Using focus groups in radiation therapy research: Ethical and practical considerations

Australian sonographers' perceptions of patient safety in ultrasound imaging: Part 1 - identifying the main safety concerns, a qualitative study

Introduction

Patient safety has been an undervalued component of quality healthcare but is a challenging area of research.Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration.This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects.The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients.

Methods

A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes.

Results

A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control.

Conclusion

This study presents a comprehensive analysis of sonographers' perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety.

A Qualitative Analysis of Human Error During the DIBH Procedure

INTRODUCTION

This quality assurance study analyzed human errors that occurred during the radiation treatment delivery of the deep-inspiration breath hold (DIBH) technique at a tertiary cancer centre. The intention is to recommend solutions and system changes that have the potential to decrease the frequency of errors based on human factors principles.

METHODS

Eighty-two incident reports from January 2012 to July 2017 were retrieved and analysed to determine theme bins of performance-influencing factors contributing to the error. Performance-influencing factors were generated from the incident reports and from focus group discussions with volunteer radiation therapists in the department. Potential solutions to mitigate the error were sought from incident reports, focus groups, literature search, and an interview with a human factors specialist. The solutions were ranked based on the hierarchy of effectiveness, and recommendations were classified using a priority matrix.

RESULTS

Eighty-nine percent of the errors captured in the incident reports were defined as a slip or lapse error type, and 11% of the remaining errors were defined as a mistake error type. Treatment-related problem solving and distractions/interruptions were the highest frequency causative factors that contributed to the observed error. Potential solutions that were suggested across sources included implementing a forcing function, such as the real-time position management system, adding reminders, such as a console sign-off, and updating the current task checklist.

DISCUSSION

The potential solutions generated were summarized into four recommendations that have varying degrees of association with known causative factors. The four recommendations include investing in (1) a forcing function, (2) updating/reinforcing the procedure, (3) managing workload, and (4) updating the checklist. A priority matrix was used to assess both potential effectiveness and cost/effort of each recommendation. Ideally, recommendation 1 would be implemented; however, it is understood that there would be an associated cost. It is therefore suggested that recommendations 2, 3, and 4 are implemented together to increase the effectiveness of the intervention until recommendation 1 can be achieved.

CONCLUSION

This qualitative study introduced a method that analyzed human factors in a specialized procedure used in the treatment of a specific population of patients with cancer. Recommendations were formulated and proposed to the radiation therapy department in hopes of potentially decreasing the frequency of this specific error in the future.

The value of pre-application clinical department visits in radiotherapy: a qualitative evaluation

Background

The mandatory clinical radiotherapy department visit undertaken by potential applicants aims to provide understanding of the profession and therefore reduce attrition. Increasing pressure on clinical departments makes visits a logistical challenge. This additional step may also present as an unnecessary barrier to applicants. With no evidence relating to visits, this study aimed to explore the perceptions of both students and clinical educators concerning potential benefits and challenges.

Method

A focus group interview method was used to gather in-depth qualitative data concerning the clinical department visit experiences from first-year undergraduate students and clinical educators.

Results

Three themes emerged from the student focus groups: the perceived purpose of the clinical visit, the visit content and the outcomes and impact arising from the visit. Clinical educator data also followed these themes in addition to ‘logistical impact’ theme.

Conclusion

The clinical visit has value to applicants in affirming their decision to study radiotherapy. There is variation in expectation and content for these visits and they are logistically challenging. Nationally agreed guidelines for visit structure and content could improve visit efficiency and effectiveness. A national clinical visit form may reduce workload for educators and applicants.

Sexual Health Issues in Patients with Cancer-An Exploratory Mixed Methods Study of the Awareness Levels of Radiation Therapists

INTRODUCTION

Patients with cancer report dissatisfaction with care they receive in relation to changes affecting intimacy and relationships. Health care professionals describe barriers in providing support in these areas due to lack of time, training, education, and privacy. Radiation therapists (RTs) play a key role in cancer care, but there is little evidence in the literature of their role in sexual health care. This project investigated awareness levels of RTs in sexual health issues related to patients with cancer receiving radiation therapy.

METHODS

A prospective mixed methods approach was used for this investigation. Quantitative data was collected via an online questionnaire developed from the literature. Two hundred eighty-four RTs from two large cancer centers were eligible to participate; 84 responded (29%). Two focus groups were conducted with 15 volunteer RTs to validate questionnaire data and further explore the topic. Content analysis was used to identify key themes from the qualitative data.

RESULTS

RT respondents acknowledged the complexity of sexual health issues in patients with cancer. Eighty-five percent (n = 56) strongly agreed/agreed that all patients with cancer, regardless of cancer site, can experience issues which may affect sexual health. Ninety-two percent (n = 61) strongly agreed/agreed that sexual health is important for a persons' quality of life. As part of the radiation therapy treatment planning process, 54.5% of RTs (n = 31) strongly agreed/agreed that they consider the impact of physical side effects of radiation therapy on the sexual health of patients; during treatment delivery, 56% (n = 36) agreed/strongly agreed that they consider the physical side effects on their patients' sexual health.

CONCLUSIONS

Data indicated that RTs are aware that a cancer diagnosis and the subsequent treatments may lead to issues that affect sexual health. They are aware of the complex nature of sexual health and understand its importance in a persons' quality of life and that all patients with cancer regardless of site may experience issues which can impact their sexual health. Their responses suggest that they can relate their training and clinical practice to sexual health issues experienced by patients in their care. Current RT involvement in sexual health care is limited due to various process and environmental factors similar to those found in other health care professionals practice. By eliminating these barriers and supporting the inclusion of sexual health into the clinical practice of RTs, health care resources can be maximized to support the resolution of unmet needs of patients and their partners. In that way the quality of patient care services can be improved.

Using Online Meeting Software to Facilitate Geographically Dispersed Focus Groups for Health Workforce Research

Focus groups as a data collection method in qualitative research have been used for several decades with great effect. Recent developments in online mechanisms for communication have prompted several researchers to explore alternate means of facilitating focus group participation. However, much of the online focus group literature has explored the use of text-based communication; there are few reports on the application of real-time online video-enabled software. In this article, we seek to inform the growing use of online-meeting software-mediated focus groups by reporting and analyzing its application within the context of a health workforce study among geographically dispersed radiation therapy professionals.

Australian radiation therapy - Part two: Reflections of the past, the present, the future

Introduction: Documentation on the history of Australian radiotherapy is limited. This study provides radiation therapists' (RTs) perspectives of the people, workplace, and work practices in Australian radiotherapy centres from 1960 onwards. It provides a follow-up to our previous study: Australian radiation therapy: An overview – Part one, which outlines the history and development of radiotherapy from conception until present day.

Methods: Four focus groups were conducted on separate occasions in 2010, one in South Australia and three in Victoria, Australia. Participants who worked in radiotherapy were purposively selected to ensure a range of experience, age, and years of work.

Results: From a RT perspective, radiotherapy has evolved from a physically demanding ‘hands-on’ work environment, often with unpleasant sights and smells of disease, to a more technology-driven workplace.

Conclusion: Understanding these changes and their subsequent effects on the role of Australian RTs will assist future directions in advanced role development.