Obstetrics And Gynecology: The Essentials Of Cl... HOT!
As nurse practitioners (NPs) and physician assistants (PAs) shoulder an increasing volume of women\u2019s health care in the United States,1 a new study finds that a large proportion of these providers are unable to identify early symptoms and potential risk factors for ovarian cancer in their patients.2 This suggests that continuing medical education initiatives must be enhanced to appropriately engage this critically expanding segment of primary care providers.\\nThe original research, published in The Journal for Nurse Practitioners by Carol L Goldstein, PhD, and colleagues, reports that while NPs and PAs are often the first contact for patients with signs of ovarian cancer, these clinicians may fail to associate the symptoms of early satiety, abdominal fullness, or urinary urgency with potential ovarian cancer, without the more obvious symptoms of pelvic pain and\/or swelling. Similarly, while NPs and PAs were able to identify \u201cfamily history of ovarian, breast, or colon cancer,\u201d \u201c genetic predisposition,\u201d or \u201cincreasing age\u201d as important risks for ovarian cancer, the majority failed to recognize \u201cundesired infertility\u201d as a risk factor. Combined, these gaps in knowledge could contribute to the late stage diagnosis and poor survival rates suffered by ovarian cancer patients in the United States.2\\nCurrently, there is no good method for early detection of ovarian cancer. Screening modalities including ultrasound and cancer antigen 125 (CA125) testing have not been shown to reduce morbidity or mortality, and are not routinely recommended.3,4 Instead, both the American College of Obstetricians and Gynecologists and the Society for Gynecologic Oncology indicate that the best method to diagnose ovarian cancer is for clinicians to have a \u2018high index of suspicion in symptomatic patients\u2019.5 Previous studies have indicated a lack of symptom awareness among primary care physicians,6 suggesting the same may be true among NPs and PAs.\\n\u201cAs NPs and PAs assume a larger role in primary care, and especially in women\u2019s care, there is a critical need for adequate education for these providers regarding the signs and symptoms of ovarian cancer and appropriate follow-up actions\u201d wrote the study authors. The primary aim of this study was to determine the ovarian cancer symptom and risk factor awareness level among NPs and PAs, to determine if a difference existed in awareness between NPs and PAs, and to determine what level of awareness was acquired during their initial education versus their continuing medical education.\\nGaps in symptom and risk awareness\\nStudy results were based upon survey questions distributed via email to NPs and PAs at a university medical center in the United States from August - October, 2015. To expand sample size, the survey was also made accessible to members of a secure forum for doctors of nursing practice (DNPs), many of whom are NPs.\\nRespondents were included regardless of specialty, due to the flexible practice patterns of NPs and PAs over their careers. Many subspecialties, including family medicine, internal medicine, obstetrics and gynecology, pediatrics, and others were represented in the sample.\\nA total of 350 surveys were distributed via email, plus an indeterminate number accessed through the DNP website. A total of 131 surveys were available for analysis, composed of 77 NPs (58.8%) and 54 PAs (41.2%). No significant difference existed between NPs and PAs with regard to age (the only demographic factor assessed), with 36.4% of NPs and 46.3% of PAs 95%) correctly identified \u201cbloating; pelvic and\/or abdominal swelling\u201d and \u201cpelvic or abdominal pain\u201d as associated with ovarian cancer. A majority (81%-88%) correctly identified the less specific symptoms such as \u201cunexplained weight loss or weight gain,\u201d and \u201cvague or persistent stomach discomfort, such as gas, nausea, or indigestion\u201d as potential symptoms of ovarian cancer. However, respondents frequently failed to associate two important symptoms with potential ovarian cancer; \u201cdifficulty eating or feeling full quickly\u201d was missed 32.3% of the time, and \u201cfrequent or urgent need to urinate (without UTI)\\\" was missed 61.7% of the time.2\\nWhen questioned regarding risk factors for ovarian cancer, NPs and PAs were again similar in their ability to identify 4.7 \u00b1 0.94 of the 7 risk factors listed correctly, with no differences based on practice group or age. Most participants identified \u201cpersonal or family history of ovarian, breast, or colon cancer\u201d (100%), \u201cgenetic predisposition\u201d (96.9%), and \u201cincreasing age\u201d (82.2%) as risk factors for