Research typically involves an investment of resources, so it is important to ensure that any associated activities align with the interests, needs and values of the wider community. Setting research priorities will help guide the allocation of resources to areas with the greatest potential for scientific advancement and societal impact, ultimately leading to evidence-based policy-making (Smith et al, 2009; Francis-Oliviero et al, 2021; Grill, 2021).
Nurses are well positioned to identify the most critical issues in patient care and areas that should be prioritised for investigation. Involving nurses in the development of priority topics may increase their engagement in research and enhance the development of high-quality nursing practice (Fossum et al, 2022). The introduction of European policies for cancer care, including the European Union (EU) Cancer Mission (European Commission, 2021a) and Europe's Beating Cancer Plan (European Commission, 2021b) makes it essential to establish a Europe-wide agenda for cancer nursing research. The existence of such an agenda will provide nurses with a set of objectives, and enable them to make a cohesive contribution to implementing any initiatives that arise as a result.
Disparities in cancer nurses’ education, specialist roles and the available resources across Europe may make the development and implementation of a shared research agenda challenging. Nonetheless, identifying research priorities that align with the needs of patients, caregivers, cancer nurses and clinical cancer care teams can enhance the effectiveness and efficiency of cancer care services, while fostering the development of nursing science (Fossum et al, 2022).
Priority-setting activities in cancer nursing are becoming more widespread (Cadorin et al, 2020; Jones et al, 2021; Zanville, 2021; Bradford et al, 2022; Fossum et al, 2022; O'Connor et al, 2022; Dowling et al, 2023). However, in Europe, there has been limited effort to engage in cohesive priority-setting activities for cancer nursing research (Browne et al, 2002; Cadorin et al, 2020; Rustøen and Schjølberg, 2000; Fossum et al, 2022). This article presents the findings arising from a consultation with nurses undertaken by the European Oncology Nursing Society (EONS) Research Working Group, with the aim of scoping potential topics for future cancer nursing research across Europe.
Method
Design
This study is the second phase of a three-phase mixed methods study, which includes:
A rapid review by Dowling et al (2023) was conducted in parallel to the consultation reported in this article.
Participants
In this second phase, the EONS research working group conducted a consultation with cancer nursing delegates attending the EONS15 Congress in September 2022 to identify their perspectives on research priorities. The EONS congress, which is an annual 3-day international conference for cancer nurses, co-hosted with the European Society of Medical Oncology (ESMO) Congress, attracts clinicians, researchers, patient advocates, journalists and healthcare industry representatives from across the world.
The EONS15 Congress drew 317 nurse delegates from across 37 countries, who were invited to be part of the consultation. Information about the study was also circulated to individual EONS members via the society's newsletters and the national cancer nursing societies that are members of EONS (individual members and 32 national societies).
Inclusion criteria
Participants were required to be registered nurses working in cancer care.
Data collection
During the EONS congress plenaries, information about the study was presented alongside a QR code directing potential participants to an open-ended question hosted on Google Forms, which asked them to spontaneously identify up to five topics that they considered were most important for future cancer nursing research in Europe.
Ethical considerations
Participants were assured that no identifying demographic information would be collected to ensure anonymity. The Koç University Institutional Review Board approved ethical exemption for this study.
Analyses
The nurses’ responses were imported into the software program MAXQDA Pro 22 (VERBI Software, 2022), for data interpretation and analysis. The authors followed a thematic analysis process that involved six steps:
Two researchers (GB, SCL) independently coded the data inductively to categorise the responses. A third researcher (AD) reviewed the coding and, following reiterative rounds among the three researchers, consensus was reached on the thematic categories and the finalised priorities.
