Radiation therapists’ perspective on barriers to clinical trials research

The Radiation Therapist profession through the lens of new technology: A practice development paper based on the ESTRO Radiation Therapist Workshops

Technological advances in radiation therapy impact on the role and scope of practice of the radiation therapist. The European Society of Radiotherapy and Oncology (ESTRO) recently held two workshops on this topic and this position paper reflects the outcome of this workshop, which included radiation therapists from all global regions. Workflows, quality assurance, research, IGRT and ART as well as clinical decision making are the areas of radiation therapist practice that will be highly influenced by advancing technology in the near future. This position paper captures the opportunities that this will bring to the radiation therapist profession, to the practice of radiation therapy and ultimately to patient care.

Research activity among diagnostic and therapeutic radiographers: An international survey

INTRODUCTION

Various national solutions have been considered and implemented to address the factors which limit radiographer engagement in conducting research. Nevertheless, national literature continues to suggest that radiographer engagement in research remains low. The aim of this study was to extend the existing evidence base by conducting an international survey to assess diagnostic radiographers and therapeutic radiographers involvement with, barriers to and support mechanisms for research.

METHODS

Data collection was obtained via an online questionnaire which was distributed by the International Society of Radiographers and Radiologic Technologists (ISRRT). The study population included an international sample of qualified diagnostic radiographers and therapeutic radiographers across clinical and academic contexts in a variety of different roles such as clinical practice, management, education and research.

RESULTS

In total, 420 diagnostic radiographers and therapeutic radiographers completed the survey. Multiple reasons were identified that were considered to inhibit respondents from conducting research. 69.3% indicated a combination of reasons for lack of engagement with research, rather than one single issue. Examples of reasons include: lack of time, insufficient research funding, limited research expertise, and lack of a suitable mentorship scheme.

CONCLUSION

A minor segment of survey respondents indicated involvement in research activity. Lack of dedicated time to research, mentors, and funding were among the main barriers to conduct research. Further research is required to explore what solutions are available to overcoming the barriers.

Research and evidence-based practice in clinical radiography: A systematic review of barriers and recommendations for a new direction

INTRODUCTION

Existing literature provides valuable insight into the application of evidence-based practice (EBP) in Radiography; however, it primarily focuses on localised, context-specific scenarios within individual countries or institutions. This review aims to systematically explore the barriers to EBP and research implementation in clinical Radiography practice internationally.

METHODOLOGY

A mixed-method systematic review was implemented to obtain data from primary studies of qualitative, quantitative and mixed-methods designs. Articles were searched between June and July 2023 from the following scientific databases: PubMed, Medline, CINAHL, Science Direct and manual search dating from 2003 to July 2023. The reviewed studies were subjected to data extraction and results-based convergent synthesis.

RESULTS

A total of 376 articles were identified through electronic database search and citation screening after the removal of duplicates. Thirty-one studies met the predetermined inclusion criteria and were included for this review. The challenges to EBP implementation in clinical Radiography are broadly themed around professional and personal obligations, motivation and organisational culture, knowledge and skill gaps, resources and opportunities, and institutional governance.

CONCLUSION

Globally, clinical radiographers perceived a high level of motivation and interest towards research activities. However, numerous barriers were reported such as insufficient time allocation for research, lack of resources, lack of research culture and inadequate research-related skills and knowledge. A transition towards greater evidence-based practice precipitates the quality of clinical Radiography services, augmenting efficiency in the workflow process and enriching patient experience.

IMPLICATIONS FOR PRACTICE

Radiography managers must develop strategies that aim to stimulate radiographers to initiate research projects. Beyond allocation of protected time, managers should inspire staff participation in research activities through implementation of effective departmental level culture and governance for quality service delivery and improved patient care.

Australian radiation therapist's research capacity and culture: investigating the extent of assistance required to build research capacity

Introduction

Building research capacity within the radiation therapist workforce/profession is essential to guarantee research is embedded into core practices. Assessment of current capacity levels within organisation, department and individual domains needs to occur to establish a baseline and ensure research capacity building (RCB) strategies will be targeted successfully. This exploratory study aimed to identify the areas within each domain where radiation therapists would benefit from extra research assistance, that being research support and process changes, particularly in relation to the workplace and health sector.