ovarian cancer. However, one important risk factor, \u201cundesired infertility,\u201d was missed 33.1% of the time.2\\nInterestingly, while no difference was found regarding risk factor identification according to practitioner type or age, practitioner age did affect which diagnostic tests would be ordered for patients deemed \u201cat risk\u201d for ovarian cancer. Older respondents (age \u2265 40 ) were more likely to order pelvic ultrasound (P = .01) and less likely to offer a referral for genetic testing (P = .06). Again, there were no differences in responses between NPs and PAs.2\\nFinally, respondents were queried regarding their sources of education on ovarian cancer. More PAs than NPs reported learning about ovarian cancer in their initial formal education (83.0% vs 65.3%; P = .027). Importantly, less than half of all respondents (42.7%) report receiving any education on the signs and symptoms of ovarian cancer since completing their education. For the 42% obtaining this information, the most commonly reported sources were TV ads (100%) and talks by organizations (100%). NPs were more likely than PAs to report gaining this information from journal articles (41.6% vs 24.1%; P = .038) or continuing medical education (CME) units on the internet (14.3% vs 1.9%; P = .015).2\\nOvarian cancer awareness CME programs for PAs and NPs\\nAs there are no reliable screening methods for ovarian cancer at the moment, reliance on practitioner vigilance is essential. Therefore, making sure that primary care practitioners have the most up-to-date information regarding ovarian cancer risks, signs, and symptoms will be paramount. Approximately 73% of the NP and PA respondents in this study reported initial formal training on the risks and signs of ovarian cancer, but only 43% reported any further education on ovarian cancer since the completion of their degrees; those that did report further education received the majority from television ads and talks by organizations.2 Again, however, not all participants specialized in gynecology.\\nEducators developing CME programs targeted to PAs and NPs may need to find novel methods to effectively reach these providers, beyond the traditional didactic conference presentations, journal articles, and CME units.\",\"notes\":[\"NPs and PAs frequently failed to associate two important symptoms with potential ovarian cancer; \u201cdifficulty eating or feeling full quickly\u201d was missed 32.3% of the time, and \u201cfrequent or urgent need to urinate (without UTI)\\\" was missed 61.7% of the time.\",\"One important risk factor, \u201cundesired infertility,\u201d was missed 33.1% of the time.\"],\"byline\":\"By Caroline Gamse PhD\\rReviewed by Mireya Reilly, NP\",\"meta_data\":\"description\":\"As NPs and PAs are increasingly relied upon in primary care, they will need to be familiar with the risk factors for and symptoms of ovarian cancer. In a relatively small recent survey, a large fraction failed to recognize several important signs associated with ovarian cancer.\",\"title\":\"Needed: More Training on Ovarian Cancer Symptoms, Risk Factors\",\"keywords\":\"ovarian cancer symptoms; ovarian cancer risk factors; ovarian cancer diagnosis; missed diagnosis ;physician assistant; nurse practitioner\",\"synopsis\":\"As NPs and PAs are increasingly relied upon in primary care, they will need to be familiar with the risk factors for and symptoms of ovarian cancer. In a relatively small recent survey, a large fraction failed to recognize several important signs associated with ovarian cancer.\",\"section_id\":\"94\",\"section_name\":\"Clinical Essentials\",\"active\":1,\"published\":1,\"images\":[\"image_id\":1,\"url\":\"\/\/clf1.medpagetoday.com\/assets\/images\/resource-center\/cs-epidemiology-Gynecologic-Cancers-600x400.jpg\",\"caption\":\"\"],\"references\":[\"display_text\":\"Farrow VA, Lawrence H, Schulkin J. Women's healthcare providers' range of services and collaborative care. J Healthc Qual. 2014;36:39-49. DOI: 10.1111\/j.1945-1474.2012.00216.x.\",\"id\":1,\"url\":\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=36%5Bvolume%5D+AND+2014%5Bpdat%5D+AND+Farrow+VA%5Bfirst+author%5D+AND+Women%27s+healthcare+providers%27+range+of+services+and+&TransSchema=title&cmd=detailssearch\",\"display_text\":\"Goldstein CL, Sheeder J, Medlin E et al. Ovarian cancer knowledge among advanced providers in a university setting. J Nurse Pract. 2017;13:221-229. DOI: \",\"url\":\"http:\/\/www.npjournal.org\/article\/S1555-4155(16)30763-2\/pdf\",\"id\":2,\"display_text\":\"Buys SS, Partridge E, Greene MH, et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol. 2005;193:1630-9. DOI:\",\"url\":\"http:\/\/dx.doi.org\/10.1016\/j.ajog.2005.05.005\",\"id\":3,\"display_text\":\"van Nagell JR Jr, DePriest PD, Ueland FR, et al. Ovarian cancer screening with annual transvaginal sonography: findings of 25,000 women screened. Cancer. 