Navigating uncertainty: The implementation of Australian radiation therapy advanced practitioners

Matthews, Kristie; Duchesne, Gillian; Baird, Marilyn

doi:10.1016/j.tipsro.2020.12.002

Cited by 7 publications

(26 citation statements)

References 40 publications

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“…However, of note, the Medical Radiation Practitioners Board of Australia has no endorsement category for Advanced Practice in any of the medical radiation practice modalities. 2 The literature on the establishment of palliative APRT roles overseas is limited. A recent publication described a similar process evolving in Ontario since 2004, leading to credentialing of currently nine (of a total of 23) 'Clinical Specialist Radiation Therapists' sub-specialising in palliative radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

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

2021

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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.

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Section: Discussionmentioning

confidence: 99%

“…1 The role subsequently spread to many other countries including Australia and New Zealand (ANZ). 2,3 However, to date, implementation in ANZ has been somewhat ad hoc and limited to a few centres only. 3 Furthermore, literature detailing the successful functioning of APRTs in practice is limited.…”

Section: Introductionmentioning

confidence: 99%

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

2021

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“…To date, there are reviews focused on AP for AHPs, but very few on TR/RTTs. 39,40,140 Inconsistent national implementation of AP was reported in Australia, 109,141 and in the case of diagnostic radiography, the AP roles were not successfully implemented. 142 Nursing, the pioneers of AP in healthcare, reported drivers, challenges and outcomes of this level of practice.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…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 15 . The study identified that a process of Navigating Uncertainty was influencing the dearth of APRT implementation in Australia, whereby conceptual, practical and social uncertainty were hampering implementation efforts.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the APRT needed to navigate uncertainty to successfully transition their professional identity from being a RT to becoming the APRT. A conceptual model resulting from the research explained in nuanced detail what was occurring during the APRT implementation process and demonstrated why there had been variable success 15 …”

Section: Introductionmentioning

confidence: 99%

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

Matthews

Duchesne

2023

J of Medical Radiation Sci

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IntroductionThe implementation of radiation therapy advanced practice in Australia has not yet been broadly realised. With anticipated growing demands on cancer services, it is imperative to understand why this is the case, and to strategise a way forward. As a result, we explored the factors influencing the implementation of advanced practitioner radiation therapists (APRT) in Australia. The research outcome was a complex process of Navigating Uncertainty, which described the contextual, social and personal factors surrounding implementation successes and challenges. Further synthesis of the findings was undertaken to highlight the fundamental features influencing this process, with the intention to provide a useful understanding for practitioners seeking APRT implementation.MethodsData were collected through national online focus groups and case studies with 53 participants. Analysis identified a constructivist grounded theory process of Navigating Uncertainty. Further analysis of the categories and properties of the process was undertaken to synthesise findings at a higher level of abstraction.ResultsFour overarching and intertwined factors were influencing the implementation of APRT. Uncertainty occurred when practitioners attempted to conceptualise and assimilate the new role into the workplace. Power was apparent in the advocacy and legitimisation of the APRT by centre leaders. Value was vital to achieving purposeful outcomes. Identity was evident in the personal transition of the APRT, and in the boundary work with others.ConclusionRecognising and negotiating uncertainty, power, value and identity is essential for APRT implementation strategies to succeed. A framework to guide practitioners towards the implementation of APRT has been described that embodies these factors.

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Navigating uncertainty: The implementation of Australian radiation therapy advanced practitioners

Cited by 7 publications

References 40 publications

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

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

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

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

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