The complexity of non face-to-face work with patients affected by metastatic breast cancer and their carers. The ‘hidden consultations’ of the clinical nurse specialist

IntroductionSurvival rates in breast cancer have risen in the last 30 years. Almost one third of those diagnosed will go onto developing metastatic breast cancer which is becoming a long term condition in cancer care. In 2006 429,000 new cases of breast cancer were recorded across Europe. In recent years treatment for metastatic breast cancer in the UK has moved to the ambulatory setting meaning non face-to-face contact, for example through telephone consultation, has become a vital method of management.MethodA prospective study conducted over a 1-month period at a London Trust. Data was collected by two clinical nurse specialists on incoming calls using Excel and a bespoke interrelational structured query database. These data were then mined using standard data mining techniques.ResultsThe study collected 28 days of data. 229 patient and carer telephone contacts were recorded across the Trust. Most calls were from patients (62.5%). Incoming calls resulted in the delivery of 1282 interventions, a mean of six interventions per call (range 1–8) and clustered into four areas: meeting information needs (29%), symptom management (26%), psychological/social issues (33%) and other issues (12%). The incoming telephone work accounted for 63 h which represented 30% of the total working time of the clinical nurse specialist. Calls primarily originated from patients who were in the follow-up phase (43% of calls), a group usually thought to prefer self management.