Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model

Bajre, Mamta; Pennington, Mark; Woznitza, N.; Beardmore, Charlotte; Radhakrishnan, Muralikrishnan; Harris, Rachel; McCrone, Paul

doi:10.1016/j.radi.2017.07.011

Cited by 29 publications

(15 citation statements)

References 24 publications

(30 reference statements)

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“…In a similar study involving 20 patients undergoing Stereotactic Ablative Radiotherapy (SABR) to the lung, Hudson et al (2015) investigated the clinical decisions made by clinical oncologists and TRs, and also found an overall agreement of 91%, with small interobserver variations between TRs: The mean (range) of X, Y and Z was; X = 0•10 (−1•02 to 0•91) Y = −0•12 (−1•61 to 1•4) and Z = 0•22 (−0•37 to 1•48). Similar findings have been published in diagnostic radiology, with several studies highlighting the ability of diagnostic radiographers to carry out reporting in cases of suspected lung cancer (Bajre et al, 2017;Donovan, Manning, & Crawford, 2008) and breast cancer (Moran & Warren-Forward, 2016b). What is not clear from these studies are the clinical reasoning processes and techniques used by the TRs and medical teams to reach their decisions.…”

Section: Clinical Reasoningsupporting

confidence: 59%

Clinical reasoning in image guided radiotherapy: A multimethod study

Collins¹

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Cone Beam Computer Tomography CT Computer Tomography CTV Clinical Target Volume Relevance Include Exclude Studies that specifically investigated the processes used during clinical decision-making. These can be carried out in the natural or simulated environment. Studies that specifically investigated image interpretation during diagnostic review and reporting. Seminal texts related to general decision-making theory to be read to inform the wider discussion. Decision-making studies unrelated to the clinical setting. Ethics Include Exclude Studies where ethical approval has been sought and granted where relevant. Studies where consideration of ethical approval is not evident. The search process is shown in Figure 2.0 using a PRISMA flow diagram (Moher, Liberati, Tetzlaff, & Altman, 2009). The search identified 82 articles that met the search criteria. The majority of articles were discussion papers and non-systematic literature reviews (n=58). These articles were used to form some of the underpinning theoretical descriptions in the chapter, but did not meet the minimum requirements of the relevant SIGN quality checklist. The remaining 24 articles were case studies that typically investigated clinical reasoning in a specific setting and these underwent full review. Despite being outside of the inclusion criteria on the basis of date, Fonteyn and Grobe (1992) was identified as a seminal article during the review process and so was included for full review. An overview of the articles that underwent full review are shown in Appendix 1.

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Section: Clinical Reasoningsupporting

confidence: 59%

Clinical reasoning in image guided radiotherapy: A multimethod study

Collins¹

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“…Using decision tree modelling, Woznitza's team 23 estimated that radiographer reporting of initial chest radiographs in a lung cancer pathway was more effective than radiologist reporting (10.3 more lung cancers detected at initial chest radiography presentation) and could offer patients 1.4 additional quality-adjusted life years in the five years after diagnosis.…”

Section: Benefits For Patientsmentioning

confidence: 99%

“…Referencing previous RCR guidelines on consultant radiologist workload, 64 Woznitza et al 15 estimated that effective multiprofessional team working had generated cost savings equivalent to three consultant radiologist posts by reducing demand on radiologist time from 15,595 to 11,834 h in the final year of their study. As above, in their decision tree modelling paper, Woznitza's team 23 estimated that radiographer reporting of initial chest radiographs in a lung cancer pathway was cheaper than radiologist reporting (detection costs reduced by £8500 over 1000 cases).…”

Section: Improved Cost Effectivenessmentioning

confidence: 99%

“…Radiologist/radiographer reporting skill mix, to make the best use of the respective skills and knowledge of both professions, enables the redesign of care pathways and has demonstrable clinical benefits for patients and logistic and economic benefits for service providers. 23,25,30,33,46 The accuracy of radiographer reporting is well established and any concern over clinical 'error' can be mitigated with the development of national standards, collaborative teamworking and ensuring reporting audit frameworks and governance are multiprofessional and inclusive of all staff who undertake reporting, regardless of profession. HEE is working with the professional colleges (RCR and SCoR) to develop national multiprofessional likely to occur in departments with a pre-existing radiographic workforce shortage or when adequately staffed with radiologists such that there is no local capacity/demand mismatch.…”

