In Western developed countries, the role of specialist nurses first emerged in the 1970s when attention was first drawn to the psychosocial issues of breast cancer patients (Yao et al., 2023). Since then, the role of specialized nurses has continuously evolved. Currently, specialized nurses are explicitly designated as core members of cancer MDTs, with their functional roles and participation pathways forming a mature standardized system (Taylor et al., 2013; Erica et al., 2022). The UK National Health Service (NHS) mandates that urological cancer MDTs be led by specialized nurses; compared to other cancer care networks, this model improved patient management quality scores by 27% (McGlynn et al., 2017). An Italian cancer center fully integrated specialized nurses into MDT implementation pathways by establishing specialized nurse clinics. Within 1 year, MDT meeting participation rates reached 95%, with patient satisfaction exceeding 83.2% (Zeneli et al., 2021).

Internationally, specialized nurses possess high autonomy within MDTs, not only fulfilling foundational duties like patient care, education, and support but also playing leading roles in clinical decision-making and team coordination. A systematic review by Cook et al. (2021) demonstrated that deep involvement of specialized nurses significantly improves patient quality of life, nursing satisfaction, and treatment continuity. MDT services led by specialized nurses effectively bridge gaps in traditional treatment models, forming an efficient and collaborative healthcare system (Sharpley et al., 2021).

The involvement of specialist nurses in cancer MDT remains in its early stages in China. However, with the growing demand for specialized cancer care, the training and deployment of specialist nurses have seen rapid development. Although not yet formally incorporated as core members of MDT teams, the role of specialist nurses in cancer diagnosis and treatment is gradually gaining recognition. A 2014 study by Yan et al. (2014) on specialized nurses participating in multidisciplinary cancer consultations revealed that 96% of physicians and 78% of patients viewed their involvement as beneficial Blaschke et al. (2019) conducted qualitative research to clarify the multifaceted roles of breast care nurses within MDTs, including data compilers, coordinators and communicators, patient advocates, and outcome implementers.

In recent years, the professional value of specialized nurses in MDTs has become increasingly prominent. They not only provide specialized consultation and guidance to patients, improve their physical and mental well-being and healthcare experience, but also ensure continuity of nursing services (Chen et al., 2021; Wang et al., 2025). MDT collaborative care models led by specialized nurses have also gradually emerged (Soukup et al., 2021; Ma et al., 2022). A randomized controlled trial by Chen et al. (2022) demonstrated that individualized care grounded in MDT principles reduced anxiety scores by 40% in breast cancer patients, significantly promoting limb function recovery and quality of life improvement.

However, the involvement of Chinese specialty nurses in MDTs still faces challenges such as regional development disparities, limited participation levels, and ambiguous role definitions. Compared to mature models in Western developed countries, significant gaps remain (see Table 2).

Specialist nurses serve as the critical guarantors of continuity in cancer patient care. Functioning as central liaison points within the healthcare system, they undertake multidimensional coordination responsibilities. At the patient level, specialist nurses provide comprehensive care navigation, coordinate diagnostic and treatment schedules, and resolve practical issues encountered during the healthcare journey. At the team level, they build communication bridges between MDT members and between MDTs and primary care providers, ensuring timely and accurate information exchange (Kramer et al., 2023). A study on colorectal cancer patients revealed that 285 (90.4%) patients acknowledged the specialized nurses’ capabilities in coordinating care, facilitating investigations, and providing information to patients and families, establishing them as pivotal nodes in doctor-patient communication (Petrushnko et al., 2022). An ethnographic study by Bobat et al. (2020) confirmed that specialized nurses undertake complex coordination, relationship-building, and advanced communication tasks within MDTs, serving as vital connectors that ensure the team’s efficient operation.

Specialist nurses play an irreplaceable role in patient education and counseling through their expertise and practical experience. Their educational content spans disease awareness, treatment plan interpretation, adverse reaction management, rehabilitation training guidance, and more. Their educational methods are more targeted and accessible, effectively addressing the time and approach limitations of medical specialists in patient education. In a survey regarding prostate cancer assessment and diagnosis, 90% (791 patients) received their prostate biopsy results from a specialized nurse. Among the 135 patients diagnosed with cancer, 90% stated they would choose this approach again, 70% perceived no drawbacks, and 96% expressed high satisfaction with the specialized nurse’s expertise, related counseling, and subsequent MDT meeting arrangements (Hawks et al., 2022). Research indicates that systematic education delivered by specialized nurses reduces the average time from referral to initial treatment for newly diagnosed cancer from 53 days to 41 days. This significantly enhances treatment adherence and self-management capabilities, shortens clinical waiting times, and lays the groundwork for the successful implementation of multidisciplinary team (MDT) protocols (Waters et al., 2021).

