Establishing a palliative Advanced Practice Radiation Therapist role: A viable alternative to a Rapid Access Palliative Radiation Therapy clinic in Australia

Abstract

Introduction: A recent survey found that Rapid Access Palliative Radiation Therapy (RAPRT) clinics have not been widely embraced in Australia and New Zealand for many reasons. The purpose of this narrative is to describe the transition of a Brisbane, Queensland, RAPRT clinic to an Advanced Practice Radiation Therapist (APRT) model to further improve access and delivery of palliative radiation therapy at that centre. Methods: The weekly RAPRT clinic commenced in 2005, run by one Radiation Oncologist (RO). The role of the attending senior Radiation Therapist (RT) was mainly to facilitate rapid passage of patients from clinic to treatment. However, because individual ROs preferred to retain care of their own patients, capture of the relevant population was limited. It was therefore decided in 2012 to gradually transition to a model where the RT would work with all ROs and manage all palliative patients from referral to follow-up, under RO supervision. Results: The steps to this palliative APRT pathway involved formulation of the role description, mentoring/training of the RT, overseas site visits, further post-graduate education, funding of the position, staff feedback surveys, evaluation studies and endorsement by professional bodies, leading to formal credentialing in 2017. Importantly, the APRT undertakes all steps in the pathway including field or volume delineation (with approval and sign-off by the responsible RO). The role has come to be highly valued by all disciplines. Conclusion: The successful establishment of a palliative APRT role in one Australian centre serves as a template for others wishing to create a similar position.

Overcoming uncertainty: A framework to guide the implementation of Australian radiation therapy advanced practitioners

“…Motivation and commitment of stakeholders were viewed as essential to the success of implementation, as were making visible the expectations through a documented role description. Validation of outcomes was also vital to prove the value of the new role 12 . Elsewhere, effective strategic planning has been described as a key feature for successful workforce redesign in health services, 66 and the provision of a framework for the implementation of new work roles has informed positive outcomes in other jurisdictions 44,67 .…”

“…There are several exemplars demonstrating the positive outcomes that can be observed following the introduction of APRT roles, 2–6 however, the systematic implementation of APRT in Australia has not been readily observed during the last two decades 7 . The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) has released a number of discussion papers and guidelines, 1,8–10 but nationally in Australia, only four APRT have been formally recognised by ASMIRT – <0.2% of all registered RT 11 – and of these only two have since maintained their accredited status 12 . This is of concern given flexible health workforce models are seen as a key enabler to support the anticipated demands on cancer care delivery with an increasing and ageing population 13,14…”

“…7 The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) has released a number of discussion papers and guidelines, 1,[8][9][10] but nationally in Australia, only four APRT have been formally recognised by ASMIRT -<0.2% of all registered RT 11and of these only two have since maintained their accredited status. 12 This is of concern given flexible health workforce models are seen as a key enabler to support the anticipated demands on cancer care delivery with an increasing and ageing population. 13,14 To better understand why the widespread implementation of APRT in Australia had not yet been realised, a doctoral research study was undertaken by the first author to explore the factors influencing implementation processes.…”

Appropriateness of the 30-day expected mortality metric in palliative radiation treatment: a narrative review

“…This type of clinic has demonstrated benefits in improving treatment wait times, allowing for improved assessment of this group of patients, and reducing the anxiety, fatigue, and pain experienced by patients due to delayed treatments and excessive hospital visits. RAPRT clinics also promote the use of evidence-based approaches such as greater use of SFRT (61), better control of prophylactic medications (steroid and antiemetic), and a reduction in the duration of inpatient stays (62,63). The benefit of these clinics has been illustrated in a retrospective analysis published in 2014, in which 97% of patients received treatment to painful bone metastases.…”

“…RAPRT programs have been adopted globally (65), with most published reports coming from centres in Canada (66-69), the United Kingdom (70), Ireland (71), the United States (61,72) Australia (62,73,74), and New Zealand (58). However, RAPRT clinics have been established in a minority of centres, predominantly within public institutions (62). It should be noted that most of them comes from advanced economies, and the adoption of these models in other jurisdictions remains unknown.…”