131: Can a Consultant Radiographer prescribe palliative radiotherapy safely and improve service?

What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers

INTRODUCTION

Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice.

METHODS

A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice.

RESULTS

261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles.

CONCLUSION

Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training.

IMPLICATIONS FOR PRACTICE

Role development. Education changes for therapeutic radiographers.

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.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

OBJECTIVES

In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.

DESIGN

A scoping review was undertaken following JBI methodological guidance.

METHODS

13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.

RESULTS

191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway.

CONCLUSION

This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

INTRODUCTION

Advanced practice roles are well documented, and continue to respond to the changing landscape in radiotherapy and oncology. In the UK the highest level of AP for the therapeutic radiographer/radiation therapist (RTT) is the consultant radiographer. These posts should meet the four domains of practice, as set out in national guidance. Here we aim to describe well established roles that meet this criteria, and provide subgroups of examples.

METHODOLOGY

Three AP post holders with over 10 years AP experience completed a questionnaire adapted from the consultant radiographer toolkit. These were completed in conjunction with guidance and framework documents. The examples were to demonstrate how they achieve a high level of practice in clinical and expert practice; professional leadership and consultancy; education, training and development; and practice and service development, research and evaluation. Participants then categorised results to add subgroups to each domain.

RESULTS

The questionnaire was completed by three RTTs specialising as a lung consultant radiographer (LCR), a neuro-oncology consultant radiographer (NCR) and a lead research radiographer (RR). Each post holder described how they meet the criteria by discussing the benefit they make to their profession, department and patients. All posts had examples for all criteria, achieving consultant practice. Clinical and expert practice was the dominant domain for the clinical specialist posts, and professional leadership and research evaluation was the strongest domains for the RR.

CONCLUSION

All three consultant RTTs have demonstrated expert practice with clear and transparent examples of their professional practice which evidence the four domains of consultant practice. Following two decades of AP practice for RTTs there is a need to be strategic in the development of future posts with a prospective view on succession planning that safeguards their longevity.