Specialist nurses provide comprehensive patient management throughout the treatment journey. Through holistic needs assessments and meticulous monitoring of treatment tolerance and toxicity, they deliver critical safeguards for multidisciplinary team (MDT) clinical quality (Sharpley et al., 2021). Compared to other healthcare providers, specialty nurses dedicate more time to patients, performing comprehensive needs assessments, monitoring treatment tolerance, and tracking rehabilitation progress. They promptly identify potential issues during care and relay them to the MDT team. A study on prostate cancer patients demonstrated that specialty nurses were present throughout all phases of active surveillance (AS), from patient evaluation and counseling to facilitating decisions, organizing diagnostic interventions, and ensuring patient needs were met (Bates et al., 2020). Typically, specialized nurses interact with other disciplines to provide continuous care. In a randomized controlled trial involving 119 rectal cancer patients, researchers divided participants into Group A (59 patients with specialized nurse support) and Group C (60 patients without specialized nurse support). Results showed that 79% of patients in Group A completed the multidisciplinary team (MDT)-prescribed management regimen, significantly higher than Group C (28%). Compliance in Group A was significantly superior to Group C (p < 0.001), fully demonstrating the critical value of specialized nurses in clinical management (Dinoy et al., 2021).

In cancer diagnosis and treatment, patient involvement in their own medical decisions is regarded as a key aspect of healthcare system success and sustainability. However, patients often face difficulties in directly participating in multidisciplinary team (MDT) meetings. As the team members with the closest contact to patients and their families, specialized nurses serve as the primary channel for advocating for patient rights and expressing their needs (Brown et al., 2018). Specialist nurses can accurately identify the psychological needs underlying patients’ non-physical symptoms (such as fear of death or treatment concerns), and incorporate key information including patient preferences, psychological state, and family support into multidisciplinary team decision-making (Cruciani et al., 2019). Providing support to cancer patients and families while advocating for patient wishes has also been identified as a key role of specialized nurses (Sheridan et al., 2020). Research indicates that the psychological support and needs feedback provided by specialized nurses enhance the scientific rigor and humanistic quality of clinical decisions, thereby improving patients’ sense of fulfillment and satisfaction with care (Maurizi et al., 2018; Farina et al., 2022).

In summary, the role of specialized nurses within multidisciplinary teams is crucial for enhancing the continuity of care experience for cancer patients. Particularly in Western countries, many nations emphasize the necessity of integrating specialized nurses into MDTs. However, research on specialized nurses’ participation in MDTs remains in its early exploratory stages in China. To date, only a limited number of studies have examined the clinical implementation pathways for specialized nurses’ involvement in MDTs from their perspective. Although results predominantly indicate positive effects, significant constraints still exist regarding specialized nurses’ participation in MDTs.

Specialist nurses, through comprehensive coordination, systematic education, holistic management and proactive support, not only enhance the continuity and seamless integration of nursing services but also systematically incorporate patients’ values, preferences and psychosocial needs into multidisciplinary team (MDT) decision-making processes. For instance, acting as ‘coordinators’ and ‘supporters’, specialist nurses convey patients’ unspoken needs and treatment preferences during MDT meetings, directly influencing the humanisation of treatment plans (Cruciani et al., 2019; Maurizi et al., 2018). This mechanism of deep engagement effectively elevates nursing continuity from the service level to the decision-integration level, thereby genuinely realising patient-centred MDT collaboration.

The core characteristic of MDT is the equal participation of all members in decision-making discussions; however, Chinese MDT teams still exhibit a pronounced imbalance in decision-making authority (Askelin et al., 2021). Specialist nurses lag considerably behind physicians in terms of participation numbers, engagement levels, representativeness, and contribution. Surveys indicate that 52 out of 79 healthcare institutions exclude specialist nurses from core MDT teams, with their opinions adopted at a rate merely 23% that of physicians. Patient-related information receives the lowest scoring in MDT discussions, leading to the neglect of critical factors such as patient preferences and psychological state, thereby undermining the individualisation and humanistic aspects of nursing care (Brims et al., 2022). MDT meetings are predominantly led by physicians from disciplines such as oncology, histopathology, and diagnostics, with specialist nurses often relegated to peripheral roles, lacking equal rights to speak and participate in decision-making (Caraceni et al., 2022).

