A literature review exploring the perceived impact, challenges and barriers of advanced and consultant practice in therapeutic radiography

Barriers and facilitators to conducting radiotherapy clinical trials: Findings from a UK survey

INTRODUCTION

As an essential component of service delivery, radiotherapy clinical trials were championed within the NHS England service specifications. A call for a 15% increase in research and clinical trial activity, alongside a demand for equity of access for patients with cancer subsequently ensued. National understanding of current radiotherapy clinical trials operational practices is absent, but essential to help establish the current provision required to support the development of a strategic plan for implementation of NHS England's specifications.

METHODS

A cross-sectional survey was developed by a multi-disciplinary team and distributed to therapeutic radiography clinical trial leads across the UK to ascertain the current provision of radiotherapy clinical trials only, including workforce resources and the trials management processes to establish a benchmark and identify potential barriers, enablers, and opportunities to increase access to clinical trials.

RESULTS

Thirty-two complete responses were obtained equating to 49% of the total UK NHS departments and 74% of those departments invited. Four key findings were identified: 1) research strategy and systems, 2) participation and activity in radiotherapy clinical trials, 3) access to clinical trials at alternative departments and 4) facilitators & barriers. Overarchingly a lack of radiotherapy clinical trials strategy or supported processes were apparent across the UK, aggravating existing barriers to trial activity.

CONCLUSION

It is essential for radiotherapy clinical trials to be embedded in to departmental and Trust strategy, this will help to ensure the processes and resources required for trial delivery are not only in place, but also recognised as imperative and important for patients with cancer as radiotherapy treatment delivery.

IMPLICATIONS FOR PRACTICE

Failure to address the barriers or build upon the facilitators may result in UK radiotherapy departments facing challenges in achieving the 15% increase in radiotherapy clinical trial activity.

Retention of radiographers in the NHS: Influencing factors across the career trajectory

INTRODUCTION

In order to meet the rising demands for imaging and radiotherapy services, the chronic workforce deficits experienced in many countries must be addressed. Improving workforce retention is essential; factors influencing radiographer attrition from the NHS have been previously reported as challenging working patterns, lack of flexibility in working patterns and lack of timely career progression and CPD. This article explores how these influencing factors for radiographers to leave the NHS change at different stages of the career trajectory.

METHODS

A qualitative research design using framework analysis explored via semi-structured telephone interviews (n = 44) the perspectives of radiography managers, radiographers who have left the NHS, and those considering leaving. Purposive sampling ensured representation across radiography disciplines, geographical and organisational diversity, and stages of career.

RESULTS

The application of Generation Theory revealed how the emphasis on the influencing factors to leave or remain within the NHS changes across the working life of radiographers. Early career radiographers were found to be a more transient workforce leaving for increased career opportunities, mid-career radiographers were more likely to leave due to the lack of progression and CPD and late career radiographers due to the inflexibility of working patterns and conditions. It is imperative managers consider the needs and requirements of each generation of radiographers to improve radiographer retention.

CONCLUSIONS

The different needs between the generations of radiographers should be viewed in terms of the strengths that they may bring to the workplace, rather than the challenges that they may pose. This generational timeline does not stand still and the learning is a continuous process.

IMPACT ON PRACTICE

Recommendations are presented which will be a catalyst for sharing of best practice between radiology and radiotherapy centres.

Images and images: Current roles of therapeutic radiographers

INTRODUCTION

Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT.

METHOD

A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data.

RESULTS

261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT.

CONCLUSION

It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT.

IMPLICATIONS FOR PRACTICE

Role development and changes in education for therapeutic radiographers.

Supporting the development of the research and clinical trials therapeutic radiographers workforce: The RaCTTR survey

INTRODUCTION

The Research and Clinical Trials Therapeutic Radiographers network is a College of Radiographers Specialist Interest Group. It was established to develop and facilitate a support network for therapeutic radiographers working in roles which involve the delivery of radiotherapy clinical trials. Its establishment highlighted the challenges faced by therapeutic radiographers employed in these roles. Consequently, the authors sought to formally capture the working landscape of this subsection of the radiographic workforce, aiming to ascertain any potential barriers to professional development and the increase of clinical trials activity by 15% mandated by NHS England.

METHODS

A Qualtrics survey was designed, pilot tested and distributed to the sixty-two radiotherapy departments across England and the devolved nations. Departments were questioned on the size, structure and the scope of practice of their radiotherapy research and clinical trials team members.

