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Oliveira C, Barbosa B, Couto JG, Bravo I, Hughes C, McFadden S, Khine R, McNair HA. Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution. Radiography (Lond) 2024; 30:896-907. [PMID: 38608565 DOI: 10.1016/j.radi.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/09/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). METHODS From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). RESULTS Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. CONCLUSION Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. IMPLICATIONS FOR PRACTICE This study highlights a policy gap in the education and practice of APs in radiotherapy.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - C Hughes
- School of Health Sciences, Ulster University, United Kingdom.
| | - S McFadden
- School of Health Sciences, Ulster University, United Kingdom.
| | - R Khine
- European Federation of Radiographer Societies, Utrecht, Netherlands; Institute of Health Sciences Education, Faculty of Medicine & Dentistry, Queen Mary, University of London, United Kingdom.
| | - H A McNair
- European Federation of Radiographer Societies, Utrecht, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, United Kingdom.
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Lockwood P, Burton C, Woznitza N, Shaw T. Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: a systematic literature review. BMC Health Serv Res 2023; 23:1270. [PMID: 37974199 PMCID: PMC10655396 DOI: 10.1186/s12913-023-10161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England. METHODS Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers. RESULTS The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership. CONCLUSION The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.
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Affiliation(s)
- P Lockwood
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK.
| | - C Burton
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK
| | - N Woznitza
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK
- Radiology Department, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, UK
| | - T Shaw
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK
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Hudson D. Reflections on leadership in advanced and consultant radiographic practice within the UK. J Med Imaging Radiat Sci 2021; 52:164-171. [PMID: 33648876 DOI: 10.1016/j.jmir.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This Educational Perspective provides an overview of how leadership fits into advanced and consultant radiographic roles within the UK setting. It draws on research in the area as well as reviewing some of the wider healthcare literature beyond the medical radiation sciences. The reflections outlined suggest how leadership at these levels may look and differ in practice. DISCUSSION Leadership should be seen as fundamental to practice and not necessarily a discreet element to either role, but one that supports all other areas. The proportion of the role that leadership takes up, along with the degree of influence, increases from advanced to consultant practice. Consideration over conflict with management and leadership within roles is also important. Ultimately leadership is about relationships with people, for which interpersonal skills are required, along with establishing networks, supported by training and development to maximise effectiveness. CONCLUSION A clearer understanding of leadership is needed to help conceptualise and measure its impact at advanced and consultant levels of practice. The content is intended to provide an opportunity for reflection and discussion around the topic, serving as a development tool in practice.
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Wong SM, Sin S, Lim L, Nurul Tassha B, Lin J, Melissa K, Koh W, Ho F, Quah DS, Sommat K, Tuan JK, Wong F, Ng W, Yeo RM, Soong Y, Wang ML. The implementation of an advanced practice radiation therapy (APRT) program in Singapore. Tech Innov Patient Support Radiat Oncol 2021; 17:63-70. [PMID: 34007909 PMCID: PMC8111035 DOI: 10.1016/j.tipsro.2021.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Sharon M.M. Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- College of Allied Health-SingHealth Academy, Singapore
- Singapore Institute of Technology, Singapore
| | - S.Y. Sin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - L.H. Lim
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Jeannie Lin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - K. Melissa
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - W.Y. Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Daniel S.C. Quah
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - Kiatissa Sommat
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - Jeffrey K.L. Tuan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - F.Y. Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - W.L. Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - Richard M.C. Yeo
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - Y.L. Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
| | - Michael L.C. Wang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore
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Harnett N, Bak K, Zychla L, Gutierrez E, Warde P. Defining advanced practice in radiation therapy: A feasibility assessment of a new healthcare provider role in Ontario, Canada. Radiography (Lond) 2019; 25:241-249. [DOI: 10.1016/j.radi.2019.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
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Hayre CM, Atutornu J. Is Image Interpretation a Sustainable Form of Advanced Practice in Medical Imaging? J Med Imaging Radiat Sci 2019; 50:345-347. [DOI: 10.1016/j.jmir.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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Reid K, Rout J, Brown V, Forton R, Crawford M, Bennie M, Curtin J. Radiographer advanced practice in computed tomography coronary angiography: Making it happen. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hardy M, Johnson L, Sharples R, Boynes S, Irving D. Does radiography advanced practice improve patient outcomes and health service quality? A systematic review. Br J Radiol 2016; 89:20151066. [PMID: 27008104 DOI: 10.1259/bjr.20151066] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. METHODS Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. RESULTS 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. CONCLUSION Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. ADVANCES IN KNOWLEDGE This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.
