Fiona Crawford-Williams

Aims: To investigate the effectiveness, including economic outcomes, of specialist cancer nurse‐led interventions. Design: A systematic umbrella review, reported in accordance with PRISMA guidelines. Methods: Systematically conducted reviews reporting any effectiveness or cost‐effectiveness outcomes published between January 2014 and June 2025 were included. Each review was screened and a quality assessment conducted by two authors. Results were narratively synthesised with specialist cancer nurse‐led interventions categorised according to the Omaha System Intervention Scheme. Data Sources: CINAHL, Cochrane DSR, Medline, PsycINFO, PROSPERO and Google Scholar. Findings: 34 of 1389 reviews screened were included, reporting on 330 individual primary studies. Over 190,000 people with various types of cancer were represented. Cancer nurse‐led interventions described in the reviews were delivered face‐to‐face, via telephone or internet and included (1) teaching, guiding and counselling; (2) treatments and procedures; (3) case management; and (4) surveillance interventions. Cancer nurse‐led interventions were more effective compared to alternative care models at improving self‐management and behaviour capabilities in 10/14 reviews (71%), symptom burden in 17/29 (58%) and patient satisfaction in 10/17 (59%). Nurse‐led interventions demonstrated comparable effects on quality of life, survival, economic outcomes overall when compared to alternative care models. Limited full or partial economic evaluations were found. Usual care was not well described in the reviews, but in primary studies, over 80% of interventions were delivered as an addition to usual care rather than as an alternative to other healthcare professionals. Conclusions: Nurses are effective at delivering care across the cancer trajectory but are most effective at self‐management and behavioural support and symptom management. Robust full economic evaluations are needed to determine the value of cancer nurse‐led interventions. Findings from this review can be used to guide policy and strategic planning on where specialist cancer nurses are best placed for maximum impact. No Patient or Public Contribution. Protocol Registration: A protocol was registered with PROSPERO (CRD42024559328), which included the methods for this umbrella review.

Objective: This scoping review examines the available qualitative evidence from systematic and scoping reviews, and mixed‐methods or qualitative studies on cancer‐related discrimination. Methods: Cancer‐related discrimination was defined as direct and recurring experiences of enacted stigma, behaviours, or unfair treatment based on an individual's cancer history, current cancer diagnosis, perceived cancer risk, or cancer caregiving role. A systematic search of ProQuest databases, Cochrane CENTRAL, Scopus, APA PsycINFO, MEDLINE, and Web of Science identified peer‐reviewed research published before December 13, 2025. Two independent reviewers screened studies, and data were narratively synthesised using the Health Stigma and Discrimination Framework (i.e., drivers and system‐level facilitators; discrimination experiences; impacts). Results: In total, 116 studies met inclusion criteria, comprising 83 qualitative studies, 23 mixed‐method, nine systematic reviews, and one scoping review. Cancer‐related discrimination was reported across four contexts: (1) familial and social; (2) hiring and workplace; (3) insurance and welfare; and (4) healthcare. Discrimination drivers included misconceptions that cancer is contagious, employer concerns about productivity and costs, rigid welfare regulations, and reduced public empathy for cancers perceived as ‘self‐inflicted’. Reported experiences ranged from social exclusion and bullying, to workplace dismissals, job rejections, and barriers to insurance or financial support. In healthcare contexts, provider blame, judgement, and strained patient‐clinician interactions were reported. Impacts of discrimination included self‐isolation, concealment of diagnosis, internalised stigma, psychological distress, financial burden, and delayed treatment‐seeking. Conclusions: Cancer‐related discrimination arises from cultural, institutional, and structural mechanisms, with significant impacts on quality of life and health. Coordinated policy, legal, institutional, and public education responses are required to address these challenges.

Objectives: This study developed and evaluated an Australian Cancer LGBTIQ+ Inclusivity Toolkit (CanLIT) for oncology healthcare professionals, combining training modules for working with LGBTIQ+ cancer patients and carers with inclusion strategies and information resources.Methods: CanLIT was based on the findings of the Out with Cancer Study, co-designed with key stakeholders, and evaluated against national panel consensus recommendations for LGBTIQ+ cultural competency training standards, encompassing learner knowledge, attitudes, intention to change, and training acceptability.Results: One hundred and forty-one learners completed four online training modules and pre-post surveys. Eleven participants were interviewed. Participants demonstrated significant (p<.001) gains in knowledge, confidence, support for LGBTIQ+ inclusivity, and intention to engage in inclusive practice, alongside reduced anti-inclusion beliefs. While overall comfort working with LGBTIQ+ patients did not change significantly, likely due to high baseline levels, comfort increased specifically for treating sexuality-diverse (LGBQ) and intersex patients. Participants endorsed CanLIT as relevant, high quality, and easy to understand, and most would recommend the training to colleagues. However, participants identified significant implementation barriers, including IT systems unable to collect SOGI data, administrative processes blocking preferred names, and interpersonal challenges such as fear of causing offence and uncertainty about language.Conclusion: CanLIT is an effective, evidence-based training package that increases knowledge, confidence, and support for LGBTIQ+ inclusion in cancer care. Following minor modifications based on learner feedback, CanLIT is freely available nationally through the Cancer Institute NSW EviQ Education platform.Practice Implications: LGBTIQ+ inclusivity training should be a core component of professional development for all cancer healthcare workers. Training should be supplemented with supervised practice such as simulation and role play to build clinical comfort. Health services need to invest in information infrastructure accommodating preferred names, pronouns, and SOGI data collection. Sustaining change requires ongoing organisational support, including refresher education, peer mentoring, and visible leadership commitment.

