Evolution of the Radiation Therapist Role in a Multidisciplinary Palliative Radiation Oncology Clinic

Abstract

Background: Palliative radiation therapists (PRTs) have been integrated in varying capacities into outpatient palliative radiation therapy (RT) services across Canada for over 2 decades. At our institution, PRTs have developed an essential role over 11 years within a palliative radiation oncology (PRO) clinic that focuses on integrating symptom management with radiation oncology assessment for palliative RT. PRTs have had direct clinical, technical, research, and administrative involvement as the clinic evolved from a pilot in 2007 supporting one half-day per week to the current model of five full clinical days.Methods: Using collaborative reflection, we explored the PRTs' experience and insight. Twelve PRTs who contributed to the PRO clinic for varying lengths of time from 2007 through to 2016 were invited to participate in the development of a collective expression of the PRT experience. Seven PRTs consented to completing an electronic survey consisting of fifteen open-ended questions regarding individual roles and perspectives relating to our PRO clinic. Survey answers were enhanced by semistructured interviews when needed for clarification. Responses were contextualized within the operational changes to our multidisciplinary clinical model, from pilot to integrated service.Results/Discussion: Five respondents answered all of the questions. From the narratives, PRT roles and responsibilities were outlined and their insights and reflections included to contextualize clinical changes. Four phases of the clinic were identified and elucidated. Beginning in January 2007, three PRTs staffed a multidisciplinary clinical pilot one half-day per week for single-fraction, symptomatic bone metastases. The clinic has now evolved through various iterations to the current model with four PRTs sharing a ''navigator'' role with two registered nurses five full clinic days per week. The range of PRT experiences, responsibilities, and challenges encountered reflected specific clinical and operational conditions.

Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review

“…In fact, an integrated service was initially planned (symptoms management at the same time as evaluation for PRT) with a staff of two people working half a day a week. However, after 11 years the service was based on a staff of six members working five full days a week [ 22 ].…”

“…Several solutions have been proposed to overcome these barriers including: the use of tools to improve prognosis prediction [ 18 ], training on PRT for experts in palliative care [ 9 , 10 , 11 ] and on palliative care for ROs [ 13 , 14 , 15 , 16 ], and introduction of pathways and organizational models [ 19 , 20 , 21 , 22 , 23 ], possibly integrated with supportive care programs, specifically dedicated to PRT [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. In particular, PRT rapid response programs in which patient assessment and radiotherapy planning and delivery are performed in the shortest time (possibly on the same day) were proposed [ 37 , 38 , 39 ].…”

Advanced practice roles of therapeutic radiographers/radiation therapists: A systematic literature review

“…83,84,94,95,107,126 An 11-yearlong clinical perspective of this AP role supports the development of holistic care for patients with advanced cancer. 176 Some papers reported new roles and opportunities 177e188 for role development in RT, and many authors believe that this is a "season of change" for TR/RTTs due to the image-guided RT developments and adaptive RT implementation. That is, traditional roles of TR/RTTs are impractical to keep pace with these technological advancements.…”

Rapid Access Palliative Radiotherapy Programmes

“…A survey study described the experiences of the seven specialised radiation therapists who had occupied the advanced practice role between 2007 and 2016 within the Rapid Access Palliative Radiotherapy Program (RAPRP)/ Palliative Radiation Oncology (PRO) clinic at the Cross Cancer Institute in Edmonton, Canada [40]. As the programme grew from one half-day weekly to a scaled-up daily model, the responsibilities of the therapist gradually shifted away from direct patient care towards administrative/ navigator duties [47]. With the substantial increase in patient volumes, the shift was deemed necessary in order to maximise the benefit from the therapists' unique educational background and knowledge of the department's logistics.…”