Beyond Randomised Trials: A Scoping Review of Real-World Evaluation Methods and Metrics of Specialist Cancer Nursing.
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.