Oncology Advanced Practice Providers Chemotherapeutic Prescribing Practices

Background: Physician Assistants (PA) and Nurse Practitioners (NP), referred to as Advanced Practice Providers (APPs), are an integral part of cancer care today in community oncology (ONC) and academic institutions across the country. It has been shown, a team approach using APPs can extend the ONC workforce (PMID: 25009939). The need for ONC services will increase with the rise in cancer incidence and prevalence. As the rise continues, studies have shown ONC services will dramatically increase due to the predicted shortages of oncologists. Increasing the use of APPs is a viable solution to this shortage (PMID: 21037868). PAs and NPs have validated their value by safely prescribing chemotherapy (CT) as they provide cancer care. This value has been key for both patient and physician colleagues. The Association of Physician Assistants in Oncology (APAO) pursued research to better understand CT prescribing practices of ONC PAs. The focus was on whether or not PAs were allowed to prescribe CT drugs in their day to day practice. Methods: A survey was used to collect data. The survey focused on APPs scope of practice to include prescribing CT independently (IND) or were there restrictions by the state or organizations they are employed by. For those allowed to prescribe CT, further questions regarding training programs and time periods to demonstrate competency were asked. The survey also viewed physician and employer attitudes towards APPs prescribing CT. The survey was sent in January 2021 to 1307 APAO members via email with a 30-day collection period. Eleven percent were returned (N=149). Results: Respondents (R) were PAs, 95%, NPs, 3% and other 1%. The majority of R worked in Hematology/Medical ONC, 87%, with fewer in Surgical ONC 6%, Radiation ONC 1%, other 6%. R came from 34 states with the largest number representing Texas, 13%, New York 12%, Pennsylvania, 8%, North Carolina,7%, Massachusetts 6% and Florida 5%. Most of the R had been in ONC for 1-8 years (y) (59%), followed by 9-16 y (21%), 17-24 y (16%), and 25+ y (3%). The survey was divided into two arms, those who could IND sign CT orders and those who could not IND sign CT orders. The survey demonstrated 44% of the R were able to IND sign CT orders and 56 % of the R could not. With regard to work setting, 60% of R in this arm worked in academic ONC centers and 35% worked in community ONC centers. Also in this arm, 23% were only allowed to sign existing CT plans that did not require modification and 77% were not. The majority of R could sign existing CT orders (89%) and fewer could initiate and sign new CT orders (35%). Most R were able to prescribe intravenous and oral medication (98%), while fewer could prescribe intrathecal 34%) and clinical trial medications (49%). Of the R in the second arm, 74% worked at academic ONC centers and 19% worked at community ONC practices. When asked if their state medical board prohibited prescribing CT, the majority (77%) reported this was not the case, then if their institution/facilities prohibited prescribing CT, the majority (69%) reported this was true. To explore physician/employer attitudes, a question was posed to ask the APP if their physicians believe that limiting CT to physicians is a safety measure. Responses were mixed, 36% reporting this is true, 33% reporting this was false and 31% as unsure. Next, the APPs were asked if their physicians believed experienced APPs should be allowed to prescribe CT. Again, responses were mixed, 44% agreeing, while 11% disagreeing. Finally, 44% were unsure. When asked if their employer believed limiting CT to physicians is an important safety measure, 47% of the R reported this is true, 19% R reported this is false and 34% were unsure. When asked if their employer believed experienced APPs should be allowed to prescribe CT, 30% of the R reported this is true, 20% R report this is false and 49% were unsure. Conclusion: CT prescribing privileges, are not universal for APPs and the reason for inconsistencies in prescribing CT is not clear. This survey provided insight to the wide range of prescribing practices throughout the US based on ONC settings, geographic regions, and experience of the APP. As APPs are valued team members in extending the ONC workforce, and prescribing CT is a common practice in cancer care which APPs participate in. This would seem worthy of further research to understand the reasons why such discrepancies exist. Disclosures Diaz Duque: Morphosys: Speakers Bureau; Hutchinson Pharmaceuticals: Research Funding; Incyte: Consultancy; Astra Zeneca: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

Beyond the pandemic: the role of the built environment in supporting people with disabilities work life

