The opinions and concerns of specialist nurses working in prostate cancer teams are not being listened to, suggests a new study, which warns of the potentially damaging effect on patient care.
Based on a survey of 285 clinical nurse specialists working in prostate cancer care, the research reveals their variable and often negative experiences of being part of a multi-disciplinary team (MDT).
“The poor experience of MDT working and meetings reported by many nurses is very concerning”
The study, published in the journal Clinical Nurse Specialist, found less than half – 45% – felt they worked in a functional and efficient MDT.
In addition, 12% reported their team was “dysfunctional” and their views were not respected, despite the fact most nurses working in the field are fairly senior with a high level of professional expertise.
Only about a third – 34% – felt they could constructively challenge all members of the team in meetings, with some describing such gatherings as “intimidating”.
Meanwhile, 14% said meetings only paid attention to medical matters, raising concerns that some of the non-medical issues that frequently mattered most to patients were not being talked about or adequately addressed.
The lack of interest in non-medical issues was also a key theme to come across in comments from individual nurses who took part in the study.
“I don’t feel my views are valued at the MDT; they certainly don’t asked for a nursing opinion,” said one band 7 clinical nurse specialist.
In another comment, a band 7 nurse said the MDT was “driven by medical diagnosis due to the number of patients we have to discuss”.
“A quarter of nurses reported there were some members of the MDT they felt uncomfortable challenging”
The most commonly raised issue was lack of time, with teams struggling to get through a large number of patients. Nurses also reported meetings being “disorganised”, while the pressures staff were under could mean they “get quite heated” at times.
The study was led by researchers at London South Bank University and the University of Plymouth, and supported by Prostate Cancer UK.
The authors said the findings were worrying, given the importance of collaborative working in ensuring the best patient care and the pivotal role played by nurses – both in delivering complex care and representing the views and wishes of patients and their families.
“Multi-disciplinary team working should facilitate excellence through collaborative working and be the cornerstone for patient-centred care,” they said in the study paper.
“However, the poor experience of MDT working and meetings reported by many nurses in this study is very concerning, with less than half of the respondents agreeing that they worked in a functional and efficient MDT,” they stated.
The fact nurses reported feeling unable to challenge other team members was also “cause for concern”, they noted.
“All members of the MDT should feel able to challenge in the meeting if appropriate, yet around a quarter of nurses reported that there were some members of the MDT they felt uncomfortable challenging in or outside the meeting,” said the researchers.
“The study highlights the need for urgent action to move this beyond undergraduate curricula”
Geoff Punshon, who led the research at London South Bank, said the study findings suggested increasing workloads and other workplace challenges were getting in the way of effective working.
“These findings show how vital it is to ensure that the views of all participants in the MDT are heard, discussed and valued,” he added.
Heather Blake, director of support and influencing at Prostate Cancer UK, described the findings as “incredibly concerning”.
“Specialist cancer nurses are integral to multi-disciplinary teams. They are in direct contact with the patients and without them the wishes and wider needs of patients would all too often be overlooked or ignored,” she said.
“It is therefore incredibly concerning that so many nurses working in prostate cancer feel that their views are not valued or respected within the MDT setting,” she warned.
Specialist nurses feel ‘ignored’ by medical colleagues
Julia Taylor, president of the British Association of Urological Nurses, said it was vital to ensure patients were fully involved in decisions about their care and treatment.
“More emphasis needs to be given to patients’ non-medical needs to ensure that ‘no decision about me without me’ becomes a reality,” she said.
She highlighted that good teamwork should be a mandatory part of ongoing training for nurses, doctors and others.
“With increased emphasis on inter-professional learning including teamwork as a key theme; the study highlights the need for urgent action to move this beyond undergraduate curricula and become embedded into mandatory training and education,” she said.