The implementation of an advanced practice radiation therapy (APRT) program in Singapore

Abstract

Background: The exploration of Advanced Practiced Radiation Therapists (APRTs) development in Singapore started in 2011. This study aims to provide an overview of the development of the APRT roles, and to discuss the approaches used to develop and implement these roles in Singapore. Materials and methods: A mixed methods approach was used in the development of the APRT program. A literature review was carried out to define the APRT scope of practice and core responsibilities. A competency and assessment framework were setup to assess the core competency areas. With this framework, a structured 1-year residency training program was developed. Results: The scope of practice and core responsibilities of APRTs were defined with five proposed advanced practice profiles being successfully validated. A competency framework was set up to assess the core competency domains: clinical, technical and professional competencies, research, education and leadership. A 4-point scoring system was developed for the competency assessment based on two criteria; the frequency with which RTTs would demonstrate competency, and the ability of performing the task competently. A 1-year structured APRT residency program was developed and implemented. The programme consisted of structured lectures, and clinical practice-based modules where APRT residents receive structured mentoring under a mentorship program. Conclusion: The APRT program in Singapore employed an evidence-based implementation process that tested the feasibility of a new practice model. Multidisciplinary involvements, mentorship and clinical training were important factors for the success of the APRT program.

An evaluation of concordance between head and neck advanced practice radiation therapist and radiation oncologists in toxicity assessment for nasopharyngeal carcinoma patients

“…However, in many centres, treatment review is usually performed by the primary ROs, registrars or medical officers (MOs) on a weekly basis. Demand on doctors’ time is increasing due to increased complexity of clinical practices, radiotherapy techniques as well as other competing demands from additional responsibilities in research, education and administration [12] . We propose that a trained APRT may be a viable solution to fill this gap.…”

“…While the APRT's role is not to deliver medical treatment or to replace the RO, early accurate recognition of toxicities needing intervention can be escalated to the ROs for medical intervention, leading to improved symptom control, improved quality of life and lesser treatment interruption. Moreover, through a strong collaboration between HN APRT and ROs in reviewing the HN patients, there is an improved communication between the RTs and ROs as well as promoting a collaborative approach in managing patients' overall wellbeing [12,14,19,22].…”

“…In 2012, the Advanced Practice Radiation Therapist (APRT) specializing in HN cancer was piloted in National Cancer Centre Singapore (NCCS), with the endeavor to provide seamless care for patients having HN radiotherapy and to elevate the professional profile of radiation therapists [12] , [13] , [14] . This was also supported from ROs in our centre for trained APRT led treatment reviews, assessment of toxicities and reinforce nutritional recommendation made by the medical team, consistent with findings performed by Shi et al [15] .…”

“…With numerous integrated holistic training and comprehensive competency assessments, the role of the HN APRT was successfully expanded to include reviewing patients independently on behalf of ROs, subsequently reducing the overall waiting time for patients. Moreover, it helped to lessen the ROs’ workload, thereby permitting them to focus more on complicated cases, treatment planning and research [12] .…”

Established advanced practice roles in radiation therapy: A scoping review

“…6 Other countries soon began to follow, such as Canada, which introduced the concept in Ontario in 2004, 6,8 and Singapore which commenced APRT role development over 10 years ago. 9 Based on evidence from these countries, there seems to be several benefits associated with advanced practice in radiation therapy, such as an improved workflow within departments, as well as advanced knowledge and skills in specific techniques and fields leading to improved outcomes for patients. 10 A clear understanding of APRT roles and their associated characteristics is needed to determine whether the extensive introduction of these models of care in radiation therapy departments is feasible.…”