PurposeThe COVID-19 pandemic has engendered changes in previously unimaginable timeframes, leading to new ways of working, which can quickly become the “ordinary” way of working. Many traditional workplace and educational practices and environments, however, are disadvantageous to people with disability and consequently are under-represented in the workforce and higher education.Design/methodology/approachContributing factors include exclusionary societal and employer attitudes and inaccessible built environments including lack of attention to paths of travel, amenities, acoustics, lighting and temperature. Social exclusion resulting from lack of access to meaningful work is also problematic. COVID-19 has accelerated the incidence of working and studying from home, but the home environment of many people with disability may not be suitable in terms of space, privacy, technology access and connection to the wider community.FindingsHowever, remote and flexible working arrangements may hold opportunities for enhancing work participation of people with disabilities. Instigating systemic conditions that will empower people with disability to take full advantage of ordinary working trajectories is key. As the current global experiment in modified work and study practices has shown, structural, organisational and design norms need to change. The future of work and study is almost certainly more work and study from home. An expanded understanding of people with disabilities lived experience of the built environment encompassing opportunities for work, study and socialisation from home and the neighbourhood would more closely align with the UNCRPD's emphasis on full citizenship.Originality/valueThis paper examines what is currently missing in the development of a distributed work and study place continuum that includes traditional workplaces and campuses, local neighbourhood hubs and homes.

Twenty-Five Years After the ADA: Situating Disability in America’s System of Stratification

Americans with disabilities represent a significant proportion of the population. Despite their numbers and the economic hardships they face, disability is often excluded from general sociological studies of stratification and inequality. To address some of these omissions, this paper focuses on employment and earnings inequality by disability status in the United States since the enactment of the 1990 Americans with Disabilities Act (ADA), a policy that affects many Americans. After using Current Population Survey data from 1988-2014 to describe these continuing disparities, we review research that incorporates multiple theories to explain continuing gaps in employment and earnings by disability status. In addition to theories pointing to the so-called failures of the ADA, explanations also include general criticisms of the capitalist system and economic downturns, dependence on social welfare and disability benefits, the nature of work, and employer attitudes. We conclude with a call for additional research on disability and discrimination that helps to better situate disability within the American stratification system.

The IAB Job Vacancy Survey: design and research potential

This article provides an overview of the IAB Job Vacancy Survey and its research potential. The IAB Job Vacancy Survey is a quarterly establishment survey covering the (un-)satisfied labor demand in Germany. This survey identifies the entire number of vacancies on the German labor market, including those vacancies that are not reported to the Federal Employment Agency. The main questionnaire obtains information about the number and structure of vacancies, future labor demand, the current economic situation and the expected development of participating establishments. In addition, the questionnaire collects information about the last new hiring and the last case of a failed recruitment process. Finally, the questionnaire enquires about employer attitudes and firms’ use of current labor market instruments. The Research Data Centre of the German Federal Employment Agency offers access to the data starting from the survey waves 2000 onwards.

Workplace Perceptions of Older Workers and Implications for Job Retention

Older workers’ opportunities for late careers are influenced by employer attitudes and willingness. Nordic managers seem unwilling to hire and retain older persons. In this article, we explore Norwegian workplace perceptions of older workers and the way they are positioned at the workplace.We base this article on qualitative interviews with managers and both union and HR-representatives from 19 companies. Previous research has linked this unwillingness to stereotypes and ageism among employers. We find that the perceptions of older workers do not rest only on stereotypes and ageism, but also on concrete experiences of older workers and processes or mechanisms of positioning and polarization that sometimes occur within the workplace. These actors perceive older workers as a heterogeneous group. We argue that these perceptions may lead to ambivalence towards older workers as a group, and in how to handle them individually. Qualified and available support and flexible strategies are needed.

The Impact of a Brief Meeting on Employer Attitudes, Knowledge, and Intent to Hire

We evaluated the ability of an intervention that consisted of a one-on-one meeting between a vocational rehabilitation (VR) professional and an employer to improve employer attitudes, knowledge, and intent to hire people who are blind or visually impaired. We evaluated the relative effectiveness of two approaches (dual customer vs. educational) and the impact of the VR professionals’ vision status (blind or sighted) on our primary outcome measures and on interest in follow-up. Participants were 59 hiring managers employed by a large company who completed measures at three time points: pre, post, and 4-month follow-up. We found that, regardless of approach used or vision status of the VR professional, the intervention was successful at improving employers’ attitudes, knowledge, and intent to hire. The educational approach resulted in increases in knowledge that were retained at follow-up, while the dual customer approach did not. Improvements in intent to hire were not retained at follow-up, suggesting that ongoing contact with employers will be beneficial to positively impact the hiring of people who are blind or visually impaired. These findings are particularly relevant given the Workforce Innovation and Opportunity Act’s focus on employer engagement for VR agencies.