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Scope-of-practice laws and expanded health services: the case of underserved women and advanced cervical cancer diagnoses
  1. Julie Smith-Gagen1,
  2. Larissa L White1,
  3. Amanda Santos2,
  4. Shaun M Hasty3,
  5. Wei-Chen Tung3,
  6. Minggen Lu1
  1. 1 Community Health Sciences, University of Nevada, Reno, Nevada, USA
  2. 2 Nevada Department of Health and Human Services, Carson City, Nevada, USA
  3. 3 Orvis School of Nursing, University of Nevada, Reno, Nevada, USA
  1. Correspondence to Dr Julie Smith-Gagen, Community Health Sciences, University of Nevada, Reno, Nevada 89557, USA; jsmithgagen{at}


Background Underserved women (rural, minority or poor) are disproportionally diagnosed with late-stage cervical cancer, indicative of inadequate access to, and use of, preventative healthcare. The Institute of Medicine (IOM) has proposed that nurse practitioners (NP) can address provider shortages among underserved populations, but to reduce shortages, scope-of-practice laws that restrict the delivery of care, must be revised. We examined the IOM recommendation of NP expanded scope-of-practice laws on reducing the disparity of underserved women diagnosed with late-stage cervical cancer.

Methods We examined the cohort of 10 673 women diagnosed with cervical cancer between 2010 and 2014 and reported to the Surveillance, Epidemiology and End Results cancer registry. We linked state-level laws regarding NP scope-of-practice to patients with cancer by their state of residence, diagnosis date and law enactment date. Hierarchical regression was used to explore NP full scope-of-practice law’s impact on late-stage cancer diagnoses considering the moderating effect of women living in medically underserved areas. We adjusted for known confounders available in this population-based data set.

Results Medically underserved women living in states with laws that restrict NP full scope-of-practice are twofold more likely to be diagnosed with late-stage cancer; adjusted OR and 95% CI (OR 2.08, 95% CI 1.4 to 3.1). These disparities were not observed among underserved women living in areas with NP full scope-of-practice laws (OR 0.95, 95% CI 0.7 to 1.3).

Conclusions NP full scope-of-practice laws could provide a pragmatic and cost-effective solution to healthcare provider shortages associated with late stage of cervical cancer diagnoses among underserved women.

  • access to hlth care
  • cancer: cervix
  • multilevel modelling
  • public health policy
  • screening

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  • Contributors JS-G: study question, study design, study analysis, study writing. LLW: study analysis, study writing. AS: data management, study analysis, acquisition of data. SMH: conception or design, acquisition of data. W-CT: conception or design, interpretation. ML: analysis of data, interpretation. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are publicly available.