Author:
Sheringham Jessica,King Angela,Plackett Ruth,Khan Anwar,Cornes Michelle,Kassianos Angelos P.
Abstract
Abstract
Background
Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral.
This review sought to summarise findings from observational studies conducted in high income countries on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care.
Method
A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009–2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation.
Results
From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis.
Conclusion
This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.
Publisher
Springer Science and Business Media LLC
Reference49 articles.
1. Sheringham J, Georghiou T, Chitnis X, et al. Comparing primary and secondary healthcare use between diagnostic routes before a diagnosis of colorectal cancer: Cohort study using linked data. Br J Cancer. 2014;111(8):1490–9. https://doi.org/10.1038/bjc.2014.424.
2. Swann R, McPhail S, Witt J, Shand B, Abel GA, Hiom S, et al. Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit. Brit J Gen Pract. 2018;68(666):e63–72. https://doi.org/10.3399/bjgp17X694169.
3. Banks I, Weller D, Ungan M, et al. ECCO Essential Requirements for Quality Cancer Care: Primary care. Crit Rev Oncol Hematol. 2019;142:187–99. https://doi.org/10.1016/j.critrevonc.2019.07.007.
4. NHS England. NHS long term plan 2019 [updated 21 Aug 2019; cited 2020 8 June 2020]. Available from: https://www.longtermplan.nhs.uk/.
5. Jabbarpour YG, Jetty, A, Coffman, M; et al, A Investing in Primary Care: A State-Level Analysis: Patient-Centered Primary Care Collaborative, 2019. Available from: https://www.pcpcc.org/resource/investing-primary-care-state-level-analysis. Accessed 25 Aug 2020.
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