6 in 10 leukemia patients prefer doctors over nurse practitioners for bone marrow tests: survey

Six out of 10 leukemia patients who have undergone a bone marrow test, including a periosteal puncture, believe such procedures should only be performed by a doctor, according to a survey.

Still, 40 percent were in favor of specially trained nurses performing bone marrow tests under a doctor's guidance.

On Tuesday, the Korea Leukemia Patient Organization released the results of a survey on bone marrow testing and patient experience from 354 leukemia and blood cancer patients who had undergone bone marrow testing between Oct. 31 and Nov. 8.

The survey found that 214 respondents, or 60.5 percent, believe that bone marrow testing is a medical procedure that should only be performed by a physician. However, 33.9 percent (120 respondents) believe it is a practice that a nurse practitioner can perform under the guidance and supervision of a physician, and 5.6 percent (20 respondents) said they were unsure.

When asked, “Do you favor allowing nurse practitioners to perform bone marrow tests if they have received education and training in bone marrow testing and are supervised by a physician?” 39.3 percent (139) responded in favor. 49.4 percent (175) said no, and 11.3 percent (40) said they were unsure.

According to the guidelines of the PA (physician assistant) pilot project implemented by the government on Feb. 27, nurse practitioners were allowed to perform bone marrow tests, including bone marrow puncture. However, after the pilot program was implemented, the number of respondents who had received a bone marrow test from a nurse practitioner was smaller than before the pilot program.

When patients were asked if a nurse practitioner, rather than a doctor, had performed their bone marrow test since the pilot program, only 2.5 percent (nine patients) said yes. In contrast, 84.2 percent (298) said they had not had a bone marrow test done by a nurse practitioner, with 13.3 percent (47) saying they were unsure. This is lower than the 5.9 percent who reported having a bone marrow test done by a nurse practitioner before the pilot.

The patient group cited the incident of the nurse practitioner's periosteal puncture at Asan Medical Center in Seoul as a reason.

“The second criminal court in the Asan Medical Center nurse practitioner periosteal puncture case overturned the first court's verdict and found Asan Medical Center guilty,” the organization said. “Given that (the pilot project period) was before the Supreme Court's final verdict, it can be assumed that the hospital had a medical doctor perform the bone marrow test rather than a nurse practitioner.”

The group also investigated the inconvenience patients experienced with the bone marrow tests.

When asked if they had undergone multiple bone marrow tests without success the first time, 61.9 percent (219 respondents) reported success the first time.

In contrast, 38.1 percent (135) said they had been tested multiple times. When asked how many times they had been tested, 50.4 percent said they were successful in two attempts, 27.4 percent said they were successful in three attempts, and 22.2 percent said they were successful in four or more attempts. About half (50.4 percent) of patients reported being switched to a different doctor after a failed bone marrow test, and 49.6 percent reported that the doctor who failed the bone marrow test kept trying.

“Patients with serious illnesses, such as leukemia and blood cancers, tend to have a strong sense of absolute trust in their doctors,” the patient organization said. “However, as a result of collective action by specialists and nurse practitioners, only 60 percent of patients said that only doctors can perform invasive tests, including bone marrow tests, contrary to expectations.”

“Invasive tests that are painful for patients, including bone marrow, urine, and ascites puncture, pose a high risk of patient safety accidents,” the group said. “To prevent patients from being harmed by inexperienced doctors, training hospitals should create and operate guidelines and manuals to ensure the safety and human rights of patients under their care.”