Findings
Out of the 106 cancer nurses who accessed the questionnaire, 73 provided responses. The analysis identified 73 research priority topics, which were developed into eight main themes, each of which was broken down into a number of subthemes (see Table 1):
| Theme | Subtheme | Priorities: Research to understand … |
|---|---|---|
| Supportive care and palliative care in cancer | Symptom assessment and management |
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| Psychological and social support |
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| Education and information |
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| Technology |
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| Service delivery |
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| Ethics and decision-making |
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| Healthcare navigation |
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| Complementary therapies |
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| Health promotion and cancer prevention |
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| Self-management |
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| Professional issues in nursing | Quality of care |
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| Role recognition and definition |
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| Safety |
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| Wellbeing and job satisfaction |
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| Workforce issues |
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| Nurse-led care and models of cancer care | Characterisation and evaluation of existing nurse-led models of care |
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| Development and evaluation of nurse-led models of care |
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| Impact and outcomes of nursing care |
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| The needs of family members and informal caregivers of people living with and after cancer | Education |
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| Support |
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| Education, training and professional development for nurses | Disease- and treatment-related knowledge and competence |
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| Interpersonal skills |
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| Leadership |
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| Inequities in cancer care | Access to care |
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| Global health |
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| Under-represented groups (eg groups that may be excluded due to race, gender identity, sexual orientation, age, physical ability, language and/or immigration status) |
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| Health literacy |
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| Research culture and capacity in nursing | Skills and training |
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| Barriers and facilitators of nurse-led research |
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| Patient and public involvement in research |
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| Clinical trials |
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| Research with specific populations |
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| Epidemiology |
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The theme that had the largest number of research topic proposals was ‘supportive care and palliative care in cancer’, followed by ‘professional issues in nursing’ (Table 1).
The priority topics cited by respondents covered the point at which palliative care should be initiated, evaluation of palliative care models, participation of nurses in decision-making processes, interventions to improve quality of life (QoL), and supporting patients and families in decision-making processes. Symptom science, including management strategies, was also listed as a priority for research. Most nurses also prioritised the use of complementary therapies and technologies, such as virtual reality (VR) and artificial intelligence (AI) in symptom management.
Within the theme ‘professional issues in nursing’, the most frequently cited issues were QoL, role recognition and definition, safeguarding from the risk of exposure to toxic therapies, wellbeing and job satisfaction, and workforce issues were the prominent topics.
Discussion
This study identified cancer nursing research priorities from the perspectives of cancer nurses. Overall, the findings provide an indication of several areas that should be targeted for nursing research.
The rapid review by Dowling et al (2023), which spanned work published between 2019 and 2022, offered valuable insights into research topics in cancer nursing identified as priorities over this period. However, this review included priorities identified by nurses from the USA and Australia only. Therefore, it is challenging to determine how transferable these topics are to contexts where cancer nursing is not yet recognised as a specialist area of practice in some countries in Europe. Involving a diverse population of nurses in terms of geography, language and competence is crucial for determining research priorities in the specialty; this will ensure that the topics identified are relevant and applicable to a wide range of contexts and cultures, and that they can be adapted to meet the unique challenges faced by patients and nurses in different countries.
The findings of this study show that priority areas for research in cancer care and nursing practice, as indicated by the respondents, coincide with many of the topics formulated by the EU Commission (2021b) and the World Health Organization (WHO) (2020), as well as by cancer and nursing organisations.
Supportive and palliative care
Among the priorities frequently highlighted by nurses are those relating to the provision of supportive and palliative care. These are concepts that are emphasised by both the EU Commission and WHO. In particular, WHO (2023) emphasises that palliative care focuses on improving QoL for patients and their families, and is an essential component of cancer care. In view of the existing disparities between countries with regard to access to cancer care, including supportive and palliative care (Lau et al, 2021; Axelsson, 2022), it is clear that research is necessary to help understand the range of factors that affect access for patients in each country. Moreover, research on improving access to palliative care services to meet the needs of cancer patients in different countries could inform the development, implementation and evaluation of interventions delivered by health professionals caring for them.
The management of side-effects and support for patients both have a significant impact on patients’ QoL and overall wellbeing, and were among the research topics identified by the study participants (priority areas 1–7). As cancer treatments become more complex, the contribution of oncology nurses in the management of side-effects is becoming increasingly important. There is significant evidence on the benefits of nurse-led side-effects management in cancer patients (Hagmann et al, 2018; Kwekkeboom, 2020) and participants consequently identified a number of related priority areas for future research, such as the need to develop new assessment tools and interventions, to help mitigate the potential side-effects of novel treatment modalities, such as immunotherapies.
Further areas identified were the remote monitoring of patient-reported outcome measures (priority areas 12–15) and multimodal interventions, including technology and self-management support strategies. These would be cutting-edge research areas into the assessment and management of side-effects.
