A survey of radiation treatment planning peer-review activities in a provincial radiation oncology programme: current practice and future directions

Abstract

ObjectivesTo describe current patterns of practice of radiation oncology peer review within a provincial cancer system, identifying barriers and facilitators to its use with the ultimate aim of process improvement.DesignA survey of radiation oncology programmes at provincial cancer centres.SettingAll cancer centres within the province of Ontario, Canada (n=14). These are community-based outpatient facilities overseen by Cancer Care Ontario, the provincial cancer agency.ParticipantsA delegate from each radiation oncology programme filled out a single survey based on input from their multidisciplinary team.Outcome measuresRated importance of peer review; current utilisation; format of the peer-review process; organisation and timing; case attributes; outcomes of the peer-review process and perceived barriers and facilitators to expanding peer-review processes.Results14 (100%) centres responded. All rated the importance of peer review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest rated perceived benefits of peer review (each median 9/10). Six centres (43%) reviewed at least 50% of curative cases; four of these centres (29%) conducted peer review in more than 80% of cases treated with curative intent. Fewer than 20% of cases treated with palliative intent were reviewed in most centres. Five centres (36%) reported usually conducting peer review prior to the initiation of treatment. Five centres (36%) recorded the outcomes of peer review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; a critical mass of radiation oncologists was the most important limiting factor (median 6/10).ConclusionsRadiation oncology peer-review practices can vary even within a cancer system with provincial oversight. The application of guidelines and standards for peer-review processes, and monitoring of implementation and outcomes, will require effective knowledge translation activities.

Predictors of breast radiotherapy plan modifications: Quality assurance rounds in a large cancer centre

“…However, across North American academic centres, where one would expect the proportion of RT cases undergoing peer review should be the highest; only 80% of institutions reported peer review of all cases [20]. Similarly, only 4 (29%) of the 14 Ontario RT centres reviewed at least 80% of its radical RT cases, and only 2 other centres (14%) reviewed between 50 and 79% of its cases [13]. Only 5 centres reviewed the treatment plans prior to initiation of therapy, citing the number of ROs present at the time of peer-review as being the most significant rate-limiting step [13].…”

“…Similarly, only 4 (29%) of the 14 Ontario RT centres reviewed at least 80% of its radical RT cases, and only 2 other centres (14%) reviewed between 50 and 79% of its cases [13]. Only 5 centres reviewed the treatment plans prior to initiation of therapy, citing the number of ROs present at the time of peer-review as being the most significant rate-limiting step [13]. A recent review of the British Columbia Cancer Agency experience over a 6-year period likewise demonstrated that only 13% of all their radical RT cases were in fact reviewed, demonstrating that significant challenges remain in our communities [12].…”

“…the importance of conducting QA rounds; however, there were significant variations in the proportion of curative cases being reviewed, as well as the timing of such reviews; the number of participating ROs was cited as a significant potential challenge [13]. With this background, the objectives of our current report are to describe the process and outcomes of our own institutional breast cancer QA rounds, and identify clinical factors that were associated with RT plan modifications, in order to inform our own future approaches to this important process.…”

Competency in Quality: Defining the Scope and Nature of Quality Competencies for Radiation Oncology Residency Programs

“…Exposure of trainees to these rounds varies, with one 2013 study in Ontario, Canada noting that of the 14 radiation treatment centres in the province, only 3 (21%) self-reported that trainees regularly attended peer review rounds [17]. It is expected that this number is increasing given the increasing attention in the community to the value of peer review.…”

The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer

“…There is a growing global recognition of the need for peer review and Brundage et al [16] surveyed 14 radiotherapy departments in Ontario, Canada with detection of errors and improvement in planning process the greatest perceived benefit among respondents. Six centres reviewed at least 50% of curative plans e limitations of radiation oncologist time being the main factor hindering this.…”