Advanced Practice Issues for Radiation Therapists in the Province of Ontario: A Case Study

Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution

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.

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

INTRODUCTION

Advances in Radiotherapy (RT) technology and increase of complexity in cancer care have enabled the implementation of new treatment techniques. Subsequently, a greater level of autonomy, responsibility, and accountability in the practice of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) has led to Advanced Practice (AP) roles. The published evidence of this role is scattered with confusing terminology and divergence regarding the perception of whether a specific role represents AP internationally. This study aims to establish an international baseline of evidence on AP roles in RT to identify roles and activities performed by TR/RTTs at advanced level practice and to summarise the impact.

METHODS

A systematic PRISMA review of the literature was undertaken. Thematic analysis was used to synthesise the roles and associated activities. Six RT external experts validated the list. The impact was scrutinised in terms of clinical, organisational, and professional outcomes.

RESULTS

Studies (n = 87) were included and categorised into four groups. AP roles were listed by clinical area, site-specific, and scope of practice, and advanced activities were organised into seven dimensions and 27 sub-dimensions. Three most-reported outcomes were: enhanced service capacity, higher patient satisfaction, and safety maintenance.

CONCLUSION

Evidence-based AP amongst TR/RTTs show how AP roles were conceptualised, implemented, and evaluated. Congruence studies have shown that TR/RTTs are at par with the gold-standard across the various AP roles.

IMPLICATIONS FOR PRACTICE

This is the first systematic literature review synthetisising AP roles and activities of TR/RTTs. This study also identified the main areas of AP that can be used to develop professional frameworks and education guiding policy by professional bodies, educators and other stakeholders.

Strengthening medical radiation technologist recognition through advanced practice in Canada: A narrative review

BACKGROUND

Lack of professional recognition from the public and other healthcare professionals has been a long-standing issue for medical radiation technologists (MRTs) in Canada. This situation was further highlighted by the pandemic when several provinces refused to recognize MRTs as essential workers. In addition to continued advocacy to develop interprofessional awareness of the MRT discipline, prioritizing the creation of advanced practice opportunities will increase the perceived value of MRTs to healthcare.

METHODS

Literature for this review was found by searching the electronic databases of PubMed, CINAHL, Google Scholar, and Athabasca University. Relevant reports from credible Canadian organizations, global MRT professional association websites, frameworks for advanced practice, and one dissertation were also reviewed.

DISCUSSION

The implementation of advanced practice radiography roles present a tremendous opportunity to increase the visibility and recognition of the MRT profession in both clinical and research domains. In Canada, role extension in radiography has underscored the significance and need for advanced practice.

CONCLUSION

To keep pace with growing demand for medical imaging, the use of human health resources must be re-evaluated to optimize care delivery and capitalize on the full skill set of MRTs.

Exploring attitudes and opinions of radiation therapists in British Columbia towards advanced practice

Introduction

Although 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 methods

A 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.

Results

A 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.

Conclusions

Although 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.

The process of developing a non-medical (advanced allied health) botulinum toxin A prescribing and injecting model of care in a public rehabilitation setting

Objective The aim of this paper was to describe the process undertaken to develop a non-medical (advanced allied health extended role) botulinum toxin A prescription and injection project for adults with upper and lower limb spasticity secondary to an acquired brain injury. The hypertonicity clinic in the present study was located in a metropolitan public hospital in Queensland where multidisciplinary services are provided by a rehabilitation specialist and an advanced occupational therapist and physiotherapist. Methods The process of developing the model included establishing potential benefits for the role extension project and documentation of a project plan. Results Project outcomes included the development of a relevant governance structure, a research evidence-based project evaluation framework, a draft research ethics application, delineation of the key eligibility criteria and competencies required for physiotherapist and occupational therapist prescribers, and a final project report. Conclusion Non-medical prescribing has the potential to increase patient access to botulinum toxin A injection for the management of focal spasticity. A process that supports early patient engagement, extensive consultation with relevant stakeholders, a strong governance structure, a high-quality research project and a long lead time may maximise the potential for successful completion of advanced allied health role extension projects, including prescription and injection of botulinum toxin A. What is known about the topic? Non-medical prescribing has been recommended as a strategy for facilitating responsive health care and addressing health workforce shortages in Australia and overseas. What does this paper add? A detailed description of the process used to develop a non-medical prescribing and injecting project within a public hospital rehabilitation unit, as well as an analysis of the facilitators and barriers to progression. What are the implications for practitioners? A process that supports early patient engagement, extensive consultation with relevant stakeholders, a strong governance structure, a high-quality research project and a long lead time may maximise the potential for successful completion of advanced allied health role extension projects, including prescription and injection of botulinum toxin A.

Stakeholder Insights into Autonomous Setup Correction by Radiation Therapists during High-Dose Prostate Radiotherapy

Although online setup correction is beneficial during high-dose radiotherapy, little is known about the attitudes and concerns of stakeholders directly involved in this process. Therefore, the purpose of this research was to explore radiation oncologists' and therapists' insights on changes in workload, procedures, and professional practice resulting from involvement in therapist-autonomous online setup correction for patients receiving radiotherapy for prostate cancer. This was a single-center study with a qualitative design. All 10 radiation oncologists and 20 therapists involved in the online-autonomous process for prostate radiotherapy were approached for participation. Two specifically designed questionnaires were developed (one for therapists and one for oncologists) using a standard interview-to-pilot process. These were distributed to the participants both by hand and by e-mail. Content analysis methods and descriptive statistics were used to summarize the qualitative responses. Twenty-eight responses to the questionnaire were received. According to the results, the online-autonomous process was considered efficient when left solely in the hands of therapists (27 of 28 responses). Participant confidence with the process was influenced by communication (8/8), education (23/28), and documentation (20/20). Stakeholder perceptions indicated that the process was implemented exclusively to improve patient outcomes (28/28). The respondents experienced no professional resentment or resistance to change (20/20). The assumption of responsibility for online setup correction improved the therapists' perceptions of their role and themselves as professionals. Despite limited generalizability, this study confirms that within a well-established process, radiation oncologists are willing to cede responsibility for autonomous image approval and setup correction to therapists. Despite increases in professional accountability, radiation therapists are prepared to accept that responsibility for the benefit of their patients.