Advancing Roles of Healthcare Professionals in Palliative Radiotherapy

Fitzpatrick, C.; Javor, Joanna; Zywine, Christine; Job, Mary; Gram, V.

doi:10.1016/j.clon.2020.07.024

Cited by 18 publications

(36 citation statements)

References 7 publications

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“…These are important studies that not only verify that quality and patient safety is maintained, but provide clear descriptions of how others are extending their scope of practice. Other authors have used case studies, commentaries and other descriptive pieces [23] , [31] . These may have less scientific rigour at times, but they provide very useful information on the overall contribution made.…”

Section: Discussionmentioning

confidence: 99%

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Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

Duffton

Moore

Williamson

2021

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction: Advanced practice roles are well documented, and continue to respond to the changing landscape in radiotherapy and oncology. In the UK the highest level of AP for the therapeutic radiographer/radiation therapist (RTT) is the consultant radiographer. These posts should meet the four domains of practice, as set out in national guidance. Here we aim to describe well established roles that meet this criteria, and provide subgroups of examples. Methodology: Three AP post holders with over 10 years AP experience completed a questionnaire adapted from the consultant radiographer toolkit. These were completed in conjunction with guidance and framework documents. The examples were to demonstrate how they achieve a high level of practice in clinical and expert practice; professional leadership and consultancy; education, training and development; and practice and service development, research and evaluation. Participants then categorised results to add subgroups to each domain. Results: The questionnaire was completed by three RTTs specialising as a lung consultant radiographer (LCR), a neuro-oncology consultant radiographer (NCR) and a lead research radiographer (RR). Each post holder described how they meet the criteria by discussing the benefit they make to their profession, department and patients. All posts had examples for all criteria, achieving consultant practice. Clinical and expert practice was the dominant domain for the clinical specialist posts, and professional leadership and research evaluation was the strongest domains for the RR. Conclusion: All three consultant RTTs have demonstrated expert practice with clear and transparent examples of their professional practice which evidence the four domains of consultant practice. Following two decades of AP practice for RTTs there is a need to be strategic in the development of future posts with a prospective view on succession planning that safeguards their longevity.

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Section: Discussionmentioning

confidence: 99%

“…It is not possible to have a simplistic approach where one model fits all. Whether comparing roles in a single centre or practitioners worldwide, there will be diversity [31] . What is possible though is to ensure that national guidance and framework standards are consistently met by practitioners [6] , [7] .…”

Section: Discussionmentioning

confidence: 99%

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

Duffton

Moore

Williamson

2021

Technical Innovations & Patient Support in Radiation Oncolo

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“…28 Importantly, almost all patients seen in collaborativepractice models are aware when their care is provided by a nonphysician provider, and based on surveys, they are extremely satisfied with their care, suggesting this is an acceptable model from a patient perspective. 29 Several practice models have been described to improve delivery of palliative RT, each with slightly different role distributions for physicians and other health care professionals that range from NPs to specialized radiation therapists and radiographers 30 ; this suggests that no single approach is the best way to improve the quality of palliative RT.…”

Section: Discussionmentioning

confidence: 99%

Timing of Urgent Inpatient Palliative Radiation Therapy

Yee

Chan

et al. 2021

Advances in Radiation Oncology

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Purpose Urgent indications for palliative radiation therapy (RT) include malignant spinal cord compression, symptomatic brain metastases, pain, airway obstruction, and bleeding. Data on the timing of palliative RT in the inpatient setting are limited. We report our experience with inpatient palliative RT at a tertiary academic center and evaluate the effect of a dedicated inpatient palliative RT nurse practitioner (NP) on treatment timelines. Methods and Materials We performed a retrospective, single-institution review of 219 inpatients consulted for RT to sites of metastatic disease between May 2012 and May 2018. We compared time-to-treatment intervals before and after integrating an NP for palliative RT in August 2017. Results The median age of the 219 patients receiving RT was 61 years (interquartile range [IQR], 51-69 years). The most frequent indications were symptomatic brain metastases (73 patients [33%]), pain (61 patients [28%]), and cord/cauda compression (48 patients [22%]). The median time from consultation request to consult was 1 day (IQR, 0-2 days), and the median time from consultation request to first RT fraction was 3 days (IQR, 2-6 days). The median time from consultation request to RT was shorter for cord compression (2 [IQR, 1-4] days) than for pain (5 [IQR, 2-7] days) ( P = .001) or symptomatic brain metastases (3 [IQR, 1-6] days; P = .037). With an NP, patients were more likely to undergo same-day consultation and simulation (75% vs 60%; P = .045), which was associated with shorter median duration from consultation to initiation of RT (1 [IQR, 0-3] days vs 4 [IQR, 2-7] days; P <.001). After the integration of an NP for palliative RT, patients had a higher median Karnofsky Performance Score (70 [IQR, 60-80] vs 50 [IQR, 40-60]; P < .001) and were more likely to complete their prescribed RT course (93% vs 82%; P = .05) Conclusions Time from consultation request to RT is necessarily short for urgent inpatient palliative RT. Advanced practice providers may facilitate and potentially expedite treatment, with significantly shorter times to treatment among patients who undergo same-day consultation and simulation.

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“…As recognized leaders on the pRT team and beyond, pCSRTs can influence jurisdictions to achieve necessary changes and improvements in practice/processes, as demonstrated by pCSRTs' research and knowledge translation, academic contribution, and stakeholder experiences [6,12,14,18,21,[27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Table 3 summarizes the metrics used by pCSRTs to illustrate their influence, along with the methodology used to gather information.…”

Section: Influencementioning

confidence: 99%

A Canadian experience of palliative advanced practice radiation therapy TIPS: Training, implementation, practice and sustainability

Rozanec

Lavergne

Harnett

2021

Technical Innovations & Patient Support in Radiation Oncolo

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The concept of the Advanced Practice Radiation Therapist (APRT) was created in 2004, in response to pressures on the radiation treatment sector in Ontario. This led to development, piloting and integration of the Clinical Specialist Radiation Therapist (CSRT) into Ontario's cancer care framework. A national certification process, competency profile and protected title of APRT(T) were established in 2017, under the Canadian Association of Medical Radiation Technologists (CAMRT), in collaboration with Cancer Care Ontario/Ontario Health. This report describes the approach to development, validation and measuring impact of the CSRT role in Ontario, specifically in palliative care (pCSRT). It also presents information to assist jurisdictions interested in developing a pCSRT position, describing competency development, assessment, and assumption of practice, and providing some keys to success. This is foundational for consistent expansion of the pCSRT role to other regions to continue to increase system capacity while improving the quality of cancer care.

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Advancing Roles of Healthcare Professionals in Palliative Radiotherapy

Cited by 18 publications

References 7 publications

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

Timing of Urgent Inpatient Palliative Radiation Therapy

A Canadian experience of palliative advanced practice radiation therapy TIPS: Training, implementation, practice and sustainability

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