Table 3.
Breast cancer: clinical tasks undertaken by percentage of physicians and nurses, by countries’ SoP, 2015/2016
| % Physicians performing tasks | % Nurses performing tasks (all nurses and APN/SN) | |||||
|---|---|---|---|---|---|---|
| Countries with SoP expansion [1] | Countries with no/limited SoP expansion [2] | Countries with SoP expansion [1] | Countries with no/limited SoP expansion [2] | Countries with SoP expansion [1] | Countries with no/limited SoP expansion [2] | |
| Breast cancer | % Physicians, N = 91 | % Physicians, N = 132 | % All nurses, N = 79 | % All nurses, N = 242 | % APN/SN, N = 46 | % APN/SN N = 43 |
| Tasks related to diagnosis/physical examination | ||||||
| Assessing extent of disease/staging: physical examination[i,ii] | 53.8 | 54.5 | 16.4*** | 1.6*** | 21.7** | 0.0** |
| Detecting and treating local recurrence: perform physical examination[i,ii] | 59.3 | 63.6 | 26.5*** | 2.8*** | 32.6*** | 0.0*** |
| Detecting and treating metastatic diseases: perform physical examination[i,ii] | 51.6 | 61.3 | 15.1*** | 3.3*** | 17.3** | 0.0** |
| Endocrine/hormonal therapy: perform physical examination[i] | 40.6 | 36.3 | 13.9*** | 1.6*** | 15.2 | 4.6 |
| Biological therapy: perform physical examination[i] | 10.9*** | 31.0*** | 8.8* | 3.3* | 8.7 | 9.3 |
| Interpret ultrasound scan[i] | 23.0*** | 46.2*** | 3.8 | 0.8 | 6.5 | 0.0 |
| Clinical interpretation of mammogram[i] | 42.8 | 31.0 | 5.0* | 0.8* | 8.7 | 0.0 |
| Clinical interpretation of MRI[i] | 34.0* | 21.9* | 2.5 | 0.8 | 4.3 | 0.0 |
| Clinical interpretation of biopsy[i] | 41.7 | 30.3 | 3.8* | 0.0* | 4.3 | 0.0 |
| Interpret X-ray[i] | 27.4 | 21.9 | 2.5 | 0.0 | 4.3 | 0.0 |
| Interpret CT scan[i] | 29.6 | 21.2 | 1.2 | 0.0 | 2.1 | 0.0 |
| Interpret bone scan[i] | 21.9 | 17.4 | 1.2 | 0.0 | 2.1 | 0.0 |
| Tasks related to treatment/therapy | ||||||
| Surgical treatment: perform surgical procedures[i,ii] | 40.6 | 43.1 | 2.5 | 3.3 | 2.1 | 2.3 |
| Local recurrence: initiate diagnosing treatment[i,ii] | 52.7 | 57.4 | 21.0*** | 0.8*** | 30.4*** | 0.0*** |
| Metastatic diseases: initiate diagnosing treatment[i,ii] | 47.2 | 58.3 | 15.1*** | 1.2*** | 19.5** | 0.0** |
| Chemotherapy: decide on therapy based on lab results and protocols[i] | 16.4*** | 44.7*** | 24.0*** | 1.6*** | 30.4*** | 0.0*** |
| Chemotherapy: revise therapy[i] | 12.0*** | 38.6*** | 22.7** | 8.2** | 30.4*** | 2.3*** |
| Endocrine/hormonal therapy: prescribe therapy[i] | 45.0 | 37.8 | 12.6** | 4.1** | 19.5** | 0.0** |
| Endocrine/hormonal therapy: revise therapy[i] | 43.9 | 34.8 | 13.9*** | 1.2*** | 19.5** | 0.0** |
| Biological therapy: prescribe therapy[i] | 12.0** | 31.0** | 8.8 | 5.7 | 13.0 | 4.6 |
| Biological therapy: revise therapy[i] | 12.0** | 27.2** | 11.3** | 1.6** | 15.2* | 0.0* |
| Lymphedema: initiate treatment[i] | 23.0 | 33.3 | 24.0* | 12.4* | 30.4 | 20.9 |
| Cancer-related fatigue: prescribe therapy[i] | 7.6*** | 31.0*** | 30.3*** | 7.8*** | 41.3** | 9.3** |
| Tasks related to prescribing medications | ||||||
| Prescribe medication related to treatment[i] | 37.3 | 46.9 | 10.1** | 2.0** | 13.0* | 0.0* |
| Adapt medication treatment in the course of therapy[i] | 30.7 | 42.4 | 16.4** | 4.9** | 21.7** | 0.0** |
| Side effects: prescribe medications[i] | 27.4** | 49.2** | 10.1** | 2.0** | 15.2 | 2.3 |
| Administer medications[i] | 5.4*** | 26.5*** | 17.7** | 35.5** | 17.3 | 32.5 |
| Palliative care: prescribe medications[i] | 17.5** | 37.8** | 6.3 | 4.1 | 10.8 | 0.0 |
| Palliative care: administer medications[i] | 0.0*** | 13.6*** | 21.5*** | 50.4*** | 21.7 | 37.3 |
| Tasks related to providing information to patients | ||||||
| Providing information to patient about test results[ii] | 61.5 | 50.0 | 35.2*** | 2.0*** | 44.6*** | 6.0*** |
| Detecting and treating local recurrence: inform patients about results[ii] | 53.8 | 54.2 | 23.5*** | 3.1*** | 34.0*** | 4.0*** |
| Detecting and treating metastatic diseases: inform patient about results[ii] | 50.5 | 52.1 | 16.4*** | 0.6*** | 21.2*** | 0.0*** |
| Providing information to patient about clinical aspects and perspective of treatment[ii] | 58.2 | 46.4 | 38.8*** | 4.8*** | 48.9*** | 10.0*** |
| Surgical treatment: inform patient about surgical treatment[ii] | 46.1 | 52.8 | 30.5*** | 11.3*** | 36.1* | 14.0* |
| Endocrine/hormonal therapy: inform patient about therapy[ii] | 50.5 | 42.8 | 32.9*** | 7.9*** | 42.5** | 18.0** |
| Information to patient about non-clinical consequences of treatment[ii] | 42.8 | 40.7 | 40.0*** | 5.5*** | 53.1*** | 14.0*** |
Source: MUNROS 2015/2016. Rationale for inclusion of tasks: [i] = suggested clinical activities as Advanced Nursing Practice: diagnosis/advanced health assessment, treatment/therapy, prescribing medications, by International Council of Nurses (ICN), [ii] = common medical tasks, reported by the majority of physicians as being part of normal duties (≥ 50% of physicians in ≥ 50% of countries). [1] England, Scotland, Netherlands, [2] Czech Republic, Germany, Italy, Norway, Poland, Turkey
SoP Scope-of-Practice, APN Advanced Practice Nurses, SN Specialist Nurses
***p value < .001; ** = p value < .01, * = p value < .05