A Systematic Review of the Characteristics and Outcomes of Cancer Nurse Practitioner Roles in Australia

Objectives: The Australian cancer health care system remains slow in realizing the benefit of nurse practitioner (NP) roles. The aim of this systematic review was to identify and report the characteristics of NP roles in Australian cancer services, with a focus on summarizing, where available, on their impacts on patient, service, and system-level outcomes. 

Methods: An integrative systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. All types of studies were included irrespective of design. Electronic databases Medline, Emcare, CINAHL Scopus, and Informit Medline were searched using the key search concepts “Nurse Practitioner,” “Cancer,” and “Australia” adjusted for each platform. A preselection eligibility criterion was applied to all records. Data extraction and methodological quality assessment were conducted independently by two reviewers, and a narrative synthesis was conducted. 

Findings: A total of 95 records were screened, and eight publications (qualitative [n = 1], quantitative [n = 4], mixed methods [n = 3]) were included. Australian cancer NPs impacted most of the cancer care continuum from health promotion, cancer screening, advanced cancer diagnostic clinical procedures, and managing life-threatening oncological emergencies during cancer treatment to supporting cancer survivorship care delivery. Emergent evidence has shown that Cancer NPs in Australia provide benefits to patients, can reduce costs to healthcare organizations, and deliver care that is noninferior, with outcomes comparable to physician/medically led care. The methodological quality of the included publications was varied, largely reflective of the underdeveloped qualitative and quantitative methods used to evaluate cancer NP roles. 

Discussion: This review adds to the wider knowledge of the work of NPs in Australia and more broadly. Cancer NPs in Australia can form a robust part of the solution to the ever-increasing demand for cancer services. Effective implementation of these roles will require educational preparation to be more transparent to health system managers, with a focus on aligning NP capabilities to national cancer policy requirements and core capabilities required to deliver optimal outcomes. 

Conclusion: Cancer NPs in Australia are a critical part of the solution to the ever-demanding needs for cancer services, but widespread implementation of the role requires appropriate support to enable NPs to work at full scope by enabling clinical privileges (eg, admitting rights, radiological test requests, full prescribing rights) and administrative assistance (eg secretarial and administrative support). Given the unique system and political challenges encountered by Australian NPs it is essential to overcome barriers to NP care delivery at patient, service, and system level in cancer control.