Preference-based patient participation in nurse-led versus surgeon-led initial visits for suspected cancer
Simon Olsson Boström, Karin Thourot Nouchi, Saha Cehic, Fredrik Klevebro, Berit SundeAbstract
Introduction
Patients referred for evaluation of suspected oesophageal or gastric cancer have traditionally been assessed by a surgeon at the initial outpatient visit. A nurse-led visit model has since been implemented, in which contact nurses conduct first visits, providing information about the planned diagnostic pathway and systematically evaluating symptoms to enable early prehabilitation interventions. As part of a quality improvement project, we evaluated nurse-led visits compared with surgeon-led visits using a validated instrument measuring patient participation.
Methods
Patient participation was assessed using the 4P instrument, measuring the match between patients’ preferences and experiences across 12 attributes. The primary outcome was preference-experience matching, analysed descriptively at item level with exploratory ordinal logistic regression reporting odds ratios with 95% confidence intervals.
Results
A total of 38 patients were included (14 surgeon-led, 24 nurse-led). High levels of preference-based participation were observed in both groups across communication-related attributes (items 1–6), with 61–100% achieved sufficient match. For planning and self-care attributes (items 7–12), sufficient match ranged from 50–75%, with some missing responses. Ordinal logistic regression revealed no statistically significant differences between groups, with precision of estimates limited by the small sample.
Discussion
Nurse-led initial visits provided preference-based patient participation comparable to surgeon-led visits, supporting feasibility of this model in the early diagnostic pathway for suspected oesophageal and gastric cancer. Lower match levels for planning and self-care attributes may reflect the nature of an initial diagnostic visit, where such aspects are yet to be fully established. The nurse-led model additionally enables structured symptom assessment and early prehabilitation interventions.