Aim: To identify and examine evaluation methods and metrics used for specialist cancer nursing. Design: A scoping review of published and grey literature on evaluation approaches for specialist cancer nursing roles and models of care. Methods: Comprehensive searches were conducted across CINAHL, Cochrane Library, Medline, PsycINFO and Google Scholar for English‐language published and grey literature published between January 2014 and November 2025. Two reviewers independently screened and extracted data. Findings were synthesised narratively and mapped to the Strong Model of Advanced Practice Nursing and Quintuple Aim. Results: Of 3360 records screened, 23 sources met the inclusion criteria: 14 published articles, and 9 grey literature sources (conference abstracts, theses, textbooks). Most sources originated from the USA ( n = 12, 52%) or high‐income countries ( n = 22, 96%), and focused on nurse navigator roles ( n = 9, 39%). Five themes emerged in the sources: (1) purpose of evaluation; (2) development of methods and metrics; (3) selection and implementation; (4) data collection approaches; and (5) challenges and considerations. Evaluation was primarily used to demonstrate value and drive quality improvement through pragmatic methods. Metrics varied widely and were concentrated in the Strong Model domains of Direct Comprehensive Care and Support of Systems, with fewer addressing Education, Research and Professional Leadership. Key challenges to evaluation included role variability and lack of standardised tools. Conclusion/Implications: Despite the lack of standardised evaluation practices for specialist cancer nursing, the five themes synthesised in this review can guide evaluation of specialist cancer nursing roles and models of care in real‐world settings. Opportunity exists for international collaboration to develop a comprehensive, context‐sensitive set of metrics, relevant in diverse healthcare settings, that capture both excellence in service delivery and nursing scholarship. Impact: What problem did the review address? Specialist cancer nurses perform a diverse range of interventions and roles that are complex in nature, leading to challenges in their accurate evaluation. Effective and efficient approaches to evaluation of specialist cancer nursing roles are crucial to demonstrate their value. A significant body of literature has demonstrated the efficacy of specialist cancer nursing roles and models of care in a research framework; however, evaluation is needed to better understand the impact of translating this evidence into real‐world settings. What were the main findings? A scoping review exploring evaluation methods and metrics of specialist cancer nursing revealed five key themes: (1) purpose of evaluation; (2) development of evaluation methods and metrics; (3) selection and implementation of evaluation methods and metrics; (4) methods of data collection; and (5) challenges and considerations. Evaluation of specialist cancer nursing is important, however variation in nurses' roles and responsibilities and lack of standardised measurement tools were key challenges. Evaluation metrics varied widely and were specific to specialist cancer nursing roles; predominantly reported under the domains of Direct Comprehensive Care and Support of Systems, with fewer reported under Education, Research and Professional Leadership. Where and on whom will the research have an impact? Nursing and health service leaders can use the identified themes and subthemes as a framework to guide evaluation of specialist cancer nursing. The predominance of English‐language and high‐income country evidence limits the global applicability of these findings. Gaps in knowledge can drive the future work of cancer nursing organisations to collaboratively develop a comprehensive list of evaluation metrics that can be contextualised for specific roles across diverse health care settings. Specialist cancer nurses in all roles and models of care should have metrics for Research, Leadership and Professional Leadership to support the scholarship of nursing. Consistent national role definitions, shared competency frameworks and standardised outcome measures should be embedded in policy and commissioning to enable systematic evaluation, appropriate resourcing, and integration into workforce and service planning of specialist cancer nurses. Reporting Method: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews PRISMA‐ScR checklist. Patient or Public Involvement: Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data and the preparation of the manuscript. No patients were involved in the conduct of this scoping review.

