A poster presented at JADPRO Live Virtual 2021 shared results of a study aimed at finding ways to better support and prioritize the role of advanced practitioners (APs) in oncology clinical research.
Researchers led by Alison Holmes Tisch, MSN, RN, ANP-BC, AOCNP, of Stanford Comprehensive Cancer Center, evaluated 63 voluntary, anonymous responses to an internally developed 40-item survey that was reviewed by external advanced practice provider (APP) leaders to remove bias regarding the current state of practice within the institution. The team also interviewed 14 physician clinical research leaders to determine physician perception of the current and ideal states of practice for APs involved in clinical research.
Using Likert, multi-select, and write-in options, the survey assessed the scope of practice, role satisfaction, study-related tasks, and areas requiring additional training. Out of 120 APs surveyed, 76 responses were provided, and 13 were excluded for incomplete data.
Among the responses evaluated, 73% of APs reported involvement in direct patient care in research visits, and 32% had been sub-investigators. The most common research-related tasks reported by survey respondents were ordering labs, imaging, and testing (66%) and conducting routine study follow-up visits (56%). Ten percent and 38% of APs responded with strongly agree or agree, respectively, that they are satisfied with their current level of involvement in clinical trials, with 56% interested in serving as a sub-investigator. Limited time because of standard-of-care patient volume represented the top AP-perceived barrier to research involvement (79%).
AP survey respondents requested additional training in the following areas:
- building an awareness of clinical trial resources for clinicians (52%)
- evaluating imaging (47%)
- protocol design (42%)
- developing presentation materials (44%)
- support for publishing or presenting at conferences (41%)
Physician interviews included targeted questions assessing physician-perceived barriers to practice and gaps in training. All doctors stated the importance of AP involvement in oncology care, with varying levels of involvement in specialty-specific research areas. Most physicians interviewed recommended top of licensure practice for APs, identifying a scope at the level of a sub-investigator or equivalent. In current practice, the top tasks physicians reported were assessing, managing, and documenting adverse events (57%) as well as providing patient education (50%). The most common barrier to AP involvement reported by interviewees was lack of time (57%).
From the physician interviews, the researchers gathered the following insights:
- APs should practice as any other sub-investigator
- AP-led research would enhance APs’ standing among similar institutions
- Enhanced training is needed to support full scope of practice
- Standard-of-care patients dominate APs’ time
- APs do not have dedicated time to attend research meetings and study-specific activities
Based on these findings, the researchers recommend developing standardized education and training to support APs at progressive levels of involvement in clinical trials in addition to dedicating time within APs’ day-to-day duties for professional development and research involvement.
“Clinical research needs to be clearly defined as a job expectation for oncology APs and time for clinical research activities needs to be prioritized,†the researchers concluded.