Department of Applied Health Research, UCL, 1-19 Torrington Place, 14, London, WC1E 7HB, UK.
NIHR Cancer Awareness, Screening and Early Diagnosis Policy Research Unit, Queen Mary University of London, London, UK.
BMC Health Serv Res. 2021 Jul 3;21(1):644. doi: 10.1186/s12913-021-06667-y.
Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs' competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care.
A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation.
From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs' competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis.
This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs' roles, including outcomes of the diagnostic process.
在初级保健中识别症状和及时转介对于癌症的早期诊断至关重要。 全世界有 18 个医疗保健系统引入了医师助理或助理医师（PAs），在某些情况下，为了解决初级保健医生短缺的问题，他们的数量有所增加。 关于他们在识别和转介疑似癌症方面的作用知之甚少。 本综述旨在总结在高收入国家进行的观察性研究中关于 PA 在初级保健中识别和转介疑似癌症的质量过程中的能力和表现的发现。
对国际同行评议文献进行快速系统综述。 在 OVID、EMBASE、Web of Science 和 CINAHL 数据库上进行了搜索（2009-2019 年）。 如果研究报告了与疑似癌症识别和转介相关的 PA 技能、流程和结果，则符合入选标准。 进行标题和摘要筛选后，进行全文审查和数据提取。 对三个主题进行定性和定量结果的综合：部署、能力和绩效。初步结果与专家咨询小组进行了讨论，以提供解释。
从 883 条参考文献中，确定了 15 篇符合条件的论文，其中 13 篇来自美国。 有 7 项研究报告了初级保健中常见的支持癌症诊断的一般临床流程，最常见的是诊断测试的订单（n=6）和专科医生的转介（n=4）。 较少的论文报告了咨询流程，如检查或病史采集（n=3）。 有 6 篇论文考虑了 PA 在癌症筛查方面的能力和表现。 PA 在开具诊断测试、转介和患者结局（满意度、医疗事故、急诊就诊）方面与初级保健医生的表现相似。 没有研究报告癌症诊断的及时性。
本综述对同行评议文献的结合与咨询小组的解释表明，将 PA 引入初级保健可能会维持支持癌症诊断所需的转诊和诊断测试的质量。 它还突出了关于 PA 角色的几个方面缺乏研究，包括诊断过程的结果。
