Background
Methods
Study selection
Group number | Search term | Number of articles medline | Number of articles CINAHL |
---|---|---|---|
Group 1 | Nurse Practitioners OR | 22,644 | 3,779 |
Physician Assistants OR | |||
Nurse Midwives | |||
Group 2 | “Counseling”[Mesh:noexp] OR | 576,608 | 9,166 |
“Nurse’s Role”[Mesh] OR | |||
“Patient Acceptance of Health Care”[Mesh] OR | |||
“Patient Education as Topic”[Mesh] OR | |||
“Health Knowledge, Attitudes, Practice”[Mesh] | |||
Group 3 | “Diet”[Mesh] OR | 335,235 | 52,213 |
“Exercise”[Mesh] OR | |||
“Motor Activity”[Mesh] OR | |||
“Tobacco Use Cessation”[Mesh] | |||
Group 4 | “Early Detection of Cancer”[Mesh] OR | 132,489 | 4,199 |
“Vaginal Smears”[Mesh] OR | |||
“Mammography”[Mesh] OR | |||
“Breast Neoplasms/prevention and control”[Majr:noexp] OR | |||
“Colorectal Neoplasms/prevention and control”[Majr:noexp] OR | |||
“Mass Screening”[Mesh] OR | |||
“Papillomavirus Vaccines”[Mesh] | |||
Group 1 and Group 2 and (Group 3 or Group 4) | 573 | 21 |
Data abstraction
Results
Study characteristics
Study characteristics | Study categories | Number of studies (N = 15) | Percentage of studies |
---|---|---|---|
Type of cancer prevention* | |||
Diet/Physical activity | 5 | 33% | |
Smoking | 9 | 60% | |
Mammogram | 3 | 20% | |
Pap test | 5 | 33% | |
Colorectal cancer screening | 4 | 27% | |
Study setting | |||
National | 6 | 40% | |
State or regional | 5 | 33% | |
Local (City or Multiple Counties) | 4 | 27% | |
Study design | |||
Intervention | 3 | 20% | |
Retrospective cohort | 2 | 13% | |
Cross sectional | 10 | 67% | |
Study date of publication | |||
<1995 | 2 | 13% | |
1995-1999 | 3 | 20% | |
2000-2004 | 4 | 27% | |
> = 2005 | 6 | 40% | |
Type of APRN/PA provider | |||
Advanced practice nurse practitioner | 13 | 87% | |
Certified nurse midwife | 2 | 13% | |
Physician Assistant | 3 | 20% | |
Comparison group | |||
Physicians | 5 | 33% | |
None | 5 | 33% | |
Other | 5 | 33% | |
Sample size | |||
100-499 | 8 | 53% | |
500-999 | 1 | 7% | |
1,000-4,999 | 5 | 33% | |
5,000-19,999 | 0 | 0% | |
>20,000 | 1 | 7% | |
Healthcare delivery setting | |||
Single institution or clinic | 2 | 13% | |
Network of institutions or clinics | 3 | 20% | |
Multiple institutions (Not a Network) | 10 | 67% | |
Outcome measure | |||
Chart review | 3 | 20% | |
Self-Report by physicians | 4 | 27% | |
Self-Report by APRN/PA providers | 6 | 47% | |
Self-Report by patients | 2 | 13% | |
Patient characteristics | |||
Insurance types* | |||
Any medicare | 2 | 13% | |
Any medicaid | 5 | 33% | |
Private | 6 | 40% | |
Not reported | 8 | 60% |
Cancer screening
Cervical cancer screening
Study | Sample size | Outcome measure | Setting and study design | Pap findings | Mammogram findings | Colorectal cancer screening findings |
---|---|---|---|---|---|---|
Menees et al., [24] | Total providers: 336 OB/GYNS: 182 | Self-Report of MDs and NPs | National survey of OB/GYNs and NPs | Pap test routinely provided: | Mammography routinely recommended: | CRC screening routinely recommended: |
NPs: 94.8% | NPs: 90.9% | NPs: 61.7% | ||||
Cross sectional Survey | ||||||
NPs: 154 | OB/GYNs: 97.8% | OB/GYNs: 98.9% | OB/GYNs: 87.2% | |||
P < 0.01
|
P < 0.01
|
P < 0.01
| ||||
Unadjusted | Unadjusted | Most common CRC screening recommended by either provider: | ||||
FOBT: 76.2% | ||||||
Colonoscopy: 28.3% | ||||||
P-value not reported | ||||||
Ordered colonoscopy: | ||||||
NPs: 19.8% | ||||||
OB/GYNs: 37% | ||||||
P < 0.005 | ||||||
All measures unadjusted | ||||||
