August 7, 2019 | Erin Bluvas, bluvase@sc.edu
Recent research led by Matthew Hudson, the director of Cancer Care Delivery Research at Prisma Health-Upstate and an adjunct associate professor in the Arnold School of Public Health’s Department of Health Services Policy and Management (HSPM) at UofSC, investigates clinical work intensity (i.e., mental workload) that medical oncologists and oncologic nurse practitioners experience while providing care to cancer patients. The study, which was published in the Journal of Oncology Practice, found that while provider characteristics (e.g., age, sex, years of experience) were unrelated to work intensity, the type of patient visit (e.g., chemotherapy, terminal prognosis discussions) was related to work intensity – both overall and among numerous work intensity attributes (e.g., time demand, effort).
“Clinical work intensity, which is a fundamental attribute of practice, is the level of requisite technical skill, physical and mental effort, and clinical judgement necessary to provide high-quality patient care, plus the level of associated stress,” Hudson says. “In addition to potentially influencing the mental health and well-being of the care provider, we need to consider whether and how work intensity-either too high or too low- negatively impact care quality for patients.”
Workforce shortages, practice reorganization, increased use of electronic medical records, and a growing emphasis on patient-centered care (demanding a thorough patient-provider discussion of treatment options) may collectively exacerbate work intensity among clinicians. Despite research suggesting a connection between these factors and clinical work intensity, few studies examine this relationship among medical practitioners – and even fewer studies specific to oncology.
"This study has profound implications not only for the delivery of cancer care but for delivery of healthcare in general in our currently evolving healthcare environment,” says HSPM professor and Arnold School associate dean for clinical public health Ronnie Horner, who is a co-author on the paper. "Government healthcare agencies, such as Center for Medicare and Medicaid Services, are engaged in extensive efforts to incentivize health systems to provide more effective and efficient care. By evaluating how clinical work intensity is affected by changes in the organization or management of medical clinics, we may be better able to identify those changes with the greatest promise of improving patient access to care, their experience with care and the health outcomes resulting from their care - what is known as high-value care."
With this study, Hudson, Horner and a team of Prisma Health researchers* assessed the level of work intensity medical oncologists and oncologic nurse practitioners experience while providing care. The team collected data from 17 medical oncologists (12 physicians and five nurse practitioners) from five national sites. Participants reported the level of work intensity associated with 339 patient visits over a 2-6 week period.
The researchers found that clinical work intensity increased with level of service, and was greatest when the visit involved a discussion of either chemotherapy or terminal prognosis. Further, they were able to identify patient, provider and practice factors that influence intensity.
“We observed several dimensions of work intensity that correlated directly with level of service,” Hudson says. “These include effort, frustration and stress, as well as mental, physical and temporal demands. The impact of these factors on level of service – and therefore clinical work intensity – was even more pronounced during visits that included chemotherapy and terminal prognosis discussions.”
The authors recommend that future research examine the potential impact of nurse practitioners’ role expansion. Individuals in these positions are likely at the center of care coordination and may possess a unique standing as the patient’s first and last contact during treatment. These studies should investigate whether such responsibilities affect work intensity for this group. These results and future research may inform policies and procedures regarding patient scheduling and oncology care team coordination in order to minimize any potentially negative effects on both patient and practitioner health and well-being.
*Co-authors include Matthew Hudson, Mark O’Rourke, Dawn Blackhurst, Jennifer Caldwell, and Ronnie Horner.