Professional issues in nursing
Other frequently cited research priorities were professional issues in nursing, including the quality of care, role recognition and definition, safety issues with regard to risk reduction of exposure to toxic therapies, wellbeing, job satisfaction and workforce issues (priority areas 27–43). Nurses highlighted recruitment, retention and turnover in the oncology nursing workforce as priority topics for research (priority area 42). These issues are critical to ensuring that healthcare systems are resilient and effective (Kelly et al, 2021).
Fostering a safe work environment contributes to the wellbeing and job satisfaction of nurses and, ultimately, affects patient care (Babapour et al, 2022; Mabona et al, 2022). Research to explore factors that affect nurse job satisfaction, burnout prevention, and strategies to promote mental health and wellbeing can profoundly impact nursing practice and retention rates within the profession(Gribben and Semple, 2021). A recent systematic review revealed that a healthy work environment for nurses requires leadership, effective communication, teamwork, and professional autonomy (Mabona et al, 2022).
The authors of this article suggest that research can explore ways in which nurses can be empowered and their autonomy enhanced, and interprofessional collaboration improves.
The study participants highlighted potential topics for research related to the quality of care delivered by nurses that had the potential to demonstrate the significant impact nursing interventions can have on improving patient outcomes in cancer care (priority areas 27–35). Nurses are central to patient care, so research on the quality of the care they deliver is crucial because nurse-led interventions can significantly impact patient outcomes, particularly in complex settings such as cancer care (Tuominen et al, 2019). Understanding how nursing practices influence the quality of care that nurse deliver helps improve not only clinical outcomes and patient satisfaction, but also overall healthcare efficiency.
Participants also highlighted the importance of advanced nursing practice roles in cancer care (priority area 37), and further research into nurse-led care and models of cancer care (priority areas 44–50) showing how nurses’ unique expertise and capacity to provide specialist and comprehensive care leads to better patient outcomes (Lai et al, 2017).
Nurse-led care and models of cancer care
The development and implementation of models of cancer care such as nurse navigation programmes, survivorship clinics, nurse-led symptom management, patient-centred interventions and nurse prescribing of systemic anti-cancer therapy (SACT) (priority areas 44–50) have all demonstrated promising results in improving patient care and the patient experience (Monterosso et al, 2019; Liang et al, 2020; Faessler et al, 2023). Research on the efficacy and cost-effectiveness of these nurse-led care models is crucial in supporting their implementation in various healthcare settings. By identifying the most efficient and patient-centred models of cancer care, nurses can advocate for their integration into oncology care pathways, ultimately leading to improved patient outcomes and better healthcare system performance.
Nurses operate within a multidisciplinary landscape, and nurse-led research has to have an interdisciplinary focus if it is to have a significant impact. By emphasising the value of involving cancer nurses in research, as well their role in clinical practice, healthcare institutions and policymakers can make informed decisions that will lead to a better patient experience and improved outcomes for those affected by cancer.
Needs of family members and informal caregivers
Identifying and improving the education and support needs of family members and informal caregivers of people living with and after cancer were among the research topics highlighted by participants (priority areas 51-54). Research on the needs of family members and informal caregivers is critical because they play a central role in the care and support of patients, who may experience significant emotional, physical, and financial burdens (Lindt et al, 2020). Understanding their needs can help inform interventions and policies to better support caregivers, improving their wellbeing and, ultimately, the quality of care provided to cancer patients. Addressing caregiver needs can also alleviate strain on healthcare systems by reducing caregiver burnout and promoting sustainable caregiving arrangements (Coyne et al, 2020).
Education, training and professional development
The participants cited education, training and professional development, including disease- and treatment-related knowledge and competence, interpersonal skills, and leadership as research priority areas (priorities 55-59). It is vital that cancer nurses are equipped with the most up-to-date knowledge and skills through education, training and professional development opportunities; this enables them to effectively handle complex clinical situations, improve patient outcomes and enhance healthcare delivery overall.
Ongoing professional development supports cancer nurses in delivering evidence-based care, while adjusting to administering new therapies and changing patient requirements (Challinor et al, 2020).