Hopkins et al., [26] | Total patients: 1339 | Chart review | Chart review in private practice | Receipt of Pap test: | Receipt of mammogram: (Aged 40+) | Patient receipt of colorectal screening: (Ages 50 +) |
PHCC NP patients: 755 | and primary care health centers in New York City | PHCC NPs: 71.5% | PHCC NPs: 69% | PHCC NPs: 19.1% | ||
PHCC MDs: 53.8% | PHCC MDs: 64.2% | PHCC MDs: 45.7% | ||||
MD patients: 441 | Retrospective cohort | P < 0.001 | P = 0.240 | P < 0.001 | ||
PP NP patients: 143 | Unadjusted | Unadjusted | Unadjusted | |||
Sansbury et al., [28] | Total providers: 1900 | Self-Report of MDs about APRN/PAs | National survey of MDs | NA | NA | Work with NP/PA to provide FOBT: |
PC MDs: 1235 | Cross sectional survey | MDs report working with a NP or PA to provide FOBT: 23.8% | ||||
NPC MDs: 665 | ||||||
Of the 24% of physicians who work with NP/PA for FOBT, they reported frequency of supervising a NP or PA for FOBT: | ||||||
Supervised a NP: 75% | ||||||
Supervised a PA: 25% | ||||||
P-value not reported for all measures | ||||||
All measures unadjusted | ||||||
Oliveria et al., [29] | Total providers: 1363 | Self-Report of MDs about APRN/PAs | National survey of MDs | MDs amenable to NP/PA screening: | NA | NA |
MDs: 1363 | Cross sectional survey | Team Practice^: 89.6% | ||||
Non-team Practice^^: 59.9% | ||||||
Team vs Non-team of amenable MDs: | ||||||
OR = 8.11 (95% CI: 5.80–11.35) | ||||||
P = 0.001 | ||||||
MDs reporting NP/PA screening: | ||||||
All MDs reporting frequency of NPs or PAs performing Pap tests: | ||||||
NPs: 33.5% | ||||||
PAs: 23.2% | ||||||
Team practice MDs reporting frequency of NP/PA performing Pap tests: | ||||||
NPs: 89.3% | ||||||
PAs: 82.7% | ||||||
P-value not reported for all other measures | ||||||
All measures unadjusted | ||||||
Shaheen et al., [30] | Total providers: 1784 | Self-Report of APRN/PAs | Survey of NPs and PAs in North Carolina | NA | NA | NP/PA who recommend/perform FOBT: |
Total NPs: 526 | Cross sectional survey | Primary Care PA: 94.6% | ||||
Total PAs: 640 | Primary Care NP: 92.1% | |||||
PC PAs: 322 | NP/PA who recommend/perform flexible sigmoidoscopy: | |||||
PC NPs: 270 | ||||||
Primary Care PA: 76.1% | ||||||
Primary Care NP: 69.2% | ||||||
P-value not reported | ||||||
Unadjusted | ||||||
Murphy, [31] | Total providers: 346 | Self-Reportof CNMs | National survey of CNMs | 98% of CNMs report they routinely provide pap tests to 81-100% of their gynecologic patients | NA | NA |
CNMs: 346 | Cross sectional survey | |||||
P-value not reported | ||||||
Unadjusted | ||||||
Mandelblatt et al., [39] | Total patients: 319 | Chart review | Two New York City study hospitals with NP led intervention and usual care control | Receipt of Pap test in intervention group: | Receipt of mammography in intervention group: | NA |
Intervention: 160 | ||||||
Baseline: 17.8% | Baseline: 18.3% | |||||
Control: 159 | ||||||
Total providers: Not Reported | ||||||
Intervention | Post: 56.9% | Post: 40% | ||||
P < 0.01 | P < 0.01 | |||||
Receipt of Pap test in control group: | Receipt of mammography in control group: | |||||
Baseline: 11.8% | Baseline: 18.1% | |||||
Post: 18.2% | Post: 18.2% | |||||
P-value not reported | P-value not reported | |||||
All measures unadjusted | All measures unadjusted |
Breast cancer screening
Colorectal cancer screening
Recommendations for cancer prevention
Smoking cessation recommendations
Study | Sample size | Outcome measure | Setting | Findings for diet | Findings for physical activity | Findings for smoking cessation |
---|---|---|---|---|---|---|
