The role of midlevel providers in cancer screening.

Data indicate that midlevel providers are more likely to provide health promotion and disease prevention counseling, health education, and preventive health and screening services as well as use more community resources. Although the literature is sparse regarding cancer screening activities by midlevel providers, such activities are routinely taught in midlevel educational programs, and midlevel providers see these activities as consistent with their roles. Therefore, it is only logical to assume that use of midlevel providers, who have already been shown to focus on health promotion and disease prevention, would be an effective way to provide quality, cost-effective cancer screening. In fact, models of this sort exist around the United States at the present time, such as the one at Moffitt Cancer Center's Lifetime Cancer Screening Program in Tampa, Florida. In such programs, midlevel providers are successfully conducting comprehensive cancer screening activities. Outcome data from these programs have yet to be published, however. In a collaborative practice environment, the delivery of preventive care, including cancer screening activities, is best accomplished when both the physician and the midlevel provider agree on the importance of these screening activities and work together as a team to integrate these preventive health activities into their office practice. Office systems that are sensitive to patient preferences and that promote preventive care, such as protocols and checklists or health maintenance flowsheets, along with appropriate education tailored to patients' ages and to their social, cultural, and educational backgrounds also help to improve compliance with cancer screening guidelines. More than ever before, health care reform has been the focus of national debate. Most of the health care reform proposals that have been advanced recognize the importance of primary and preventive health care and the role that midlevel providers could and should be playing in such a system. As competent providers, NPs, CNMs, and PAs have the ability to enhance medicine's effectiveness in preventive care, through improved outreach and more thorough screening.