Methods

Practising radiation therapists (RTs) within Australia were recruited through professional organisations and invited to complete the online Research Capacity Culture Tool (RCCT). The survey was conducted using Qualtrics with data exported to SPSS.V27 for analysis. Descriptive statistics and the Industry Specific Item Interpretation for Policy and Strategy were used to analyse and report the results.

Results

Survey participation rate was 121/2640 (4.6%). Within the Organisation and Department domains, the most research assistance was required in infrastructure (n = 92–37) and support (n = 66–45) categories, respectively. Participants from private sector (Organisation: 42.7%, Department: 53.7%) and metropolitan centres (Organisation: 32.6%, Department: 47.5%) required a higher rate of assistance when compared to their counterparts in both categories. The individual domain showed similar levels of assistance required across health sectors and work locations. Workplaces showed similar levels of complexity of research activity; private sector (62.5%) recorded the highest level of no research activity.

Conclusion

This study has provided insight into how the research capacity and culture of organisations and departments in which individuals' work will influence their abilities and opportunities to perform research.

Survey on the interest and commitment of AIFM members to scientific activities (SicAS) - The initiative of the FutuRuS working group

PURPOSE

The "FutuRuS" working group of the Italian Association of Medical Physics and Health Physics (AIFM) designed a survey (SicAS) to get feedback from its members regarding their interests and their experience in taking part in scientific activities and events, with the objective of focusing future efforts of the AIFM towards increasing the scientific activity of the medical physics expert (MPE).

METHODS

SicAS was sent out in March 2022 to all AIFM members by newsletter and official communication. SicAS was structured into three sections: personal information and institution of affiliation information, involvement in scientific activities, interest in and commitment to scientific activities. Responses were collected in a fully anonymised mode from the Google Forms platform and analysed with descriptive statistics.

RESULTS

Out of 1289 members (active at the end of 2021), 467 responded to the Survey (response rate of 36%). The Survey results highlighted that AIFM members ranked the involvement of the MPE in scientific activities as highly relevant to the profession. However, 34.7% indicated devoting less than 10% of their working time to scientific activities. 67.5% of the respondents were dissatisfied with the time spent on scientific activities. The primary barrier was the lack of time (77%), followed by a lack of mentoring (32%).

CONCLUSIONS

SicAS highlighted the need for AIFM initiatives to support members' scientific activities. National societies should help develop and support networks between members, create links among universities, hospitals, research institutions and industries, and provide guidelines and learning platforms for enhancing the MPEs' involvement in scientific activities.

Engagement in radiation therapy research: What happens after graduation?

BACKGROUND

To prepare undergraduate radiation therapy (RT) students for the professional role of Scholarly Practitioner the University of Alberta's Radiation Therapy Program (RADTH) provides research education, and students conduct novel research studies during their final practicum year with the final result being a publishable paper. A curriculum evaluation project was carried out to examine the impact of the RADTH undergraduate research education by examining the final outcomes of these research projects and whether the learners carried out further research after graduation.

METHODS

Alumni who graduated from 2017 to 2020 were surveyed to seek information on the dissemination of their research projects, whether the projects resulted in a change to practice, policy, or patient care, if subsequent research has been performed by the graduates, and the motivators or barriers to conducting research post-graduation. A subsequent manual search of publication databases was conducted to fill in data gaps pertaining to publications.

RESULTS

All RADTH research projects have been disseminated by conference presentation and/or publication. One project was reported to have had an impact on practice, with no impact reported for five projects and two respondents not sure about any impact. All respondents reported they have not participated in any new research projects since graduation. Barriers listed included: limited local opportunity, lack of topic ideas, other professional development, no interest in research, COVID impact, and lack of research knowledge.

CONCLUSIONS

RADTH's research education curriculum successfully enables the RT students to conduct and disseminate research. All RADTH projects have been successfully disseminated by the graduates. However, participation in research post-graduation is not occurring due to a variety of factors. While MRT education programs are required to develop research skills, this education alone may not alter motivation nor ensure research participation post-graduation. Exploring other avenues of professional scholarship may be key to ensuring contribution to evidence-informed practice.

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.

Research demographics of Australian medical radiation practitioners

INTRODUCTION

Advancement within the Medical Radiation Profession has seen an increased need for Medical Radiation Practitioners (MRPs) to develop research skills to provide and access relevant and accurate information to maintain best practice. The aim of this study was to ascertain the current research demographics of Australian Medical Radiation Practitioners (MRPs), determine perceived barriers to participating in research and to establish needs-based initiatives to support MRPs in undertaking research.