2007;109:1887-96. DOI: 10.1002\/cncr.22594\",\"id\":4,\"url\":\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=Ovarian+cancer+screening+with+annual+transvaginal+sonography%3A+findings+of+25%2C000+women+screened&TransSchema=title&cmd=detailssearch\",\"display_text\":\"Andersen MR, Lowe KA, Goff BA. Value of symptom-triggered diagnostic evaluation for ovarian cancer. Obstet Gynecol. 2014 Jan;123(1):73-9. DOI:10.1097\/AOG.0000000000000051.\",\"id\":5,\"url\":\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=Value+of+symptom-triggered+diagnostic+evaluation+for+ovarian+cancer.&TransSchema=title&cmd=detailssearch\",\"display_text\":\"Goff BA, Matthews B, Andrilla CH, et al. How are symptoms of ovarian cancer managed? A study of primary care physicians. Cancer. 2011;117:4414-23. DOI: 10.1002\/cncr.26035.\",\"id\":6,\"url\":\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=.+How+are+symptoms+of+ovarian+cancer+managed%3F+A+study+of+primary+care+physicians&TransSchema=title&cmd=detailssearch\"],\"ad_zone\":\"\",\"rewrite_url\":\"needed-more-training-ovarian-cancer-symptoms-risk-factors\",\"main_image_url\":\"\/\/clf1.medpagetoday.com\/assets\/images\/resource-center\/cs-epidemiology-Gynecologic-Cancers-600x400.jpg\"}","publish_date":"2017-12-06 00:00:00","published":"1","active":"1","dc":"0000-00-00 00:00:00","dlm":"2017-12-06 00:00:00","rewrite_url":"\/resource-centers\/nurse-practitioner-focus\/needed-more-training-ovarian-cancer-symptoms-risk-factors\/1658","main_image_url":"\/\/clf1.medpagetoday.com\/assets\/images\/resource-center\/cs-epidemiology-Gynecologic-Cancers-600x400.jpg","brightcove_video_id":null,"ign_video_id":null,"case_id":null,"sailthru":"neoplastic disease,mass of body structure,malignant adenomatous neoplasm,weight increased,mass of pelvic structure","adRefreshRate":"60000"}; window.MPT.decodedJSON = "title":"Needed: More Training on Ovarian Cancer Symptoms, Risk Factors","publish_date":"2017-12-06 00:00:00","description":"As NPs and PAs are increasingly relied upon in primary care, they will need to be familiar with the risk factors for and symptoms of ovarian cancer. In a relatively small recent survey, a large fraction failed to recognize several important signs associated with ovarian cancer.","content_id":"1658","content":"As nurse practitioners (NPs) and physician assistants (PAs) shoulder an increasing volume of women\u2019s health care in the United States,1 a new study finds that a large proportion of these providers are unable to identify early symptoms and potential risk factors for ovarian cancer in their patients.2 This suggests that continuing medical education initiatives must be enhanced to appropriately engage this critically expanding segment of primary care providers.\nThe original research, published in The Journal for Nurse Practitioners by Carol L Goldstein, PhD, and colleagues, reports that while NPs and PAs are often the first contact for patients with signs of ovarian cancer, these clinicians may fail to associate the symptoms of early satiety, abdominal fullness, or urinary urgency with potential ovarian cancer, without the more obvious symptoms of pelvic pain and\/or swelling. Similarly, while NPs and PAs were able to identify \u201cfamily history of ovarian, breast, or colon cancer,\u201d \u201c genetic predisposition,\u201d or \u201cincreasing age\u201d as important risks for ovarian cancer, the majority failed to recognize \u201cundesired infertility\u201d as a risk factor. Combined, these gaps in knowledge could contribute to the late stage diagnosis and poor survival rates suffered by ovarian cancer patients in the United States.2\nCurrently, there is no good method for early detection of ovarian cancer. Screening modalities including ultrasound and cancer antigen 125 (CA125) testing have not been shown to reduce morbidity or mortality, and are not routinely recommended.3,4 Instead, both the American College of Obstetricians and Gynecologists and the Society for Gynecologic Oncology indicate that the best method to diagnose ovarian cancer is for clinicians to have a \u2018high index of suspicion in symptomatic patients\u2019.5 Previous studies have indicated a lack of symptom awareness among primary care physicians,6 suggesting the same may be true among NPs and PAs.\n\u201cAs NPs and PAs assume a larger role in primary care, and especially in women\u2019s care, there is a critical need for adequate education for these providers regarding the signs and symptoms of ovarian cancer and appropriate follow-up actions\u201d wrote the study authors. The primary aim of this study was to determine the ovarian cancer symptom and risk factor awareness level among NPs and PAs, to determine if a difference existed in awareness between NPs and PAs, and to determine what level of awareness was acquired during their initial education versus their continuing medical education.