Characterizing the Clinical Role of Radiation Oncology Advanced Practice Providers Using Entrustable Professional Activities.

Abstract

Purpose/objective: Advanced practice providers (APPs), including physician associates (PAs) and nurse practitioners (NPs), are increasingly utilized in radiation oncology. However, radiation oncology-specific training for APPs is not standardized. This study elucidates the current role of US radiation oncology APPs by assessing clinical responsibilities.

Methods: Radiation oncology APPs in the US were sent a survey examining demographics, training, practice structure, and clinical tasks using the framework of the 52 entrustable professional activities (EPAs) developed by the Radiation Oncology Education Collaborative Study Group (ROECSG).

Results: 37 PAs and 84 NPs participated. 53.7% practiced a different specialty previously. 63.6% had three or more APPs in the department, and 71.9% covered multiple physicians. 65.3% worked in a practice alongside radiation oncology residents, and 79.7% of these APPs worked directly with residents. 25.6% performed procedures. 95% completed follow-up/survivorship visits, 71% completed acute symptom visits, 65% completed ambulatory consults, 45% completed inpatient consults, and 38% completed on-treatment visits. 21.5% specialized in one disease site, 39.7% covered multiple disease sites, and 38.8% covered all disease sites. 22 of 52 ROECSG EPAs were performed by > 90% in some capacity. > 90% did not complete EPAs 15, 32, 33, 35, 36, 37, 38, 40, and 46. Only 2.5% of APPs received formal radiation oncology training during APP education.

Conclusions: APPs perform many ROECSG EPAs, primarily during follow-up/survivorship visits. However, job responsibilities vary widely across radiation oncology clinics. Further definition of the APP role is essential to meet the growing demands of cancer care, support the evolution of radiation oncology, and enhance patient care.