Consensus-based guidelines for Clinical Nurse Specialists providing psychological support in cancer care: A modified Delphi study

Psychological distress is common among people with cancer and affects quality of life, treatment engagement, and survivorship. Clinical Nurse Specialists are well placed to provide psychological support, yet no consensus-based best practice guidelines exist for the role. This study aimed to develop expert consensus best practice guidelines for Clinical Nurse Specialists providing psychological support to people with cancer.

We conducted a modified Delphi study. A preliminary phase combined a literature review with interviews with five Clinical Psychologists working in cancer care to generate initial guideline statements. This was followed by a three-round Delphi process with 20 panellists (11 people with cancer, nine Clinical Nurse Specialists). Of these, 17, 14 and 11 completed Rounds 1, 2 and 3. Ratings were analysed using descriptive statistics and free-text responses using qualitative content analysis. Consensus was defined a priori at ≥75% and used to classify guidelines as Essential or Important.

The panel endorsed 38 guidelines, 15 Essential and 23 Important, covering communication, assessment and care planning, individual needs, training and supervision. The research team organised them into seven domains within two broader groupings: a holistic view of the person, and mobilisation of a psychologically informed system.

The guidelines provide a consensus-based framework to support Clinical Nurse Specialist practice, training, supervision, and service development in cancer care. They clarify the relational skills and the organisational conditions needed to deliver psychologically informed care. Further research should examine their implementation, adaptation, and sustainability across clinical contexts.