Tompkins et al., [33] | Total providers: 398 | Self-report of NPs | Survey of NPs at Pacific Northwest Annual National Conference | NA | Physical activity counseling of appropriate patient in past week: | NA |
NPs: 398 | ||||||
Cross sectional survey | 25% of NPs reported counseling 50% of appropriate patients | |||||
37.75% of NPs reported counseling 75% of appropriate patients | ||||||
14.8% of NPs reported counseling 100% of appropriate patients | ||||||
Selected factors that facilitate physical activity counseling with patients: | ||||||
69.2% of NPs reported length of patient visit | ||||||
55.4% of NPs reported part of preventative health visit | ||||||
P-value not reported | ||||||
Patton et al., [25] | Total providers: 1802 | Self-report of MDs and NPs | Surveys of health professionals in North Carolina | NA | NA | NPs report that they assess: |
Patient’s past tobacco use: 95.1% | ||||||
Family physicians: 273 | ||||||
Patient’s present tobacco use: 97.9% | ||||||
NPs: 294 | ||||||
Dentists: 584 | Cross sectional Survey | Type and amount of tobacco: 92.3% | ||||
Hygienists: 651 | ||||||
P-value not reported | ||||||
Family MDs report that they assess: | ||||||
Patient’s past tobacco use: 98.5% | ||||||
Patient’s present tobacco use: 100% | ||||||
Type and amount of tobacco: 95.5% | ||||||
P-value not reported | ||||||
Adequately trained for smoking cessation | ||||||
NPs: 71.4% | ||||||
Family MD: 93.5% | ||||||
P-value not reported | ||||||
Physicians are significantly more likely to feel adequately trained to provide tobacco cessation compared to NPs | ||||||
OR = 5.3 (3.2 - 8.6) | ||||||
P-value<.0001 | ||||||
All measures unadjusted | ||||||
Price et al., [35] | Total providers: 194 | Self-report of CNMs | Survey of CNMs in Ohio | NA | NA | CNMs reported that they always/usually: |
CNMs: 194 | Cross sectional survey | Document cigarette smoking use status at each visit: 73% | ||||
All patients pregnant women | Assess whether the patient is willing to make a quit attempt within the next 30 days: 66% | |||||
Use counseling to help patients willing to make a quit attempt: 48% | ||||||
P-value not reported for all measures | ||||||
All measures unadjusted | ||||||
Running et al., [36] | Total patients: 400 | Chart review | Chart review of urgent care setting in HMO in the Southwest | NA | NA | Smoking cessation addressed among non-pharmacological interventions for sinusitis: |
NP patients: 200 | ||||||
Physician patients: 200 | ||||||
Retrospective cohort | NPs: 49% | |||||
MDs: 31% | ||||||
Number of times smoking cessation is addressed for subjects in all categories | ||||||
NPs: .97 | ||||||
MDs: 1.95 | ||||||
P-value=.309 | ||||||
Unadjusted | ||||||
Hopkins et al., [26] | Total Patients: 1339 | Chart review | Chart review in private practice and primary care health centers in NY City | Receipt of assessment and counseling on nutrition and diet: | Receipt of assessment and counseling on physical activity: | Receipt of assessment and counseling on tobacco use: |
Primary health care center (PHCC) NP patients: 755 | ||||||
PHCC NPs: 41.4% | PHCC NPs: 15.8% | PHCC NPs: 79.2% | ||||
PHCC MDs: 14.7% | PHCC MDs: 2.5% | PHCC MDs: 87.8% | ||||
MD patients: 441 | ||||||
Retrospective cohort | P-value=0.000 | P-value=0.000 | P-value=0.000 | |||
Private practice NP patients: 143 | ||||||
Unadjusted | Unadjusted | Unadjusted | ||||
Lin et al., [27] | Total hospital outpatient department visits: 90,476 | Chart review | National survey of hospital ambulatory settings (NAMCS) | Received diet counseling at an OPD visit with a NP compared to one without a NP | Received physical activity counseling at an OPD visit with a NP compared to one without a NP | Received tobacco use counseling at an OPD visit with a NP compared to one without a NP |