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Affiliation(s)
- Maryann Hardy
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Louise Johnson
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | | | - Stephen Boynes
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Donna Irving
- Faculty of Health Studies, University of Bradford, Bradford, UK
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Harris R, Paterson A. Exploring the research domain of consultant practice: Experiences of consultant radiographers. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Smith T, Harris J, Woznitza N, Maresse S, Sale C. Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions. J Med Radiat Sci 2015; 62:204-11. [PMID: 26451243 PMCID: PMC4592675 DOI: 10.1002/jmrs.115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/02/2015] [Accepted: 05/08/2015] [Indexed: 11/08/2022] Open
Abstract
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.
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Affiliation(s)
- Tony Smith
- University of Newcastle Department of Rural Health Taree, New South Wales, Australia
| | - Jillian Harris
- Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Nick Woznitza
- Homerton University Hospital and School of Allied Health Professions, Canterbury Christ Church University Canterbury
| | - Sharon Maresse
- Department of Imaging and Applied Physics, Curtin University Perth, Western Australia, Australia
| | - Charlotte Sale
- School of Medical Science, RMIT University Melbourne, Victoria, Australia
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Matthews K, Wright C, Osborne C. Blending work-integrated learning with distance education in an Australian radiation therapy advanced practice curriculum. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Exploring attitudes and opinions of radiation therapists in British Columbia towards advanced practice. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396913000319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIntroductionAlthough the notion of advanced practice (AP) has been widely accepted and implemented in some countries, for example, the United Kingdom, in Canada it is has yet to be widely tested as a model of working. Currently it has been implemented and evaluated in Ontario, but this approach is not widespread across the country. To date in British Columbia (BC), there are no advanced practitioners and no research has been conducted regarding the opinions and attitudes of radiation therapists (RTs) in BC towards the implementation of AP. Understanding RTs attitudes and perceptions towards AP may be important when considering the acceptance and implementation of new roles. The research objectives were to explore the attitudes and opinions of RTs and establish what the term AP means to BC RTs, and also to discover what they consider to be benefits, and barriers to implementing AP.Materials and methodsA quantitative approach was utilised and an on-line questionnaire was sent to 266 RTs that currently practice in BC. Likert and demographic questions were used to explore the definition of AP and ascertain opinions about the barriers and benefits of implementing AP in BC.ResultsA total of 183 questionnaires were completed for a response rate of 69%. The majority of respondents agreed with the Canadian Association of Medical Radiation Technologies (CAMRT) and the literature's definition of AP. Cost, time, lack of support and training and issues of medical dominance were cited as barriers. Job satisfaction, autonomy, and increased recruitment and retention of staff were considered benefits.ConclusionsAlthough RTs believe there are obstacles to be overcome regarding the adoption and implementation of AP, these are outweighed by the potential benefits such as enhanced patient care due to increased levels of professional knowledge and development that can lead to increased levels of job satisfaction. These are seen as important drivers for creating the AP role in BC.
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Kelly J, Piper K, Nightingale J. Factors influencing the development and implementation of advanced and consultant radiographer practice – A review of the literature. Radiography (Lond) 2008. [DOI: 10.1016/j.radi.2008.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hardy M, Legg J, Smith T, Ween B, Williams I, Motto J. The concept of advanced radiographic practice: An international perspective. Radiography (Lond) 2008. [DOI: 10.1016/j.radi.2008.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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