METHODS

A quantitative and qualitative cross-sectional survey of Australian MRPs using an electronic survey tool was distributed between November and December 2020. Participants were recruited via an invitation email sent to Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) members. A chain-referral sampling technique was adopted for data collection.

RESULTS

A total of 431 participants responded to the survey, representing 2.3% of Australian MRPs. The majority of respondents had a bachelor's degree or higher (71.9%) with 8.4% having postgraduate research qualifications (PhD- 3.2%; Professional Doctorate- 0.7%; Masters- 4.5%). Of the respondents, 15.4% plan to undertake postgraduate research in the future, with 68.2% having no plans for postgraduate research. Respondents identified lack of time (47.0%), lack of interest (33.4%), cost (24.2%) and workplace support (23.9%) as contributing factors for not undertaking postgraduate research.

CONCLUSION

The number of MRPs who have been awarded or will be awarded a postgraduate degree has increased over recent decades. However, many still indicate a lack of interest in being actively involved in research. Targeted support mechanisms should be implemented to address perceived or real barriers to continue to grow research capacity within the profession.

Radiation therapy technologists' involvement and opinion in research: A national survey in Italy

Introduction

This survey describes Italian RTTs' involvement and opinions in research activities related to radiation oncology. Primary aim was to assess the degree of involvement of the national RTTs community in research and to describe how RTTs can integrate their skills collaborating with other professionals.

Materials and methods

A ten-items multiple-choice questionnaire, with 2-8 possible responses, was developed by a steering committee and generated on a survey platform. Links were sent via email to Italian RTTs.The questions were divided in 3 domains: demographic data; scientific research and activity; opinions about RTTs role in scientific research. The survey started on October 1, 2018 and ended on January 31, 2019.

Results

One hundred thirty-five out of 509 (26.5%) RTTs responded to the questionnaire at its expiring date; 97.73% think to be valid contributors in radiation oncology research, expressing clear interest in "data collection" tasks (52.71%); 38.64% feel unsupported by other professionals in the research team and 59.85% of the respondents are not members in any scientific society.

Conclusions

The role of Italian RTTs in research is heterogeneous. Mainly RTTs in the age range from 30 to 40 years responded to the survey showing their interest in scientific research. This might be related to different informatics and educational skills as well as to personal attitudes. RTTs particular skills, like data management and technical hypothesis generation abilities, are of benefit to realize research projects. Therefore, engaging RTTs in research activities is strongly suggested.

Internationalising Research Methods Teaching of Undergraduate Health Professionals

OBJECTIVE

The project aims were: (1) identifying the pedagogical impact of collaborative student experience on student understanding of research methods and (2) evaluating the perceived value of providing students with an international perspective on their professional practice.

METHODS

Student cohorts from year 1 of the University of Liverpool (UoL) (n = 80) and year 2 of the Royal Melbourne Institute of Technology University (RMIT) (n = 128) undergraduate Medical Radiation Science degree programmes participated in the intervention as part of their teaching. Students were tasked with designing, deploying, and analysing data from survey-based research projects and invited to provide feedback via an anonymous and voluntary online survey (UoL students) or an equivalent paper-based survey (RMIT students), comprising both quantitative (Likert) and qualitative (open) questions.

RESULTS

Responses were received from 83% of RMIT and 31% of UoL students. Over 42% of respondents enjoyed the opportunity to interact with overseas peers, while 14.7% did not; 40% of respondents felt the intervention helped in their understanding of research methods, whilst 28% indicated it had not. The main positive themes were learning the research process, team working skills, networking opportunities, and understanding cultural differences. Interpreting data were invaluable; only a minority valued the engagement with their overseas counterparts. There was poor engagement with social media.

CONCLUSIONS

Students reported clear value of the innovation for learning research skills and process. The extent of research skills learning supports changes in research activity and culture in the past 10 years. With internationalisation becoming increasingly important in today's health care economy, the degree to which the students identified this aspect of the research as a key learning point highlights the benefits of the active approach. The negative appraisal of the social media support was interpreted as a response to the platform (WhatsApp) and privacy issues with sharing phone numbers.

Facilitation of child health research in hospital settings: The views of nurses

AIMS AND OBJECTIVES

To explore the views of nurses towards child health research and to identify factors influencing their willingness to facilitate it in practice.