Concurrently, China lacks established role specifications and workflows for specialty nurses in MDTs. There are no unified standards defining their responsibilities, scope of participation, or collaboration methods within these teams. Some specialty nurses hesitate to engage in MDT meetings due to unclear role definitions, hindering their ability to fully leverage their professional expertise. A cross-sectional study analyzing 223 MDT cases across six hospitals revealed that specialized nurses contributed significantly less than other team members (Gandamihardja et al., 2019). Disease-centered information dominated MDT decision-making, while patient-centered factors (such as patient preferences and comorbidities) were secondary (Wihl et al., 2021). A case review of 349 patients revealed that radiology information scored highest, followed by histopathology, while patient-related information scored lowest (Bruun et al., 2022). Traditional hierarchical structures, core member absences, and unequal decision-making power pose disruptive risks. These factors foster bias and groupthink within MDTs, marginalizing specialized nurses and undermining the very purpose of collective decision-making. This structural inequality in decision-making authority directly constrains specialist nurses from fulfilling their role as patient advocates and humanistic care liaisons within multidisciplinary teams. Due to a lack of equal voice, critical information such as patient preferences and psychosocial needs is frequently marginalised in MDT discussions (Brims et al., 2022). This results in inadequate personalisation of treatment plans and insufficient humanistic care, thereby compromising the overall quality of patient-centred holistic care.

The complex work environment in cancer subjects specialized nurses to dual pressures in communicating with patients and multidisciplinary teams, intensifying their ethical dilemmas and ethical decision-making capabilities, leading to emotional exhaustion among specialized nurses (Banerjee et al., 2017). Communication between oncology nurses and team members faces significant challenges due to factors such as hierarchical status (Price et al., 2014), the independent nature of disciplines and their distinct training approaches (Leonard et al., 2004), and multidisciplinary team roles (Rowlands and Callen, 2013). A survey of cancer nurses revealed the complexity of their engagement attitudes: whilst the majority (178/230) expressed willingness to actively participate in multidisciplinary team (MDT) meetings, only approximately half (92/178) felt confident enough to challenge other team members’ viewpoints during these sessions. Furthermore, 35 nurses admitted feeling intimidated by the atmosphere within MDTs (Stewart et al., 2018). This contradictory mindset, which combines a willingness to participate with a reluctance to speak up or even feelings of intimidation, concretely reflects both hierarchical communication barriers and a suppressive team atmosphere.

Furthermore, communicating with cancer patients presents difficulties, particularly regarding diagnosis and prognosis. Cancer patients often exhibit ambivalent attitudes toward diagnostic and prognostic information, oscillating between wanting to know and not wanting to know. Physicians, meanwhile, tend to convey diagnoses fully while avoiding detailed prognosis discussions to preserve patients’ hope. A phenomenological study by Melis et al. (2020) revealed that specialty nurses often perceive the disclosure of diagnosis and prognosis as a conflicting value (positive value: empowering patient autonomy; negative value: incompatibility with patient wishes). In communicating prognostic information, specialty nurses frequently face the ethical dilemma of balancing “telling the truth” with “preserving hope,” with most viewing prognosis communication as the physician’s responsibility and lacking awareness or capacity for proactive involvement.

The current state of strained medical resources and personnel shortages in China subjects specialty nurses to heavy workloads. Even after obtaining specialty nurse certification, they must still handle substantial routine nursing tasks, leaving them with insufficient time and energy to participate in multidisciplinary team (MDT) activities. A UK survey revealed that 63.5% of specialty nurses worked over 10% overtime weekly, with over half reporting inadequate administrative support (Stewart et al., 2018). This phenomenon is even more pronounced in China.

Concurrently, professional incentive mechanisms for specialty nurses are severely deficient. In terms of benefits and compensation, there is little discernible difference between specialty nurses and general cancer nurses, failing to reflect their specialized value. Regarding career development, the absence of specialized assessments, training, and promotion pathways for MDT participation dampens their enthusiasm. Furthermore, the fluid nature of their roles within MDTs, in which they often serve multiple functions, frequently leads to role ambiguity. A lack of understanding about MDTs among 85.7% of nursing staff further undermines participation effectiveness (Khan et al., 2023). Research by Maharaj et al. (2021) indicates that most other MDT members have experienced role overlap with specialized nurses. Furthermore, specialized nurses lack confidence in voicing opinions within their own areas of expertise (Cook et al., 2019). Although they perceive themselves as patient advocates capable of providing supportive care when needed, expressing their recommendations during MDT meetings proves challenging, leading them to prefer discussing matters privately with physicians (Findlay et al., 2021).

The development of specialty nurses in China remains in its infancy, lacking unified certification bodies and training standards. Currently, specialty nurse certifications include both those issued by the Chinese Nursing Association and those recognized by provincial health departments and hospitals. Significant discrepancies exist in training systems, curricula, and assessment criteria. This unstandardized training system results in inconsistent professional competence among specialty nurses, compromising training quality and making their professional authority vulnerable to questioning by patients and peers.

Furthermore, specialized nurses often lack sufficient interdisciplinary knowledge, making it difficult for them to contribute professional insights on other disciplines during MDT meetings. This limitation also diminishes their voice and influence within the team. Some specialized nurses, lacking confidence, prefer to discuss patient issues privately with physicians rather than openly express their recommendations during MDT meetings (see Table 5).