Understanding the Role of Advanced Practice Providers in Oncology in the United States

Bruinooge, Suanna S.; Pickard, Todd; Vogel, Wendy H; Hanley, Amy; Schenkel, Caroline; Garrett‐Mayer, Elizabeth; Tetzlaff, Eric D; Rosenzweig, Margaret; Hylton, Heather; Westin, Shannon N.; Smith, Noël; Lynch, Conor C.; Kosty, Michael P.; Williams, Stephanie

doi:10.1200/jop.18.00181

Cited by 60 publications

(86 citation statements)

References 8 publications

(3 reference statements)

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“…Evidence from the development of nonphysician prescribing demonstrates that NPs prescribe appropriately in a wide range of clinical settings and that both patients and medical staff have positive views on these initiatives . Successful examples of NPs practicing in high‐acuity and hematology/oncology‐based clinical areas have been reported, and the number of NPs practicing in these areas is growing . Minimal knowledge exists of the competency of NPs to exercise the scope to prescribe transfusions specifically.…”

Section: Discussionmentioning

confidence: 99%

“…Nurse practitioners (NPs) in multidisciplinary care teams prescribing transfusions are increasingly common in clinical areas including hematology‐oncology, medical oncology, and the intensive care unit . Over 5000 advanced practice providers (APPs) in the United States, mostly composed of NPs, practice in oncology, and many states allow NPs to practice with full autonomy . However, there is a paucity of educational resources aimed at NPs, and little is known about the knowledge and competency of NPs to practice transfusion after their initial training educational curricula and practicums …”

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confidence: 99%

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Educating the next frontier of transfusionists: a transfusion camp pilot program for nurse practitioners

Shih

Morrison²,

Sekhon

et al. 2020

Transfusion

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BACKGROUND Blood transfusion is common and potentially lifesaving but is associated with risk and overuse. Nurse practitioners (NPs) in multidisciplinary care teams are increasingly expanding their scope of practice to transfusion medicine (TM). Resources aimed at NPs are lacking, and little is known about NP TM knowledge. Thus, we developed a pilot TM curriculum for NP credentialing and assessed its impact. METHODS NP leads and TM directors adapted the successful Canadian Transfusion Camp for medical postgraduate trainees into a 3‐day curriculum for NPs. Two modalities were used to assess the pilot: 1) a participant demographics survey and needs assessment; and 2) the validated BEST‐TEST knowledge assessment exam administered before and after the course. RESULTS Of the 23 volunteer participants, the majority reported prescribing blood products within the last year, primarily red blood cells. Minimal opportunities to undertake continuing medical education in TM were identified. NPs often used preprinted order forms, consultation with physicians sharing care, or local fact sheets to guide transfusion; rather than TM physician consultation or guidelines. Exam scores significantly improved after the course (before, 35.2% vs. after, 50.3%; p = 0.005), suggesting average initial knowledge being below medical postgraduate trainee‐level improving to postgraduate trainee level. Questions on appropriate transfusion triggers and correct recipient identification were most correctly answered; and responses to transfusion reaction questions required improvement. CONCLUSIONS Our needs assessment suggests that TM resources for NPs are relevant but lacking. Our initiative supports the generalizability, scalability, and effectiveness of the Transfusion Camp program. Further implementation, refinement, and future impact assessments are required.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Educating the next frontier of transfusionists: a transfusion camp pilot program for nurse practitioners

Shih

Morrison²,

Sekhon

et al. 2020

Transfusion

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“…The American Society of Clinical Oncology (ASCO) conducted a cancer workforce survey in 2015 and estimated the NP workforce at 2700 and the PA workforce at 1100 individuals . A more recent collaboration in 2017, of the Oncology Nursing Society, ASCO, and the Association of Physician Assistants in Oncology identified 3623 NPs and 1796 PAs . These numbers are lower than our findings, which identified 4806 NPs and 3767 PAs in the SEER‐Medicare data alone.…”