Section: Overcoming Barriers To Expansion Of Radiographer Reportingmentioning

confidence: 99%

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Radiographer reporting: A literature review to support cancer workforce planning in England

Culpan

Docherty

et al. 2019

Radiography

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Objective: Clinical Imaging contributes to screening, diagnosis, planning and monitoring of treatment and surveillance in cancer care. This literature review summarises evidence about radiographer reporting to help imaging service providers respond to Health Education England's 2017 Cancer Workforce Plan project to expand radiographer reporting in clinical service provision. Key findings: Papers published between 1992 and 2018 were reviewed (n ¼ 148). Evidence related to dynamic examinations (fluoroscopy, ultrasound) and mammography was excluded. Content was analysed and summarised using the following headings: clinical scope of practice, responsibilities, training, assessment, impact in practice and barriers to expansion. Radiographer reporting is well established in the United Kingdom. Scope of practice varies individually and geographically. Deployment of appropriately trained reporting radiographers is helping the NHS maintain high quality clinical imaging service provision and deliver a cost-effective increase in diagnostic capacity. Conclusion: Working within multiprofessional clinical imaging teams, within a defined scope of practice and with access to medical input when required, reporting radiographers augment capacity in diagnostic pathways and release radiologist time for other complex clinical imaging responsibilities.

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“…Adaptation of a health economic model that examined the impact of radiographer CXR reporting on the lung cancer pathway will be performed [ 35 ]. The model for this project will map out the care pathways following standard reporting and immediate reporting.…”

Section: Components Of the Chest X-ray Reporting Pathwaymentioning

confidence: 99%

Impact of radiographer immediate reporting of chest X-rays from general practice on the lung cancer pathway (radioX): study protocol for a randomised control trial

Woznitza

Devaraj

Janes

et al. 2017

Trials

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BackgroundDiagnostic capacity and suboptimal logistics are consistently identified as barriers to timely diagnosis of cancer, especially lung cancer. Immediate chest X-ray (CXR) reporting for patients referred from general practice is advocated in the National Optimal Lung Cancer Pathway to improve time to diagnosis of lung cancer and to reduce inappropriate urgent respiratory medicine referral for suspected cancer (2WW) referrals. The aim of radioX is to examine the impact of immediate reporting by radiographers of CXRs requested by general practice (GP) on lung cancer patient pathways.MethodsA two-way comparative study that will compare the time to diagnosis of lung cancer for patients. Internal comparison will be made between those who receive an immediate radiographer report of a GP CXR compared to standard radiographer GP CXR reporting over a 12-month period. External comparison will be made with a similar, neighbouring hospital trust that does not have radiographer CXR reporting. Primary outcome is the effect on the speed of the lung cancer pathway (diagnosis of cancer or discharge). Secondary outcomes include the effect of the pathway on efficiency including the number of repeat CXRs performed in a timely fashion for suspected infection and the effect of immediate reporting of GP CXRs on patient satisfaction.DiscussionThe radioX trial will examine the hypothesis that immediate reporting of CXRs referred from GP reduces the time to diagnosis of lung cancer or discharge from the lung cancer pathway.Trial registrationInternational Standard Randomised Controlled Trial Number ISRCTN21818068. Registered on 20 June 2017.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2268-x) contains supplementary material, which is available to authorized users.

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Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model

Cited by 29 publications

References 24 publications

Clinical reasoning in image guided radiotherapy: A multimethod study

Clinical reasoning in image guided radiotherapy: A multimethod study

Radiographer reporting: A literature review to support cancer workforce planning in England

Impact of radiographer immediate reporting of chest X-rays from general practice on the lung cancer pathway (radioX): study protocol for a randomised control trial

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