Visits with NP: 6,062 | Cross sectional survey | 32.6% vs. 22.9% | 14.5% vs. 9.3% | 6.7% vs. 4.3% | ||
Visits without NP: 84,416 | Odds ratio adjusted for patient age, sex, clinic type, metropolitan status, geographic region of hospital, and number of providers seen. | Non-illness patients: 1.7 OR (95% CI OR: 1.2-2.5) | Non-illness patients: 1.8 OR (95% CI OR: 1.2-2.8) | Non-illness patients: 1.7 OR (95% CI OR: 1.2-2.5) | ||
P- value = 0.004 | P- value = 0.007 | P- value = 0.004 | ||||
OPD visits for patients with chronic problems with a NP compared to one without a NP: | OPD visits for patients with chronic problems with a NP compared to one without a NP: | OPD visits for patients with chronic problems with a NP compared to one without a NP: | ||||
32.3% vs. 17.1% | 20.2% vs. 8.9% | 4.7% vs.2.9% | ||||
2.5 OR (95% CI OR: 1.6-3.8) | 2.8 OR (95% CI OR: 1.6-5.1) | 1.8 OR (95% CI OR: 1.1-3.0) | ||||
P-value = 0.001 | P-value = 0.007 | P-value = 0.01 | ||||
Moody et al., [37] | Total Providers: 44 | Self-report of | Survey of NPs in Tennessee | Provider report nutrition counseling: | Provider report physical activity counseling: | Provider report smoking cessation counseling: |
NPs: 44 | NPs | Cross sectional survey | NPs: 19% | NPs: 12% | NPs: 7% | |
Total patients: 680 | MDs: 15% | MDs: 7% | MDs: 2.5% | |||
P-value not reported | P-value not reported | P-value not reported | ||||
Unadjusted | Unadjusted | Unadjusted | ||||
Gebauer et al., [38] | Total patients: 178 | Self-report of patients and Salivary Cotinine Sample | Follow up survey at outpatient obstetric clinic - state not specified | NA | NA | Smoking rate/day at follow-up: Mean (SD) |
Control patients: 94 | Control: 13.7 (14.1) | |||||
Intervention patients: 84 | Intervention | Intervention: 7.8 (7.3) | ||||
All patients pregnant women who report smoking and intervention includes being seen by an advance practice NP | P =.008 | |||||
Unadjusted | ||||||
Smoked any amount in past 7 days: | ||||||
Control Baseline: 94 participants | ||||||
Control Follow up: 94 participants | ||||||
Intervention Baseline: 83 participants | ||||||
Intervention Follow up: 70 participants | ||||||
Difference between groups =15.5% P-value<0.001 | ||||||
Unadjusted | ||||||
Murphy, [31] | Total providers: 346 | Self-report of CNMs | National survey of CNMs | Nutritional counseling of gynecologic patients | Physical activity counseling of gynecologic patients | Smoking cessation counseling of gynecologic patients |
CNMs: 346 | Cross sectional survey | 52% of CNMs report counseling 81-100% of their patients | 46% of CNMs report counseling 81-100% of their patients | 72% of CNMs report counseling 81-100% of their patients | ||
P-value not reported | P-value not reported | P-value not reported | ||||
Unadjusted | Unadjusted | Unadjusted | ||||
Zahnd et al., [32] | Total patients: 1217 | Self-report of patients | Survey of patients from Four Kaiser Permanente Medical Centers in San Francisco Bay Area | NA | NA | Patients report discussing smoking cessation: |
NP patients: 269 | NP Patients: 64% | |||||
Physician patients: 948 | MD Patients: 50% | |||||
P-value<0.001 | ||||||
Total providers: 52 | Intervention | Unadjusted | ||||
Physicians: 40 | Independent predictors of counseling about smoking: | |||||
NPs: 12 | NP vs. Physician: OR 1.7 | |||||
P-value=.0006 | ||||||
Adjusted for differences in patient characteristics |