By Whitney Pritham, APRN, CNP

I walked into the exam room to meet with my next patient. “So, are you leaving?” he asked as I came through the door.

“Well, no,” I responded. “Why?”

“My next three appointments are with a different nurse practitioner. Since I wasn’t scheduled with you, I thought you may be leaving. Can I get my schedule changed to see you?” he said with an awkward chuckle.

For this patient, an 84-year-old rancher with metastatic melanoma undergoing immunotherapy, I have been a steady part of his cancer care team since his medical oncologist left our clinic. As described in ASCO’s 2020 Snapshot: State of the Oncology Workforce in America report, two-thirds of rural U.S. counties lack an oncologist.¹ It is clear that a recent challenge for our community cancer center has been a shortage of medical oncologists, a shortage which has highlighted the importance of team-based care. A cancer care team that includes advanced practice providers (APPs) helps to provide consistent care to patients in an increasingly complex health care system.

Team-based care is not new in health care or oncology but is a key element in ensuring continuity and consistency in care. A shortage of health care providers and medical oncologists is not unique to the cancer center where I work. Health care worker shortages persist despite increasing demand for care. A collaborative team with oncologists and APPs is one way to help offset this shortage, improve health care delivery, and enhance the patient experience. Oncologists and APPs working together have the opportunity to increase practice volume, improve access to care, and ensure continuity for the patient.

How do we create a successful and consistent team-based collaborative practice for the APP and physician?

• When implementing team-based care, it is important to clarify roles and responsibilities.
• It is evident that knowing the patient well improves efficiency and the value of care. If the team has multiple APPs, consider optimizing scheduling to connect patients with the same APP.
• Introduce the team members at the patient’s first visit and outline the care model.
• Allow time for the team to review the plan of care.
• Standardize communication to ensure comprehensive and quality oncologic care.
• Utilize the full scope of practice for each health care provider on the team. The unique strengths and perspectives of each clinician are an asset when providing the safest, best possible care.

The ASCO Workforce Advisory Group’s 2018 survey of oncology APPs described 3 types of clinical visits: independent visits only (APP sees patient), shared visits only (APP and physician see patient together), and a combination of independent/shared visits. According to this survey, APPs who practice in the independent visit model had the highest level of job satisfaction (85%). In the independent visit model, “an APP sees patients independently but works with physicians to address the most critical care decisions, such as treatment plans and end-of-life decisions.”² Data has shown that patients and collaborating physicians are very satisfied with patient care provided by APPs. The overarching goal is to empower APP/physician teams to be set up for successful team-based collaborative practice.

Being a consistent part of the cancer care team for my patient, who travels long distances from his ranch to the cancer center for treatment, is a privilege. It is evident that patients appreciate a health care team for the continuity and the perspective each health professional offers to their care.

Ms. Pritham is a nurse practitioner at Bozeman Health Cancer Center in Bozeman, MT. She is a member of the ASCO Clinical Practice Committee’s APP Task Force. Disclosure.

References

1. 2020 Snapshot: State of the Oncology Workforce in America. JCO Oncol Pract. 2021;17:30. doi: 10.1200/OP.20.00577.
2. Bruinooge SS, Pickard TA, Vogel W, et al. Understanding the Role of Advanced Practice Providers in Oncology in the United States. J Oncol Pract. 2018;14:e518-e532. doi: 10.1200/JOP.18.00181.