ORIGINAL PAPER A mixed-method evaluation of nurse-led community-based supportive cancer care D. M. Howell & J. Sussman & J. Wiernikowski & N. Pyette & D. Bainbridge & M. O’Brien & T. Whelan Received: 26 September 2007 / Accepted: 30 January 2008 / Published online: 12 March 2008 # Springer-Verlag 2008 Abstract Goals of work The study purpose was to evaluate a nurse- led supportive care clinical case management program in the community using multi-methods to delineate care processes prior to outcome evaluation. Materials and methods Multiple data sources including program service records, chart reviews and interviews with nurses and key interdisciplinary informants were used to identify population served (coverage and reach), processes of care (implementation), and providers’ perceptions of the effectiveness of the nurse-led program (reaction). Main results The program provided care to over 700 cancer patients in a 1-year period. Nurse-led support interventions were focused on direct care inclusive of teaching/coaching for symptom management, counseling and support, and mobili- zation of services through system navigation based on an initial comprehensive assessment of supportive care needs. Conclusions Nurse-led models of supportive care have the potential to reduce unmet supportive care needs, improve continuity of care, and overall health-related quality of life that should be tested in future trials. Keywords Supportive care . Community . Evaluation . Nursing . Case management Introduction Individuals with cancer and their families face a myriad of challenges as they attempt to meet the physical demands of cancer and treatment while adjusting to psychosocial and spiritual consequences [1]. Since most cancer care is delivered on an outpatient basis, the day-to-day adjustments required to meet these challenges is experienced in the individuals’ own home and community. Unmet supportive care needs, poor communication with health care providers, piecemeal and fragmented information, and poor access to emotional support and community-based services are reported [2–4]. The highest levels of unmet needs have been noted in the psychological domain contributing to high levels of psychosocial distress across cancer patient populations [5–7]. Consequently, access to coordinated supportive care accessible close to home in order to meet the physical, informational, psychological, social, spiritual, and practical needs of persons living with or affected by cancer [8] has become a focus of attention in the cancer care system [9]. Unfortunately, accessing relevant community-based sup- portive care may be challenging since services exist as disconnected parts resulting in fragmented and discontinuous care across providers and care systems [10]. Cancer patients report difficulty navigating the health care system to obtain information and support relevant to their unique circum- stances due to the complexity and multitude of different types of cancer service agencies [4]. Care models that facilitate access to coordinated supportive care have been proposed including supportive care system networks [11], Support Care Cancer (2008) 16:1343–1352 DOI 10.1007/s00520-008-0416-2 D. M. Howell (*) Princess Margaret Hospital, 610 University Ave. (Room 15-617), Toronto, ON M5G 2M9, Canada e-mail: doris.howell@uhn.on.ca J. Sussman Supportive Cancer Care Research Unit, Juravinski Cancer Center, 699 Concession St., Hamilton, ON L8V 5C2, Canada J. Wiernikowski : N. Pyette : D. Bainbridge : M. O’Brien : T. Whelan Juravinski Cancer Center, 699 Concession St., Hamilton, ON L8V 5C2, Canada