APP Supervisor University of Texas MD Anderson Cancer Center Missouri City, Texas, United States
BACKGROUND As health care continues to evolve in the United States, there has been a growing emphasis on providing high-quality, team-based care, especially in the care of cancer patients. Advanced practice providers (APPs), including physician assistants (PAs) and nurse practitioners (NPs), have helped to bridge the gap to meet the demand of patient oncology needs; however, APPs remain at a higher risk of developing clinician distress and burnout. To address a “system in crisis,” particularly during the COVID-19 pandemic, teamwork and effective team functioning may be a necessary solution. Psychological safety (PS) may be a contributing factor that affects team engagement in health care. Studies among PAs in oncology have demonstrated that high burnout rates could be associated with team leadership factors, such as the PA relationship with the collaborating physician (CP), as well as their leadership qualities. Among APPs in oncology care, the question remains whether PS correlates with clinician well-being (WB), including the risk of distress and adverse work-related outcomes.
PURPOSE This study aimed to examine the professional characteristics and team leadership factors that may contribute to PS among oncology APPs and determine whether PS was related to clinician well-being (WB).
METHODS A national, web-based, cross-sectional survey of oncology APPs from two leading oncology APP professional societies was completed during a 60-day study period in the setting of the COVID-19 pandemic in early 2021. Descriptive statistics were obtained, followed by a series of bivariate tests to identify which demographic, professional, and team-leadership variables were significantly related to the dependent variables, PS and clinician WB. All explanatory variables that demonstrated a statistically significant relationship with the dependent variables were included in the third phase, multivariate analysis using multiple linear regression models. Lastly, since this study was conducted in the setting of the COVID-19 global pandemic, respondents provided context to their responses through two open-ended questions.
RESULTS The study consisted of 84 oncology APPs who completed the survey, and 28.6% (n = 24) reported WBI scores within the high-risk group of distress. On final multivariate analysis, high PS scores were associated with high leader inclusiveness and leader-member exchange (LMX) scores, and low PS scores were related to those within the high-risk group of distress. Study participants in hematology-oncology specialty were five times more likely to be within the high-risk group of distress compared with those in the medical oncology group. Participants with high PS scores had a reduced likelihood of being in the group with a high risk of distress.
CONCLUSION Among oncology collaborative practice teams, APPs play a crucial role in providing high-quality patient care, but they remain at increased risk of developing clinician distress. Team-leadership factors affecting APPs may contribute to low PS, which may also be associated with low clinician well-being. Efforts to optimize clinician well-being should also address effective team functioning, team engagement, and leadership development.
