Nurse-Led MPN Clinic Model Cuts Symptom Burden, Boosts Satisfaction

Integrating a structured nurse-led visit into an academic hematology outpatient clinic reduced symptom burden and produced near-perfect patient satisfaction scores among patients with myeloproliferative neoplasms (MPNs), according to a quality improvement project published in BMJ Open Quality.¹ The findings add to a growing evidence base on nurse-led care models but represent one of the first applications specifically tailored to this chronic blood cancer population. This project was started in September 2024 and remains ongoing.

High-demand patients—those with new diagnoses, complex disease, or treatment resistance—require at least 3 outpatient visits annually, but focus groups conducted with 16 of these patients revealed that 20-minute physician visits left insufficient time to address symptom burden, disease education, or long clinic wait times, the study investigators explained.

What Prompted the Nurse-Led Model?

The project originated at a hospital-based hematology clinic in northern Italy that manages roughly 200 patients with Philadelphia-chromosome–negative MPNs, a category that includes essential thrombocythemia, polycythemia vera, and myelofibrosis. The unmet need for extended clinician visits is consistent with broader research on the disease.

Previous research demonstrates that the variable and often nonspecific symptoms of MPNs—fatigue, difficulty concentrating, and other subtle complaints—can delay diagnosis and complicate ongoing management, underscoring the value of dedicated time for symptom review.² Similarly, the evolving treatment landscape for myeloproliferative disorders shows potential for modest cost savings, illustrating how new therapies are reshaping the cost calculus health plans use to evaluate MPN care.³

A multidisciplinary team of hematologists, nurses, and academic partners designed the intervention using the person-centered care framework and the Donabedian model, which separates quality improvement into structure, process, and outcome domains.¹ Implementation proceeded through 5 sequential Plan-Do-Study-Act (PDSA) cycles over 3 months.

What Did the Data Show?

The first cycle tested feasibility but found that only about half of eligible patients could be seen in 1 day because of time constraints, prompting the addition of 2 alternating dedicated nurses in cycle 2 to guarantee full coverage. Subsequent cycles introduced and refined a patient symptom diary, which staff and patients found improved continuity, self-management, and the depth of follow-up conversations. By the fifth cycle, nurse–patient shared readings of diary entries revealed active patient engagement, with several patients volunteering additional narrative details about their physical and psychological health.

Each visit incorporated validated instruments spanning symptom burden, fatigue, anxiety and depression, nutritional risk, medication adherence, quality of life, and patient activation, along with objective measures of physical function such as handgrip strength and a 30-second chair stand test.

Over the study’s first 6 months, all 102 eligible high-demand patients received an assessment visit, and none declined a follow-up—yielding full compliance with both the nursing visits and the symptom diary. Median MPN Symptom Assessment Form Total Symptom Score declined from a median (IQR) 13 (5-12) at baseline to 11 (8-25.75) at 6 months, and anxiety and depressive symptoms showed similar improvement: from 5 (1-8.25) to 2.5 (0-5) and 5 (1.75-8) to 3.5 (1.5-6), respectively. Fatigue and most quality-of-life domains remained broadly stable. Four patients were newly identified as at risk for malnutrition and referred for nutritional assessment. Patient satisfaction was rated a mean (SD) 9.6 (0.75) of 10, and no adverse events were reported. Critically for clinic operations, waiting times did not increase—every visit occurred within 30 minutes of a patient’s scheduled arrival—and adding the 2 dedicated nurses did not strain staffing once the service transitioned to a single embedded nurse for ongoing follow-ups.

What Potential Lies in These Results?

This project could offer a low-cost template for care-delivery redesign, the authors explain. The only reported ongoing expense was 6 hours of dedicated nurse time per week, and the profile echoes a recent commentary on the benefits of nurse-led care management.⁴ Further, patients often carry a hard-to-articulate symptom burden that standard visits can struggle to surface, reinforcing the rationale for dedicated, structured symptom review.⁵

Still, there are limitations to these results. The project was conducted at a single center, limiting generalizability, and nurses currently lack independent authority to refer patients to specialists such as psychologists or dietitians—a gap the team says protocol-based referral authority could close. Documentation also remains siloed in nursing records rather than the shared electronic health record, an integration the team plans to pursue.

Despite the growing global popularity of nurse-led clinics, the authors note that implementation in Italy lags behind other countries, largely because of constraints in physical space, staffing flexibility, and access to sufficiently trained personnel.¹ This model may offer a replicable, low-cost pathway for improving symptom monitoring and patient engagement in rare hematologic malignancies.

“Unlike many nurse-led models focused primarily on reducing health care utilisation,” the authors concluded, “this project emphasized empowerment and self-management with potential sustained impact over time.”

References

1. Berardinelli D, Fava C, Sinisi F, et al. Implementation of a nurse-led visit and follow-up for patients with myeloproliferative neoplasms: a quality improvement project. BMJ Open Qual. 2026;15(3):e003632. doi:10.1136/bmjoq-2025-003632
2. Caffrey M, Joszt L. Recognizing symptoms of myeloproliferative neoplasms and clinical trial challenges. AJMC^®. October 24, 2024. Accessed July 29, 2026. https://www.ajmc.com/view/recognizing-symptoms-of-myeloproliferative-neoplasms-and-clinical-trial-challenges
3. Joszt L. Utilization of momelotinib for myelofibrosis with anemia can result in small savings. AJMC. April 12, 2024. Accessed July 29, 2026. https://www.ajmc.com/view/myeloproliferative-disorders-and-myelofibrosis
4. Basaj M. Contributor: how to pair data with clinical care to manage health care costs. AJMC. June 6, 2026. Accessed July 29, 2026. https://www.ajmc.com/view/contributor-how-to-pair-data-with-clinical-care-to-manage-health-care-costs
5. Shaw M, Kuykendall A. Addressing the hidden burden of polycythemia vera: Andrew Kuykendall, MD. AJMC. July 29, 2025. Accessed July 29, 2026. https://www.ajmc.com/view/addressing-the-hidden-burden-of-polycythemia-vera-andrew-kuykendall-md