Living Well With Breast cancer

The success of the Living Well With Breast Cancer Nurse-Led Clinic (NLC) was enabled  by the right clinical environment and strong organisational support. At Gold Coast University Hospital, increasing demand within oncology outpatient services had led to prolonged waiting times for medical oncology appointments, particularly for clinically  stable patients requiring regular monitoring on CDK4/6 therapy. There was clear recognition that specialist resources needed to be optimised without compromising safety or quality. The established framework of the McGrath Foundation Model of Care underpinned  the project, supporting continuity, coordination and holistic, patient-centred care. Executive endorsement, multidisciplinary consultation, clearly defined clinical eligibility criteria and robust escalation pathways were critical to safe implementation.

Key lessons learnt included the importance of early stakeholder engagement and transparent communication. Consultant buy-in was essential to building confidence in scope of practice and shared care arrangements. Developing detailed work instructions and escalation  criteria prior to launch strengthened governance and patient safety. Prospective data collection allowed us to demonstrate impact on clinic efficiency and waiting times, reinforcing sustainability. Limitations include reliance on an experienced Specialist  Breast Clinical Nurse Consultant workforce, making the model vulnerable to staffing constraints. The clinic is suitable only for clinically stable patients, limiting broader applicability. Telehealth utilisation was lower than anticipated, indicating the need  to better understand patient preference and digital access barriers. Formal evaluation of patient-reported outcomes is underway but not yet complete.

The strengths of the model include measurable reduction in waiting times for consultant appointments, improved  clinic flow, and enhanced holistic care. Thirty-minute nurse consultations allow comprehensive toxicity monitoring, endocrine side-effect management, psychosocial support and routine distress screening. The extended consultation time fosters therapeutic rapport  and often identifies unmet needs not raised during medical appointments, strengthening patient activation and shared decision-making. Weaknesses include workforce dependence and the administrative burden of data tracking. Opportunities exist to expand the  model to other oral systemic therapies, survivorship pathways and additional tumour streams.

The demonstrated ability to release consultant capacity presents a compelling case for broader adoption. If implemented again, we would embed a formal evaluation framework  and patient-reported experience measures from inception, alongside real-time data dashboards to better quantify efficiency gains and patient outcomes. Earlier promotion and optimisation of telehealth pathways would also be prioritised. This model has strong  potential for replication across Queensland Health facilities, particularly in tertiary and regional centres with established specialist cancer nursing roles and high outpatient demand. With appropriate governance and escalation frameworks, similar nurse-led,  protocol-driven clinics could support sustainable workforce redesign across multiple oncology settings. Next steps include completing formal evaluation, incorporating structured consumer and medical feedback, refining telehealth integration, and developing  a scalable implementation guide to support expansion across other Hospital and Health Services. The long-term objective is a sustainable, nurse-led model that safely reduces waiting times, enhances holistic care.