Oncology advanced practitioners (APs) are non-physician providers with clinical expertise and specialized training in caring for patients with cancer. The Advanced Practitioner Society for Hematology and Oncology (APSHO) defines advanced practitioners to include physician assistants, nurse practitioners, clinical nurse specialists, and pharmacists.
Both cancer care and the demographics of patients with cancer in the U.S. continue to evolve, as do the roles of oncology advanced practitioners in care delivery. For more than a decade, the American Society of Clinical Oncology and others have projected that demand for medical oncology services will not keep pace with the supply of medical oncologists. Although no one solution is likely to resolve this conundrum, an increased role for oncology advanced practitioners is seen as one piece of the puzzle.
In January 2021, ACCC released a statement on the value of oncology advanced practitioners that emphasizes the importance of care delivery models designed so that APs can practice at the top of their licensure:
“This interdisciplinary approach to cancer care increases cancer programs and practices ability to meet community cancer needs, especially in rural and underserved areas where access to care continues to be difficult. Optimizing models of care that include APs as team members who can practice at the full scope of their license strengthens the ability of a practice to provide multidisciplinary, comprehensive care to more individuals.”
As the oncology community takes action to improve diversity and equity in cancer clinical research and care delivery, in spring 2021 ACCC and Harborside hosted a “Virtual Summit to Define the Role of Oncology Advanced Practitioners in Equitable Cancer Care Delivery.” Over three sessions, a select group of thought leaders, including oncology nurse practitioners, advanced degree nurses, physician assistants, oncology pharmacists, patient advocates, and other members of the multidisciplinary cancer care team discussed the role for APs in equitable care delivery.
The Summit conversation centered on equitable cancer care across three domains: care coordination and communication, clinical trials, and acknowledging and mitigating implicit bias. Participants agreed that advanced practitioners play crucial roles in delivering and advocating for equitable cancer care.
Download Executive Summary
Through a consensus-driven process, participants identified the following ten opportunities as immediately actionable.
Participants identified a need to create resources for advanced practitioners to learn to foster open dialogue with patients and engage in dynamic shared decision-making that elicits the patient’s care preferences.
A unifying theme across Summit sessions was the need to curate and build on existing resources. Participants supported establishing a working group of advanced practitioners to conduct a literature review (including of grey literature) and research to aggregate existing data collection measures and screening tools. The importance of identifying tools that integrate into EMRs was emphasized. Such resources are vital to accurately measure health disparities and demonstrating the value of care coordination, participants agreed, and to developing an understanding of where and how break down in care coordination/communication occurs relative to disparities for specific patient populations.
Participants agreed that advanced practitioners can help level set clinical trials for patients and all members of interdisciplinary teams by delivering a consistent message which clarifies how clinical trials represent a standard of care and that every patient with cancer should be considered for clinical trial participation. Advocate for cancer programs/practices to include “discussion of clinical trials” in AP job descriptions.
Findings from a recent study show that many oncology advanced practitioners have an interest in greater participation in research. Summit participants agreed that APs in oncology are often ideally situated for conducting health disparities research. To extend advanced practitioners’ role in research, participants recommended development of quality improvement (QI) CME education programs so that APs can gain the added skills needed to plan and conduct research.
Research-focused advanced practitioners working at the top of their licensure have proven capacity to engage in all aspects of clinical research, including serving as principal investigators (PIs) and co-PIs. Summit participants strongly agreed that advocacy to enable APs to sign off on clinical trial orders is an important step in support of their evolving role on clinical research teams. Advanced practitioners are often the healthcare professional most engaged with clinical trial participants. On behalf of their patients, advanced practitioners can amplify patient-voiced barriers to trial enrollment, challenges faced by patients who are participating in clinical studies, and at the trial’s completion, the importance of sharing aggregate trial results with study participants.
Summit participants concurred that to expand advanced practitioners’ role in publication, curated resources, tools, and education are needed. Areas of opportunity cited by participants include unpublished clinical trial data that advanced practitioners may utilize to develop and publish original research papers as lead author and co-authors, particularly in the area of novel agent adverse event prevention, mitigation, and management.
Elevating equitable care delivery will require on-going learning and commitment, participants acknowledged. Advanced practitioners need access to training resources, such as short videos, podcasts, or webcasts, that explore issues related to diversity, equity, and inclusion in cancer clinical trials and that include advanced practitioners interacting with patients to describe trial enrollment, what clinical trial participation entails, and the voices of patients who have participated in clinical trials.
An equity-focused checklist can serve as a low-cost, easily integrated (ideally into the EMR) tool that APs could use to support awareness of implicit bias. Summit participants recognized that implicit (or unconscious) bias exists in all human beings and is a consequence of how the human brain is hardwired. At the same time, awareness of the subtle ways in which implicit bias may affect equitable cancer care delivery through a process of regular self-assessment, intervention, and re-assessment is essential to effect change at the individual level.
During Summit discussions, some participants shared their lived experience with biases embedded in professional education and training. Participants agreed that APs have a role in advocating for medical professional graduate programs to examine their curricula and take action to address explicitly and implicitly biased training, including the requirement that faculty be trained in implicit bias awareness. An additional call-to-action is for APs to encourage their professional organizations/societies to join in a collective statement of support for this action to graduate curriculum programs and accrediting/credentialing bodies.
Advanced practitioners together with professional organizations such as AAPA, ACCC, APSHO, Harborside, and others, can commit to publishing on these issues to help disseminate best practices in moving toward more equitable cancer care delivery.
Download Summit Call to Action
ACCC and Harborside produced a mini-podcast series with three of the Summit’s organizers, highlighting several of the key themes and priorities that were discussed.
Ep 60: Advancing Clinical Trial Equity
Colleen Lewis, MSN, ANP-BC, AOCNP, Director of Clinical Operations, Phase I Program, The Winship Cancer Institute of Emory University, talks about the critical role oncology advanced practitioners can play in moving the needle on equity and inclusion in cancer clinical trials.
Ep 63: Advanced Practitioners’ Role in Research
Christa Braun-Inglis, MS, APRN, FNP-BC, AONP, Nurse Practitioner and Clinical Researcher, University of Hawaii Cancer Center, discusses how oncology advanced practitioners can play a greater role in clinical research and, according to a recent national study, have a strong interest in doing so.
Ep 65: The Evolution of the Advanced Practitioner
Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN, Nurse Practitioner, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, shares the evolution of the advanced practitioners’ role at her cancer center, where they work to the top of their licensure.
For additional resources for oncology nurse practitioners, physician assistants, pharmacists, clinical nurse specialists, and advanced practice nurses, please visit the Advanced Practitioner Society for Hematology and Oncology website.
For more information about this program, please contact Elana Plotkin, CMP-HC, Assistant Director, ACCC Provider Education.