Aim: To describe the development, consultation, and endorsement process for a joint position statement from the Cancer Nurses Society of Australia (CNSA) and the Clinical Oncology Society of Australia (COSA) regarding the contribution of nurses to cancer survivorship care in Australia. Methods: A development team of nursing and oncology experts ( n = 11) was convened in September 2025. The draft position statement was informed by key literature, including the COSA Model of Survivorship Care, Australian Cancer Plan, a modified Delphi study defining nurse capabilities in survivorship care, and an overview of systematic reviews on nurse‐led care models. A consultation survey was then distributed via Qualtrics to CNSA and COSA members and partner organisations from October to November 2025. Respondents provided qualitative feedback across four domains: service delivery, research, education and policy. The expert panel incorporated the feedback and finalised the position statement, which was endorsed by COSA Council and CNSA Board in March 2026. Results: Submissions from 37 individuals and 10 organisations provided feedback on the draft position statement. Respondents were clinical nurse consultants/specialists ( n = 24), nurse practitioners ( n = 3), researchers ( n = 2), educators ( n = 1), managers ( n = 3), non‐nurse healthcare professionals ( n = 4), and administrators of relevant not‐for‐profit organisations ( n = 10) across Australia. Feedback was highly supportive, with respondents endorsing the statement's comprehensiveness. Key feedback included calls for greater specificity around implementation in under‐resourced settings, recognition of survivorship as a nursing speciality, the need for a national survivorship minimum dataset, and emphasis on telehealth‐enabled models. The final CNSA‐COSA position statement articulates 40 recommendations to strengthen nursing contribution across service delivery ( n = 9), research ( n = 11), education ( n = 9), and policy ( n = 11). Conclusion: This joint CNSA‐COSA position statement provides a framework to guide the integration of nursing into cancer survivorship care across Australia. Its implementation will require coordinated investment in workforce, education, research, and policy reform. Trial Registration : Not applicable as this is not a clinical trial.

Issue Addressed: For people in rural and remote areas, government‐funded travel subsidy schemes provide vital financial assistance and equitable access to specialist healthcare in city centres. However, few studies have examined users' experiences of these schemes. Methods: Adults travelling for healthcare in Queensland, Australia, completed an online survey capturing their most recent experience applying for the Patient Travel Subsidy Scheme (PTSS). Participants' responses were analysed using descriptive statistics and thematic analysis. Results: From 69 respondents (aged 29–80 years, 60% female, 88% most recent application for cancer‐related care), 57% agreed information about the scheme was easy to access, although only 39% found the initial registration process easy. Most indicated that local hospital staff and PTSS officers were knowledgeable and helpful (65%–70%). Less agreed that staff were available to assist (48%) or that processes were well‐coordinated across hospitals (42%). Of those who sought reimbursement for travel costs (75%), almost two‐thirds (63%) were out‐of‐pocket post‐reimbursement (mean = AU$725; range = AU$20–10 000). Delayed reimbursement was relatively common (60%) and contributed to financial hardship (36%). For some (13%), challenges accessing the scheme impacted treatment decisions. User feedback included improved visibility of online application and reimbursement status, and fast‐tracking of high‐risk, urgent and ongoing cases. Conclusions: While information about the scheme and interactions with frontline staff were viewed positively by most, several system‐level challenges remain. So What?: Substantial out‐of‐pocket costs and reimbursement delays contribute to financial hardship and can affect treatment decisions. Increased subsidy reflecting actual travel costs, timely reimbursement, fast‐tracking, and greater application assistance and coordination would improve user experiences.

Female partners of prostate cancer (PCa) survivors are a cohort of cancer carers exposed to social and economic vulnerability. This vulnerability can be compounded by the impact of living in rural/remote areas, yet the experiences of these partners have received little attention and a gender‐based approach is needed. We conducted an exploratory qualitative study to examine the experiences of female partners of PCa survivors living in rural/remote areas across Australia and their needs and preferences for support. In‐depth interviews were conducted with 17 female partners from 2020 to 2023. Inductive thematic analysis was used to analyse data. Female partners were simultaneously dealing with the accumulated impact on their well‐being of the carer role in addition to broader familial and community obligations. Negative interactions with health professionals when engaging local services in the support role were difficult to navigate given a lack of alternative healthcare options. Multiple financial and well‐being challenges were associated with travelling away from home in support of their partners seeking treatment. PCa specialist nurses (PCSNs) were integral to supporting female partners, and they also accessed peer support and identified the need for clinician prompting to bolster their personal agency in seeking support for their own well‐being. Supporting the well‐being of these female partners requires consideration of accumulated life stressors and the realities of living in rural/remote locations. Primary healthcare clinicians and PCSNs are in a unique position to provide contextualised support for these female partners through routine assessment and referral to appropriate support as part of survivorship care.