Section: Discussionmentioning

confidence: 99%

Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer

Coombs

Max

Kolevska

et al. 2019

J American Geriatrics Society

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OBJECTIVES To describe the composition of the US provider workforce for adults with cancer older than 65 years and to determine whether there were differences in patients who received care from different providers (eg, nurse practitioners [NPs], physician assistants [PAs], and specialty physicians). DESIGN Observational, cross‐sectional study. SETTING Adults within the 2013 Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare claims database. PARTICIPANTS Medicare beneficiaries who received ambulatory care for any solid or hematologic malignancies. MEASUREMENTS International Classification of Diseases, Ninth Revision (ICD‐9), diagnosis codes were used to identify Medicare patient claims for malignancies in older adults. Providers for those ambulatory claims were identified using taxonomy codes associated with their National Provider Identifier number. RESULTS A total of 2.5 million malignancy claims were identified for 201, 237 patients, with 15, 227 providers linked to claims. NPs comprised the largest group (31.5%; n = 4,806), followed by hematology/oncology physicians (27.7%; n = 4,222), PAs (24.7%; n = 3767), medical oncologists (10.9%; n = 661), gynecological oncologists (2.6%; n = 403), and hematologists (2.4%; n = 368). Rural cancer patients were more likely to receive care from NPs (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.65‐2.05) or PAs (OR = 1.57; 95% CI = 1.40‐1.77) than from physicians. Patients in the South were more likely to receive care from NPs (OR = 1.36; 95% CI = 1.24‐1.49). CONCLUSIONS A large proportion of older adults with cancer receive care from NPs and PAs, particularly those who reside in rural settings and in the southern United States. Workforce strategies need to integrate these provider groups to effectively respond to the rising need for cancer care within the older adult population.

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“…We compared the routine activities of OPs [1] to those of NPs and PAs [12]. From the activity lists in the two studies, we only compared those activities performed by ≥ 80% of either group.…”

Section: Methodsmentioning

confidence: 99%

“…In 2007, it was estimated that NP/PAs could increase patient visits by 0.8 to 3.4 million by 2020 [2,3]. A more recent 2018 study updated the progress in incorporating NPs and PAs in oncology care teams noting that despite growth in both Advanced Practice Provider (APP) groups, a shortfall in projected patient visits persists [12]. This study identified 5350 APPs who were involved in cancer care and considered to be vital in ensuring access to quality patient care.…”

Section: Introductionmentioning

confidence: 99%

Oncology Pharmacists Can Reduce the Projected Shortfall in Cancer Patient Visits: Projections for Years 2020 to 2025

Knapp

Ignoffo

2020

Pharmacy

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Based on the projected need for a larger oncology care workforce, we estimated the patient care visits and care activities that Board Certified oncology pharmacists (BCOPs) could contribute to oncology care from 2020–2025. Using projected counts for BCOPs through 2025, we estimated that 2.9–4.1 million 30-min BCOP patient visits were possible at 50% workforce capacity. BCOPs’ clinical activities overlapped strongly with those of nurse practitioners (NPs) and physician assistants (PAs) in patient education and treatment management. BCOPs could help reduce provider stress and burnout concerns by spreading these activities across a broader set of providers. BCOPs were more active than NPs and PAs in clinical trials research. Recent advances in immunotherapy, pharmacogenetics, pharmacogenomics, and oral oncolytic agents make the medication-focused training of OPs particularly useful to care teams. Comparison also showed that BCOPs were less active in providing follow-up visits and prescribing. Fulfilling the projected BCOP numbers through 2025 will require continued growth in Postgraduate Year 2 (PGY2) oncology pharmacy resident programs and on-the-job training programs. Our review of the trends in cancer incidence, mortality, and survivorship suggest a sustained need for the activities of BCOPs and other oncology care providers.

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Understanding the Role of Advanced Practice Providers in Oncology in the United States

Cited by 60 publications

References 8 publications

Educating the next frontier of transfusionists: a transfusion camp pilot program for nurse practitioners

Educating the next frontier of transfusionists: a transfusion camp pilot program for nurse practitioners

Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer

Oncology Pharmacists Can Reduce the Projected Shortfall in Cancer Patient Visits: Projections for Years 2020 to 2025

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