing on existing research, including conversations with nurses and allied health professionals, the idea was to create a competence framework – helping nurses identify the knowledge needed to care for cancer patients and survivors.

The original intention was to focus solely on those working in oncology.

“But we realised very rapidly that was too limiting,” says Professor Greenfield, Macmillan consultant nurse at Sheffield Teaching Hospitals NHS Foundation Trust and a member of Macmillan’s Consequences of Cancer and its Treatment Collaborative (CCaT). “This is relevant for every nurse who comes into contact with a patient who has cancer, or who has had cancer.”

That is increasingly likely to be every nurse, regardless of area of practice. According to Macmillan Cancer Support – which endorsed and published the competence framework – there are now more than two and a half million people in the UK living with or beyond the disease.

”If that rate remains steady, as many as one in two of us will be expected to have cancer during our lifetimes”

This number is increasing by 3.2 per cent every year and, if that rate remains steady, as many as one in two of us will be expected to have cancer during our lifetimes.

A crucial factor in those growing numbers is that this is a disease that is increasingly becoming a long-term condition. “We are seeing models of advanced breast cancer and advanced prostate cancer where people are living with those conditions for a long time, more than a decade,” explains Professor Greenfield. “Macmillan research shows the median figure now for living beyond cancer is six years, but that’s taking into account big tumour groups like lung that often don’t do terribly well.”

What that all means, she suggests, is that “cancer is everybody’s business. Nurses – whatever their background – need to be considering this. It’s not just enough to think about treatment and acute care. We must consider long term care, beyond treatment, to optimise patients’ recovery. Patient-centred comprehensive care is so important, and we must be considering holistic needs.”

”We must consider long term care, beyond treatment, to optimise patients’ recovery”

Professor Greenfield

Adds Emily Bowman, the Macmillan project manager who worked with Professor Greenfield on the project: “The story of cancer is changing, and new skills and competences are needed to address that, whether in the community setting or in hospitals.”

The framework is written accordingly. It is centred on eight domains: clinical nursing practice; care coordination; proactive management; psychosocial wellbeing; identifying high risk individuals; supporting self-care, self-management and enabling independence; professional practice and leadership; and interagency and partnership working. All are based on a training needs analysis, drawing on the results of research by Professor Sara Faithfull at the University of Surrey, coupled with patient and expert input.

Throughout the framework, there are three different levels of competence identified – essential, specialist and leadership. “What we’re not trying to advocate is a super nurse,” explains Clare Warnock, practice development sister in specialist cancer services at Sheffield Teaching Hospitals NHS Foundation Trust and another of the experts who led the development of the toolkit. “Not everybody needs to be at leadership level – what we’re really advocating is that frontline nurses are able to do some of this work.”

The hope is that framework – which has been endorsed by the Royal College of Nursing and UK Oncology Nursing Society as well as Macmillan – will be helpful for individual nurses and managers alike.

”The ability to offer care for those living with and beyond cancer is one that all nurses will possess”

For those responsible for workforce planning, it can be used as job descriptions are developed, and help suggest services and roles which could be developed in future. “We are keen to produce a toolkit on the back of the framework,” adds Professor Greenfield. “We’re hoping that would include example job descriptions, example individual assessments for appraisals, and then identify needs in terms of training and education. So dipping into learning and development, and making sure we’re influencing educational policies and educational providers to fill gaps where necessary.”

For individual nurses, meanwhile, the framework affords the opportunity to assess their own skills and knowledge. However, Professor Greenfield is keen to emphasise her belief that the ability to offer care for those living with and beyond cancer is one that all nurses will possess.

 “Nursing is all about assessing needs, and what we’re saying is consider your patients with cancer and consider their entire needs, not just during treatment. So all nurses are capable of this.”


Visit the Macmillan channel here


A Competence Framework for Nurses: Caring for Patients Living with and Beyond Cancer can be downloaded from
Hard copies can be ordered, free of charge, at

Macmillan-caring for patients

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