Advanced practice: An ESTRO RTTC position paper

Duffton, A.; Devlin, L.; Tsang, Yatman; Mast, M.; Leech, Michelle

doi:10.1016/j.tipsro.2019.06.001

Cited by 27 publications

(48 citation statements)

References 35 publications

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“…These role extensions can provide cost-effective utilisation of the radiotherapy workforce. 9 Although skill mix initiatives are widespread and can enhance the job satisfaction of staff involved, 10 there is limited evidence of impact upon service quality and patient outcomes. 11 Against a backdrop of increasing demand and sustained shortages within the consultant clinical oncologist workforce, the Department of Clinical Oncology at Northampton General Hospital (NGH) NHS Trust developed a skill mix initiative under the leadership of their clinical radiotherapy lead.…”

Section: Introductionmentioning

confidence: 99%

Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience

2020

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Aim: To investigate whether a radiographer-led radiotherapy pathway can provide an efficient service for patients requiring treatment for symptomatic skeletal metastases. Materials and Methods: A retrospective review of 425 courses of palliative radiotherapy was conducted. Data was analysed assessing diagnosis, dose/fractionation, time from referral to treatment, gender, age, inpatient/outpatient status and referring clinic location for radiographer- and clinical oncologist-led cohorts. Results: Patients aged ≥70 years were more likely to be planned by radiographers (n = 162/57, p < 0·001). Patients were more likely to be treated with 8 Gy in single fraction than with 20 Gy in five fractions (n = 279/136, p = 0·012). The median referral to treatment time in 8-Gy single-fraction prescriptions was 3 days for radiographer-led versus 7 days for clinical oncologist-led cohorts. In all patients and in 20 Gy in five-fraction prescriptions, it was 4 versus 8 days. A comparison of all prescriptions (p < 0·001), 8 Gy in single-fraction (p < 0·001) and 20 Gy in five-fraction prescriptions (p = 0·001) showed radiographer-led procedures as enabling faster access to treatment in each category. Findings: A radiographer-led service can facilitate faster access to treatment than a clinical oncologist-led pathway for an appropriately selected patient caseload.

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Section: Introductionmentioning

confidence: 99%

Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience

2020

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“…Increasingly complex IGRT practices places greater demands on RTT training to ensure accurate and precise treatment delivery, including calls for advanced practice RTTs to enable adaptive radiotherapy [20,21]. However, several studies have demonstrated that specialized training enables adaptive radiotherapy decision making (e.g.…”

Section: Discussionmentioning

confidence: 99%

Patterns of practice of adaptive re-planning for anatomic variances during cone-beam CT guided radiotherapy

Stankiewicz

Rosewall

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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Purpose: Substantial, unanticipated anatomic variances during cone-beam CT (CBCT)-guided radiotherapy can potentially impact treatment accuracy and clinical outcomes. This study assessed patterns of practice of CBCT variances reported by RTTs and subsequent interventions for multiple-disease sites. Methods: A chart review was conducted at a large cancer centre for patients treated with daily online CBCT-guided radiotherapy. Patients selected for review were identified via RTT-reported variances that then triggered offline multidisciplinary assessment. Cases were categorized by the type of anatomic variance observed on CBCT and any further interventions recorded such as unscheduled adaptive replanning. Results: Over a 1-year period, 287 variances from 261 patients were identified (6.2% of the 4207 patients treated with daily CBCT-guided radiotherapy), most often occurring within the first 5 fractions of the treatment course. Of these variances, 21% (59/287) were re-planned and 3.5% (10/287) discontinued treatment altogether. Lung was the most frequent disease-site (27% of 287 variances) reported with IGRT-related variances although head and neck and sarcoma were most frequently re-planned (19% of 59 re-plans for each site). Technical or clinical rationales for re-planning were not routinely documented in patient medical records. All disease-sites had numerous categories of variances. Three of the four most frequent categories were for tumor-related changes on CBCT, and the re-planning rate was highest for tumor progression at 25%. Normal tissue variances were the second most frequency category, and replanned in 14% of those cases. Conclusion: RTTs identified a wide range of anatomic variances during CBCT-guided radiotherapy. In a minority of cases, these substantially altered the care plan including ad hoc adaptive re-planning or treatment discontinuation. Improved understanding of the clinical decisions in these cases would aid in developing more routine, systematic adaptive strategies.

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“…In radiation oncology centres specifically, radiation therapists (RT) performing advanced practitioner roles were introduced in the United Kingdom at the turn of the century [1] , and in the Canadian province of Ontario shortly after [2] . Discussion papers, frameworks elaborating expectations of practice and formal recognition pathways exist across multiple jurisdictions [3] , [4] , [5] , [6] , [7] , [8] , and many reports of local practice outcomes as a result of radiation therapy advanced practitioner implementation have been published during the last two decades [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] .…”

Section: Introductionmentioning

confidence: 99%

Navigating uncertainty: The implementation of Australian radiation therapy advanced practitioners

Matthews¹,

Duchesne²,

Baird³

2021

Technical Innovations & Patient Support in Radiation Oncolo

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Radiation therapy advanced practice has been implemented in several international jurisdictions; however, it is yet to be systematically integrated into Australian radiation oncology centres. This paper presents the outcomes of a doctoral research study to explore the factors that may be influencing the implementation of radiation therapy advanced practice in Australia. Using a constructivist grounded theory methodological approach to guide procedures, data collection occurred via 6 nationally facilitated online (video mediated) focus groups, and during interviews and observations at 5 purposively selected clinical case study locations. Data analysis led to the development of a grounded theory 'navigating uncertainty' to describe the process influencing the implementation of radiation therapy advanced practice in Australia. Navigating uncertainty is explained by three inter-related contextual processes of conceptualising radiation therapy advanced practice, integrating radiation therapy advanced practice, and becoming the radiation therapy advanced practitioner. The research suggests that the process of actively finding a way to accommodate uncertainty is necessary for advanced practice implementation objectives to be realised.

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Advanced practice: An ESTRO RTTC position paper

Cited by 27 publications

References 35 publications

Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience

Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience

Patterns of practice of adaptive re-planning for anatomic variances during cone-beam CT guided radiotherapy

Navigating uncertainty: The implementation of Australian radiation therapy advanced practitioners

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