FINDINGS

Thirty-nine complete responses were received, providing a response rate of 62%, with each region of the UK represented in the survey. The findings demonstrated issues related to the number of posts affecting capacity, contract status jeopardising the security and effectiveness of their role and the activities specific to research and clinical trials being 'bolted on' to existing roles. Although advanced practice was being undertaken by around a third of this workforce the findings established several barriers including individual/teams' capacity and a perceived lack of support for therapeutic radiographers to progress in clinical trials roles.

CONCLUSION

The findings illustrate several important implications which if not addressed may not only hinder UK radiotherapy departments to achieve the national increase of 15% of clinical trial activity over the next three years but also restrict the growth in size and scope of professional practice of the workforce.

IMPLICATIONS FOR PRACTICE

The research and clinical trials workforce need to adopt a collaborative approach to profile raising and establish a standardised professional scope of practice to support growth and recognition of their role.

Compassionate communication: Keeping patients at the heart of practice in an advancing radiographic workforce

INTRODUCTION

Compassion is a poorly understood concept in diagnostic and therapeutic radiography, but an increase in its focus was recommended in the Francis Report (2013). Much of the healthcare literature including policy and protocol has focussed on benchmarking and individualising compassion. Two separately conducted doctoral research projects, one therapeutic and one diagnostic, aimed to conceptualise compassion in order to understand its meaning and behavioural expression.

METHODS

A constructivist approach was taken with appropriate ethical approval. Patients and carers, student radiographers and radiographers took part in interviews and focus groups and tweets were harvested from a Twitter journal club discussion between radiographers of the second author's published literature review. Data were transcribed and analysed thematically.

FINDINGS

Key aspects of communication are fundamental to giving compassionate patient-centred care. These include verbal and non-verbal cues, actively listening and engaging and establishing rapport with the patient. Specific skills associated with these are also identified in these studies.

CONCLUSION

Keeping the patient as a person at the centre of radiographic practice in the rapidly evolving technical and cultural environment in which it exists requires timely and appropriate behavioural expressions of compassion from radiographers deploying a range of highly specific communication and interpersonal skills.

IMPLICATIONS FOR PRACTICE

When undertaking reflective practice, radiographers could consider key aspects of how they communicate with patients, including: verbal (in particular the language they use with patients and their tone of voice); non-verbal (especially eye contact and smiling and their body language). They could also usefully explore and develop skills in reading their patients' body language as well as their own in order to pick up subtle or hidden cues that might suggest a patient is suffering emotionally or psychologically. Finally, they could think about the sort of targeted questions they could ask of patients when welcoming them into the x-ray or treatment room that would both facilitate the procedure and leave the patient feeling that their radiographer had taken a genuine interest in them and their situation. These reflections could then be used to possibly modify their existing communications with their patients.

Workplace factors facilitating the radiographers' assessment of referrals for diagnostic imaging - A qualitative study

INTRODUCTION

Radiology referrals are assessed for appropriate imaging based on the available clinical information. The task is legally the responsibility of the radiologists but could be delegated to radiographers under guidance. Knowledge of how this task is organised in radiology departments is limited. The study aim was to identify workplace factors facilitating the radiographers' assessment of referrals for medical imaging.

METHODS

Five radiographers were recruited by convenience- and snowball-sampling techniques through the online social media platform LinkedIn. The participants represented different private and public hospitals and had from three to above ten years of experience with assessment of referrals for plain and cross sectional imaging. Following a qualitative approach, 60-min in-depth semi-structured interviews were conducted through online video meetings. Interviews followed a topic guide with 15 questions and 20 keywords, previously tested through a pilot interview. Systematic text condensation was performed using NVivo 12, where central themes and underlying subthemes were developed.

RESULTS

Five central facilitating factors were identified, each with subthemes identified as: (1) Formal responsibilities; Documented delegation, Specific role description, (2) Training; Achieving skills, Maintaining skills, (3) Guidelines; Clinical indications, Priority, (4) Resource allocation; Time, Staff, (5) a Supporting environment; Teamwork, Mutual benefits, Feedback and knowledge sharing.

CONCLUSION

The study adds new and valuable insights into workplace factors facilitating the radiographers' delegated task of assessing referrals. Workflows adapting such factors benefit radiographers by increasing knowledge and professional development, while positively re-allocating radiologist resources.

IMPLICATIONS FOR PRACTICE

The study findings may support radiology workplaces in establishing or improving referral assessment by radiographers. Subsequently, improved quality of patient services may be achieved.