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| Author year name and title of the publication | Country of origin | Topic | Patient population | Salient points raised that relate to the scoping review question |
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| Borogovac et al. (2021) [44] | USA | Safety and feasibility of outpatient chimeric antigen receptor CAR-T cell therapy on an outpatient basis | Adult haematology | The potential for CAR-T cell therapy services to be planned on an outpatient basis from inception |
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| Cunningham et al. (2021) [45] | USA | Nursing’s role in supporting CAR-T cell therapy on an outpatient basis | Not specified | Describe the nurses’ role as critical to the service. Report that outpatient tisagenlecleucel administration is preferred by patients, and supports an increased level of activity, better nutrition, and decreased exposure to infectious organisms compared with inpatient admission |
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| Myers et al. (2021) [46] | USA | Perspectives on outpatient administration of CAR-T cell therapy | Adult haematology | Outpatient CAR-T cell therapy can be feasible and safe with policies, procedures, and governance arrangements in place. |
| Expansion of CAR-T cell therapy on an outpatient basis is likely as expertise develops |
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| Pirschel (2019) [16] | USA | Explores the role of oncology nursing in ambulatory care | Adult cancer | Ambulatory care helps make sure that patients are not defined by their cancer diagnoses. It is an evolving field as new treatments are moving from the inpatient to ambulatory setting. There is a need to focus on caregivers, as well as patients. |
| Improved QoL positioned as a key driver for the service |
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| Comerford and Shah (2019) [47] | UK | Explores the practicalities of starting, staffing and managing an ambulatory cancer service | Adult haematology and oncology | Ability to increase bed capacity across a cancer service is a driver and a benefit of an ambulatory care whilst avoiding treatment delays. |
| The benefit to patients’ experience should remain the priority when implementing the pathway |
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| Comerford and Shah (2019) [48] | UK | Explores ambulatory care as a nurse-led service, alongside the importance of team collaboration. Describes the eligibility criteria and safety features of the service | Adult haematology and oncology | Suitability for AC should be reviewed on a case-by-case basis. The role of the nurse is critical to running an AC service. |
| Educating patients to self-care is critical to their safety. Caregivers may need safeguarding from burden |
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| Moore et al. (2018) [49] | USA | Discusses drivers for AC in the USA, and a guide to the transition of different chemotherapy regimens | Adult haematology | Lower inpatient bed availability, increased care costs, and commitment to increase patient satisfaction are described as drivers for ambulatory care alongside improvements in supportive care medications and continuous infusion pumps. |
| Patient and caregiver education critical to safety. |
| Caregiver support and availability can influence suitability for AC |
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| Comerford and Shah (2018) [14] | UK | Discusses the AC approach from the perspective of the patient experience. Explores the roles of the multidisciplinary team and their part in patient safety and the benefits, challenges, and cost considerations of an AC service | Young adult and adult haematology and oncology | Not all patients require a hospital inpatient bed and continuous nursing care, despite undergoing intensive cancer treatment. Describes the routines, eligible protocols, and responsibilities of AC from a multidisciplinary perspective. |
| Presents results of patient experience captured via electronic survey in 2017 (average responses to each question = 104) which included perceptions of safety and confidence alongside quotes from services users suggesting service well-suited to meet their needs. Reports that AC delivers tailored care whilst enabling independence |
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| Mastal (2018) [55] | USA | Describes the evolution of the ambulatory care professional nursing specialism in the USA | Ambulatory care nursing in general | The professional speciality of ambulatory care nursing first conceptualised in 1998 emphasised the individuality of the patient and the role of different outpatient and community providers. |
| The American Academy of Ambulatory Care Nursing professionally leads the speciality, although not synonymous with the transition of inpatient treatment to the outpatient setting |
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| Ingram (2017) [15] | UK | Describes drivers for ambulatory care in the UK and the planning and guidance required to set-up services | Haematology and oncology (age not specified) | The portable nature of treatment delivery gives patients freedom from the hospital environment, provides families time together, and allows a degree of normality to remain. |
| Consideration should be given to the potential added costs to patients and caregivers |
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| McKeag (2015) [50] | UK | Describes the evolution of infusion pumps since the 1960s which have facilitated ambulatory care | Cancer | Portable ambulatory infusion pumps which can be used to infuse chemotherapy or hydrating fluids have made ambulatory care possible |