Inequalities in cancer care
Further topics identified for research included inequalities in cancer care, particularly in terms of access to services, with a focus on ensuring equitable health care for under-represented groups to identify the specific challenges they face, which includes health literacy (priorities 60–65). Inequitable access to services can have a considerable impact on cancer outcomes, widen health disparities and impede efforts to reduce the burden of cancer worldwide (De Souza et al, 2016; Hirko, 2023).
Research focusing on access to care can identify barriers and facilitators, as well as lead to new interventions to improve access for underserved groups (priorities 66–72). By addressing disparities, researchers and policymakers can work towards reducing cancer-related mortality and improving cancer outcomes for all populations (Hirko, 2023).
Another key research area is to explore the availability, or lack of, equitable health care for under-represented groups to identify the specific challenges faced by these populations and to inform the design of culturally tailored interventions. The promotion of knowledge exchange and capacity-building between high-income and lower-middle-income countries will also help facilitate any changes to improve the provision and delivery of care to these groups. By fostering collaboration and understanding, researchers can develop strategies to address disparities in cancer outcomes globally (Patel et al, 2020).
Research on patient health literacy can help identify strategies to improve communication between healthcare providers and patients, develop patient-centred educational materials and implement interventions to enhance health literacy among vulnerable populations. Equipping individuals with the necessary knowledge and skills can empower them and ensure better engagement in cancer prevention, management and improved adherence to treatment (Berkman et al, 2011).
Research culture and capacity in nursing
Another research priority area highlighted by nurse participants was research culture and capacity in nursing, including research skill training, barriers and facilitators of nurse led research, patient and public involvement in research, clinical trials, and research with specific populations (priorities 66-69). Competence, motivation, infrastructure (material and managerial support), academic/clinical collaboration, and effective leadership are crucial factors for enhancing research capacity. Strengthening research capacity enables nurses to engage in studies that address gaps in cancer care, ensuring that nursing practice evolves in line with current scientific advancements (O'Brien et al, 2022).
Epidemiology
Although it was cited less than other topics, cancer epidemiology, including cancer diagnosis risk factors, was another area for potential research (priority 73). Research focusing on cancer diagnosis risk factors can enable nurses to identify high-risk patients early on, implement preventive measure and provide tailored care plans, all of which will contribute to improving patient outcomes. By understanding these risk factors, nurses can better educate patients and advocate for early detection, potentially reducing cancer morbidity and mortality rates (Liebermann et al, 2023).
New research areas
Most of the priorities identified in this survey are similar to those reported previously (Cadorin et al, 2020; Jones et al, 2021; Zanville, 2021; Bradford et al, 2022; Dowling et al, 2023). However, a number of new priority research topics also emerged, for example the investigation of side-effects related to the new generation of cancer treatments and the use of technologies such as VR to support symptom management. Technology and digital competence were highlighted by Fossum et al (2022) as research priorities; however, in this survey, the research areas related to technology suggested the need to focus on medical-technical equipment, simulation and e-health.
Technologies such as VR and AI have the potential to benefit not only patients, but also healthcare providers. They can be applied to enhance patient care, improve treatment outcomes and increase patient satisfaction (Ali et al, 2023). However, more evidence is needed on the use of VR and AI interventions with regard to symptom management in cancer patients, to establish their efficacy, sustainability, acceptability, safety and long-term effects. Robust clinical trials and research studies are necessary to validate new technologies, as complementary or alternative interventions in cancer care and ensure that they are beneficial, patient-centred and aligned with evidence-based practice.
Limitations
A limitation of this study is that the consultation involved only a specific group of conference delegates, whose views may not necessarily reflect those of the wider cancer nursing population across Europe. However, it is a good proxy because this was a diverse group of clinical, academic and research professionals representing a range of countries across the continent. Despite the small number of participants in the consultation, the authors have made the assumption that they are representative of a range of European countries, and consequently have contributed valuable data.
Conclusion
Scoping and exploring key research priorities should support the development of research studies to generate evidence to enable specialist cancer services to optimise the allocation of time, funding and nursing expertise to ensure the delivery of care that leads to impactful and relevant outcomes edit.
The researchers consider that the list of research priorities generated through this consultation study provides the basis for further priority-setting activities at local and national levels within European countries. It can act as a starting point for setting research priorities that are both sensitive to each cultural setting and take account of contextual factors that affect cancer nursing.