Commentary: Developing and piloting a nurse-led model of follow-up in the multidisciplinary management of colorectal cancer

Abstract

Knowles and colleagues have demonstrated the value of nurse-led follow-up for patients with colorectal cancer. They chose the endpoints of this study wisely. These involved different perspectives such as quality of life, patient and clinician satisfaction (including both doctor and nurse). Whilst these demonstrated improvements in quality of life and acceptance to both patient and clinician, a comparator is also needed and this was unfortunately lacking in this pilot study. A follow-up study using a more robust methodological approach is warranted. Evaluating interventions in a clinical setting is difficult and there is a case for a wide range of research methodologies to contribute to a scientific body of knowledge (Closs and Cheater, 1999). As with the testing of a medicinal product, it is preferable to compare interventions (in this case models of follow-up) with a strong scientific approach. That is, the accepted gold standard versus the new. Ideally, similar patients would be randomly allocated to the standard consultant-led or new nurse-led clinic in order to compare the two. This design, given adequate power, is good science, and good science provides good evidence. Evidence is graded according to quality of research (Muir Gray, 1997) and, whether we like it or not, the best form of evidence for testing an intervention is a randomised control trial (RCT) and preferably a metaanalysis of many RCTs. A portfolio of good quality studies forms an evidence base on which to justify nurse-led services to NHS funders, managers and service purchasers. The purpose of this study was specifically to improve the care of certain colorectal patients with respect to the detection of cancer recurrence. However, the majority of the patients also received chemotherapy and as such they