Graduation Semester and Year

2015

Language

English

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Barbara M Raudonis

Abstract

Purpose: The purpose of this study was to describe and compare the colorectal cancer screening practices of Texas nurse practitioners (NPs) and physician assistants (PAs). Research Questions: 1) What are the beliefs, attitudes, barriers, and practices of Texas NPs and P As with regard to risk stratified CRC screening in adults? 2) Is there a relationship between provider demographics (professional role, age, gender, race/ ethnicity, time in professional role, specialty, practice setting, percentage of primary care provided, percentage of patients aged>50, and weekly patient volume) and CRC screening practices? 3) What are the differences between NPs and P As in knowledge of national screening guidelines for adults at varying risk of CRC and their CRC screening behavior? Background: CRC is the second most common cause of cancer death from cancers affecting both men and women. It is projected to account for an expected annual 50,000 deaths in 2015 (American Cancer Society [ACS], 2015; Rodriguez, 2014; Siegel, Miller, & Jemal, 2015). Despite advances in screening and early diagnosis 50%-60% of patients are diagnosed at an advanced stage (stage III or IV). Metastatic CRC has a five year survival rate of 12% (Rodriguez, 2014). CRC is preventable and survivable if appropriate risk stratified screening and surveillance is undertaken. There are gaps in NP and PA knowledge of risk stratified CRC screening and surveillance guidelines. CRC screening in primary care is under-utilized compared to breast and cervical cancer screening(Gany, Trinh-Shevrin, & Aragones, 2008; Menees, Patel, & Dalton, 2009). No previous studies comparing the beliefs attitudes and practices of Texas NPs and PAs with regard to CRC screening were found. Theoretical Framework: The theoretical framework that guided this study was Ajzen's Theory of Planned Behavior Ajzen, (1991). Methods: This study used a descriptive correlational and comparative design. Data were collected with a self-administered web-based questionnaire using Qualtrics® (version 12018) software. The survey invitation was emailed to the eligible membership of the Texas Nurse Practitioner organization (TNP) (N=l 780) and the Texas Academy of Physician Assistants(TAP A) (N= 17 40). The survey instrument for this study was adapted from previously published studies. The questionnaire consisted of 44 items categorized in three domains: personal and practice demographics, knowledge of national guidelines for risk stratified CRC screening, and providers' personal practices and perceived barriers to screening. One-hundred sixty seven NPs (9%) and 91 P As ( 6%) completed the survey. Results: The majority of respondents believed their professional education program included risk stratified cancer screening (NP 94%, PA 96.7%). Sixty percent of the NPs and 57% of the PAs were confident in their knowledge of hereditary cancer syndromes. Less than 10% in either group believed this content was not covered in their formal education program. Over 89% of the participants believed they had adequate time to perform comprehensive cancer screening. Almost 60% reported financial concerns for their patients' low CRC screening rates. There were no significant relationships between provider demographics and CRC screening behavior. An independent samples t-test was conducted to compare NP and PA knowledge of national CRC screening guidelines. There was a significant difference in the scores for NP (M= 3.09 SD= .96) and PA (M=3.44 SD= .85) knowledge of national CRC screening guidelines for adults at varying risk and their CRC practices t (222) = 2.8,p < .005. However, there was no significant difference between NP (M= 1.82 SD=.59) and PA (M=l.70 SD= .69) CRC screening behavior t(249) =1.5 p >. 05 Conclusions: The concomitant contraction of the physician work-force, and the addition of more individuals with insurance coverage, will require a primary care workforce capable of meeting complex needs. NPs and P As stand ready to provide comprehensive cancer screening, co-management of treatment, and survivor care. Texas NPs and PAs are a valuable group of nonphysician providers who utilize recommended colorectal cancer screening techniques in average risk adults, however, there are knowledge gaps in risk assessment and appropriate screening for those at higher risk of CRC. Efforts to increase the education and training of these providers in the importance of obtaining a three generation family history of cancer in all patients, and to identify red flags in the history that identify those at higher risk, was identified as a need from this survey.

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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