\nGaps in symptom and risk awareness\nStudy results were based upon survey questions distributed via email to NPs and PAs at a university medical center in the United States from August - October, 2015. To expand sample size, the survey was also made accessible to members of a secure forum for doctors of nursing practice (DNPs), many of whom are NPs.\nRespondents were included regardless of specialty, due to the flexible practice patterns of NPs and PAs over their careers. Many subspecialties, including family medicine, internal medicine, obstetrics and gynecology, pediatrics, and others were represented in the sample.\nA total of 350 surveys were distributed via email, plus an indeterminate number accessed through the DNP website. A total of 131 surveys were available for analysis, composed of 77 NPs (58.8%) and 54 PAs (41.2%). No significant difference existed between NPs and PAs with regard to age (the only demographic factor assessed), with 36.4% of NPs and 46.3% of PAs 95%) correctly identified \u201cbloating; pelvic and\/or abdominal swelling\u201d and \u201cpelvic or abdominal pain\u201d as associated with ovarian cancer. A majority (81%-88%) correctly identified the less specific symptoms such as \u201cunexplained weight loss or weight gain,\u201d and \u201cvague or persistent stomach discomfort, such as gas, nausea, or indigestion\u201d as potential symptoms of ovarian cancer. However, respondents frequently failed to associate two important symptoms with potential ovarian cancer; \u201cdifficulty eating or feeling full quickly\u201d was missed 32.3% of the time, and \u201cfrequent or urgent need to urinate (without UTI)\" was missed 61.7% of the time.2\nWhen questioned regarding risk factors for ovarian cancer, NPs and PAs were again similar in their ability to identify 4.7 \u00b1 0.94 of the 7 risk factors listed correctly, with no differences based on practice group or age. Most participants identified \u201cpersonal or family history of ovarian, breast, or colon cancer\u201d (100%), \u201cgenetic predisposition\u201d (96.9%), and \u201cincreasing age\u201d (82.2%) as risk factors for ovarian cancer. However, one important risk factor, \u201cundesired infertility,\u201d was missed 33.1% of the time.2\nInterestingly, while no difference was found regarding risk factor identification according to practitioner type or age, practitioner age did affect which diagnostic tests would be ordered for patients deemed \u201cat risk\u201d for ovarian cancer. Older respondents (age \u2265 40 ) were more likely to order pelvic ultrasound (P = .01) and less likely to offer a referral for genetic testing (P = .06). Again, there were no differences in responses between NPs and PAs.2\nFinally, respondents were queried regarding their sources of education on ovarian cancer. More PAs than NPs reported learning about ovarian cancer in their initial formal education (83.0% vs 65.3%; P = .027). Importantly, less than half of all respondents (42.7%) report receiving any education on the signs and symptoms of ovarian cancer since completing their education. For the 42% obtaining this information, the most commonly reported sources were TV ads (100%) and talks by organizations (100%). NPs were more likely than PAs to report gaining this information from journal articles (41.6% vs 24.1%; P = .038) or continuing medical education (CME) units on the internet (14.3% vs 1.9%; P = .015).2\nOvarian cancer awareness CME programs for PAs and NPs\nAs there are no reliable screening methods for ovarian cancer at the moment, reliance on practitioner vigilance is essential. Therefore, making sure that primary care practitioners have the most up-to-date information regarding ovarian cancer risks, signs, and symptoms will be paramount. Approximately 73% of the NP and PA respondents in this study reported initial formal training on the risks and signs of ovarian cancer, but only 43% reported any further education on ovarian cancer since the completion of their degrees; those that did report further education received the majority from television ads and talks by organizations.2 Again, however, not all participants specialized in gynecology.\nEducators developing CME programs targeted to PAs and NPs may need to find novel methods to effectively reach these providers, beyond the traditional didactic conference presentations, journal articles, and CME units.","notes":["NPs and PAs frequently failed to associate two important symptoms with potential ovarian cancer; \u201cdifficulty eating or feeling full quickly\u201d was missed 32.3% of the time, and \u201cfrequen