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

Abstract

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.

Established advanced practice roles in radiation therapy: A scoping review

“…12,44,45 A total of eight of the included studies were UK-based and outlined the steps to implementation of an APRT role in the UK. 21,23,24,32,35,36,42,43 These papers discussed the four step APRT framework established by the UK called the 'four domains of practice'. These four domains are set out by national guidance and comprise the following domains: Eleven of the studies reported on the establishment of an APRT role in Canada, 8,14,17,19,22,26,[29][30][31]33,35 many of them referring to the four-step model previously created in the UK.…”

“…The APRT scope of practice varied between countries and departments as it was based on service needs. The roles and responsibilities expected of the APRT were discussed in 29 of the included studies, 6,[8][9][10]16,19,[21][22][23][25][26][27][30][31][32][33][34][35][37][38][39][40][41][42][43]46 though some papers provided much greater detail than others. The two main approaches in defining the APRT scope of practice were either site specific or service based.…”

“…28,33,44,46 The key duty for the paediatric APRT role was to closely liaise with all those involved in the treatment of the child, including both medical professionals and the patient's family. APRT roles were also identified in services such as treatment planning, 20,28,31,33,38,42,45,46 brachytherapy, 19,25,42,44 urology, 28,29 stereotactic, 26 image guided radiation therapy, 9,29 patient education and research. 29,44 A recent Khine et al study, 43 discussed the importance of clearly defining the scope of practice expected of APRT roles.…”

Images and images: Current roles of therapeutic radiographers

“…The line between ACP and routine clinical practice blurs with time. 10,28,35 A more adaptable model would be incorporating aspects of ACP into current roles. The challenges of gaining continuous funding with the need for regular training and auditing, increases resistance and places a strain on departments.…”

“…2,10,24 In some MRIgRT settings, TRs are already performing roles that were previously the remit of other MDT members to streamline the workflows and facilitate easier implementation. 24,25,26,27,28 In other MRIgRT centres, the number of treatment sites are increasing due to the success and tolerability of the pathway. 26,27,29 Good, 'standard' radiotherapy skills are a necessity for MRIgRT and subsequent role development 10,24 and is the case with other role extensions, advanced technique developments, and for existing ACP TR roles.…”