Ulighed i kræft: Sygeplejerskens møde med sårbare kræftpatienter

English abstract

Inequality in cancer: Nurses’ encounters with vulnerable patients

There is well‑documented inequality in cancer pathways from diagnosis to access to treatment, rehabilitation and survival, particularly among patients with lung cancer, who often have advanced disease, complex needs, limited social support and low health literacy. Nurse navigation has shown promising results in reducing time to diagnosis, but we still lack knowledge about the effects of nurse navigation on symptoms, quality of life and survival after a lung cancer diagnosis.

To address this gap and tackle inequality, we developed the NAVIGATE intervention, the first of its kind designed to improve survival and quality of life in vulnerable patients with lung cancer. NAVIGATE combines consultations with a nurse navigator, support for symptom management and physical exercise. The nurse navigator uses techniques from motivational interviewing to support each patient in completing cancer treatment and managing symptoms related to the disease and its treatment, as well as to help patients make health behaviour changes they themselves consider relevant. Before conducting a randomised controlled trial, we carried out a pilot study in which all patients were offered the intervention.

The results highlight the importance of flexibility and adaptation of both research methods and the intervention when vulnerable patients take part in research. The role of nurse navigator represents a major shift from usual clinical practice, but it is also rewarding to experience how much of a difference nurses can make for vulnerable patients with lung cancer during a difficult and complex treatment trajectory, not least by having sufficient time to listen and let patients’ needs form the basis of the conversations.

Keywords: Cancer inequality, vulnerable lung cancer patients, nurse navigation, NAVIGATE intervention, motivational interviewing, quality of life, survival.