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| Newton and Ingram (2014) [51] | UK | Describes the key features of the young people’s service with an emphasis on infusion pumps as a facilitator of ambulatory care | Adolescent and young adult cancer | The experience of ambulatory care is empowering as it enables teenage and young adult patients to take control of their care and can promote normalcy. |
| Patient education is vital to running a safe service |
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| Knott et al. (2013) [52] | UK | Describes the preparation of patients and experiences of staff engaging in self-monitoring. Explores the development of a teenage and young adult ambulatory service from a change project perspective | Adolescent and young adult cancer | Self-monitoring on the ward is a first step to preparing patients for ambulatory care |
| Focus on nurse-led to patient-led monitoring can challenge the philosophy and culture of nursing care on the ward. |
| The concept of peer support could be challenged by the ambulatory care model |
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| Anderson et al. (2013) [53] | USA | The clinical team share their philosophy, strategies, and tools to support adolescents and young adults to receive treatment for osteosarcoma on an outpatient basis | Adolescent and young adult cancer | Portable infusion pumps and advances in supportive care medications have made ambulatory chemotherapy possible. |
| Role of family in practically and emotionally supporting the patient to receive treatment on an outpatient basis |
| Improved QoL positioned as a key driver for service. |
| Philosophy of care as “family-centred” |
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| Ganzel and Rowe (2012) [54] | Israel | Commentary paper which explores the “revolutionisation” of haematology care | Adult haematology | Portable infusion pumps, effective supportive care medications, and residing close to the hospital make ambulatory care effective and safe. |
| Asks whether the expansion of an ambulatory care might involve mobile teams going out to give treatments and support patients at home |
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| Kelly (2005) [56] | UK | Discusses development, rationale, and details of an ambulatory care programme at UCLH | Adult haematology | Describes the programme in its infancy where up to six patients ambulate from a nearby hotel for treatment. Service informed by a visit to a US ambulatory care service. |
| Describes strong clinical drivers: managing increased patient activity alongside the creation of more normality for patients. Positioned as empowering for patients. |
| Captures patient feedback via a questionnaire. Recommends using a pilot project approach including thorough audit, regular patient feedback, and financial evaluation when introducing ambulatory care services |
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| Mikhail et al. (1995) [57] | USA | Describes and contextualises the shift to ambulatory care in the USA | Cancer services in general | Describes the progress made in 1995 in a shift to outpatient and ambulatory cancer care. Increased effectiveness and efficiency alongside patient preference and US legislative attempts to increase equity are described as a driver. |
| Infusion therapy devices, surgical advances, and haematopoietic growth factors to reduce myelosuppression made ambulatory care feasible alongside better antiemetics and other supportive care medications |
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| Schulmeister (1991) [58] | USA | Discusses how nurse-led patient education programmes meet the need of ambulatory patients | Cancer services in general | Positions ambulatory care as a cost containment strategy in the US |
| Describes “ambulatory care” as a misnomer as non-ambulant patients also access services. |
| Describes the role of the nurse as critical to patient education and therefore safety in this setting. Technology and the promotion of self-care have led to the need for greater emphasis on patient education. |
| Notes providers have started to competitively market their AC services |
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| Corrigan Wandel et al. (1990) [59] | USA | Describes an ambulatory care service within the context of the expanded scope of a nurse | Adult haematology | Describes the successful management of consolidation chemotherapy amongst 23 patients in the ambulatory setting. Indicates that this provides patients with independence and control over their care. Poor family support is described as something that limits suitability for ambulatory care |
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| Esparza et al. (1989) [60] | USA | Discusses ambulation of high-dose cisplatin and MTX alongside conceptual factors informing ambulatory care. Describes service set-up and coordination of care | Cancer services in general | Drivers for ambulatory care include technical developments and patient choice, quality of life, convenience and economics (keeping costs down). |
| Describes 24-hr access to clinical services as a key feature of the ambulatory cancer centre, within which patients can retain their normal lifestyles and can exercise choices |
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| Nirenberg and Rosen (1979) [61] | USA | Describes the setup of an ambulatory care unit at Memorial Sloan Kettering, and the philosophy of care informing the service | Adolescent oncology | Describes over 200 adolescent patients who received high-dose methotrexate for osteosarcoma on an outpatient basis, enabling them to live at home and participate in their normal educational and social life whilst maintaining independence. Promotion of a degree of normal lifestyle described as a driver |
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