The Nurse Practitioner Workforce in Cancer Care

AbstractBackground/Objectives: Cancer is most frequently diagnosed in adults over the age of 65 years in the United States (U.S.) Access to cancer care is unequal and the anticipated insufficient supply of oncology physicians may further worsen access to services. The growth of older adults with the corresponding increase in cancer prevalence necessitates the need to characterize Nurse Practitioner (NP) and Physician Assistant (PA) oncology workforce. Design: In this observational, cross-sectional analysis, we examined all ambulatory care malignancy claims from the 2013 Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare. We identified Fee-for-service Medicare recipients over age 65 years with a cancer diagnosis who received ambulatory care and the providers who cared for them, as identified by the taxonomy codes associated with their National Provider Identifier number. Results: An analysis of over 7 million claims yielded 2.5 million claims for malignancy-specific care. Of the 15,227 cancer providers identified, 32% were NPs (4,806), 28% were double boarded hematology/oncology physicians (4,222), 24% were PAs (3,767), 11% were singled boarded medical oncologists (661), 2.6% were gynecology oncologists (403) and 2.4% were single boarded hematologists (368). Compared to physicians, NPs and PAs were more likely to provide care to rural patients (OR 1.84, 95% CI 1.65-2.05 and OR 1.57, 95% CI 1.40-1.77, respectively). Patients who received NP care were more likely to be female, and reside in high poverty areas. Evaluation of NP care vs. no NP care revealed that NPs were more likely to see female patients (56% vs. 48%, p=.0001) and those who resided in high poverty areas (21% vs. 18%, p=.05). Conclusions: Our study identified a large number of previously unrecognized NPs and PAs providing cancer care to older adults, especially in the Southern U.S., in rural settings and for poorer older adults

A scoping review of the nurse practitioner workforce in oncology.

The quality of cancer care may be compromised in the near future because of work force issues. Several factors will impact the oncology health provider work force: an aging population, an increase in the number of cancer survivors, and expansion of health care coverage for the previously uninsured. Between October 2014 and March 2015, an electronic literature search of English language articles was conducted using PubMed(®) , the Cumulative Index to Nursing and Allied Health Sciences (CINAHL(®) ), Web of Science, Journal Storage (JSTOR(®) ), Google Scholar, and SCOPUS(®) . Using the scoping review criteria, the research question was identified "How much care in oncology is provided by nurse practitioners (NPs)?" Key search terms were kept broad and included: "NP" AND "oncology" AND "workforce". The literature was searched between 2005 and 2015, using the inclusion and exclusion criteria, 29 studies were identified, further review resulted in 10 relevant studies that met all criteria. Results demonstrated that NPs are utilized in both inpatient and outpatient settings, across all malignancy types and in a variety of roles. Academic institutions were strongly represented in all relevant studies, a finding that may reflect the Accreditation Council for Graduate Medical Education (ACGME) duty work hour limitations. There was no pattern associated with state scope of practice and NP representation in this scoping review. Many of the studies reviewed relied on subjective information, or represented a very small number of NPs. There is an obvious need for an objective analysis of the amount of care provided by oncology NPs

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

ObjectivesTo 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).DesignObservational, cross-sectional study.SettingAdults within the 2013 Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare claims database.ParticipantsMedicare beneficiaries who received ambulatory care for any solid or hematologic malignancies.MeasurementsInternational 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.ResultsA 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).ConclusionsA 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

Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review

Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors. A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review. Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45–60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes. Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains. •Cancer caregivers provide complex care and are at risk for poor health.•Self-efficacy may influence cancer caregiver well-being.•Cancer caregiver self-efficacy and physical/environmental health are understudied.•Cancer caregiver self-efficacy improved with interventions for education, training, and support.•More research is needed to examine self-efficacy and cancer caregiver intersectionality

Cancer treatment-related decision-making among culturally and linguistically diverse older adults with cancer: A scoping review by the International Society of Geriatric Oncology Nursing and Allied Health Interest Group

INTRODUCTION: Countries with large economies are observing a growing number of culturally and linguistically diverse (CALD) older adults, many of whom will be affected by cancer. Little is known about the experiences and factors that influence cancer treatment decision-making in this population. The purposes of this scoping review are: (1) to summarize the published literature on cancer treatment-related decision-making with this population; and (2) to identify potential differences in how cancer treatment decisions are made compared to non-CALD older adults with cancer. MATERIALS AND METHODS: We conducted a scoping review following Arksey and O'Malley and Levac methods, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines. We conducted a comprehensive multidatabase search, screening 1,139 titles/abstracts. Following data abstraction, we analyzed the data using tabular and narrative summary. RESULTS: We extracted data from six studies that met the inclusion criteria: four quantitative and two qualitative; five from the United States and one from Canada. Three themes were identified: (1) barriers to decision-making, (2) the influence of family and friends on decisionmaking, and (3) differences in uptake and types of treatment received between CALD and non-CALD older adults. DISCUSSION: This comprehensive review of treatment decision-making among CALD older adults with cancer highlights the paucity of research in this area. The findings are limited to North American populations and may not represent experiences in other regions of the world. Future research should focus on studying their treatment-related decision-making experiences to improve the quality of care for this vulnerable population

Cancer treatment-related decision-making among culturally and linguistically diverse older adults with cancer : a scoping review by the International Society of Geriatric Oncology Nursing and Allied Health Interest Group

Introduction: Countries with large economies are observing a growing number of culturally and linguistically diverse (CALD) older adults, many of whom will be affected by cancer. Little is known about the experiences and factors that influence cancer treatment decision-making in this population. The purposes of this scoping review are: (1) to summarize the published literature on cancer treatment-related decision-making with this population; and (2) to identify potential differences in how cancer treatment decisions are made compared to non-CALD older adults with cancer. Materials and Methods: We conducted a scoping review following Arksey and O'Malley and Levac methods, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines. We conducted a comprehensive multidatabase search, screening 1,139 titles/abstracts. Following data abstraction, we analyzed the data using tabular and narrative summary. Results: We extracted data from six studies that met the inclusion criteria: four quantitative and two qualitative; five from the United States and one from Canada. Three themes were identified: (1) barriers to decision-making, (2) the influence of family and friends on decisionmaking, and (3) differences in uptake and types of treatment received between CALD and non-CALD older adults. Discussion: This comprehensive review of treatment decision-making among CALD older adults with cancer highlights the paucity of research in this area. The findings are limited to North American populations and may not represent experiences in other regions of the world. Future research should focus on studying their treatment-related decision-making experiences to improve the quality of care for this vulnerable population