BACKGROUND

Child health research in clinical practice is increasing throughout the UK. Nurses and midwives facilitate access to patients, enact research study protocols and have a critical role in parental decisions to enrol children into research studies. Little is known about their perception of this process.

DESIGN

This study was a descriptive study design.

METHODS

A newly designed questionnaire was completed in 2013 by 105 nurses in three neonatal and two children's units in two discrete acute hospital sites.

RESULTS

Overwhelming support for clinical research was reported. Participants were motivated to facilitate research in order to improve patient care and contribute to the evidence base, but discouraged by external organisational factors and ethical concerns. Training, education and a dedicated team to support research were considered important. Misconceptions regarding consent and the allocation of treatment were reported. Participants raised particular concerns about trials of investigational medicinal product.

CONCLUSION

Negative views of nurses towards research, combined with a lack of knowledge of research processes, governance and ethics, have the potential to threaten the success of clinical research studies.

RELEVANCE TO CLINICAL PRACTICE

Focus on three main areas: staff education, improved communication and the demonstration of managerial commitment to clinical research.

Radiation therapists' perspectives on participating in research

INTRODUCTION

The objectives of this research were to: (1) determine the extent of Australian radiation therapists (RTs) research participation; (2) evaluate the impact of research involvement on career perceptions (3) explore which research topics require investigation and (4) identify benefits and barriers to research participation.

METHODS

This study used mixed methods to collect qualitative and quantitative data using an online survey from a larger workforce study of RTs and radiation oncology medical physicists. Participants practising in Australia completed questions about their research involvement. Chi-square tests and logistic regression were used to analyse quantitative data and content analysis was used to explore qualitative data.

RESULTS

Two hundred and ninety-six RTs answered the research questions. Forty-six percent had been involved in research. Of these, 91% had been involved in departmental, 28% in national, 14% in international and 29% in informal or self-directed research studies. Eleven RTs (8%) had received funding as a chief/principal investigator. Involvement in research was associated with a desire to make a career change. However, it also appeared to be associated with greater satisfaction with career progression and staying in the career. Respondents identified a range of potential research topics, benefits of participating in research and barriers which included lack of time, support and cost.

CONCLUSION

Almost half of the RT participants identified that they were participating in research. Our data suggest that continued involvement in research, and opportunities to participate, improve RT job satisfaction. RTs' research activities are likely to be extended through provision of additional time and support.

Key factors influencing allied health research capacity in a large Australian metropolitan health district

OBJECTIVE

The aim of this study was to identify key factors affecting research capacity and engagement of allied health professionals working in a large metropolitan health service. Identifying such factors will assist in determining strategies for building research capacity in allied health.

MATERIALS AND METHODS

A total of 276 allied health professionals working within the Sydney Local Health District (SLHD) completed the Research Capacity in Context Tool (RCCT) that measures research capacity and culture across three domains: organization, team, and individual. An exploratory factor analysis was undertaken to identify common themes within each of these domains. Correlations were performed between demographic variables and the identified factors to determine possible relationships.

RESULTS

Research capacity and culture success/skill levels were reported to be higher within the organization and team domains compared to the individual domain (median [interquartile range, IQR] 6 [5-8], 6 [5-8], 5 [3-7], respectively; Friedman χ2(2)=42.04, p<0.001). Exploratory factor analyses were performed to identify factors that were perceived by allied health respondents to affect research capacity. Factors identified within the organization domain were infrastructure for research (eg, funds and equipment) and research culture (eg, senior manager's support for research); within the team domain the factors were research orientation (eg, dissemination of results at research seminars) and research support (eg, providing staff research training). Within the individual domain, only one factor was identified which was the research skill of the individual (eg, literature evaluation, submitting ethics applications and data analysis, and writing for publication).

CONCLUSION

The reported skill/success levels in research were lower for the individual domain compared to the organization or team domains. Key factors were identified in each domain that impacted on allied health research capacity. As these factors were different in each domain, various strategies may be required at the level of the organization, team, and individual to support and build allied health research capacity.

Achieving success in clinically based research: the importance of mentoring

Within the professions of radiation therapy and medical imaging, clinician led research activity is becoming more prevalent. However, more is needed. A key component of continuing to develop professional groups who are both research active and producing high quality clinical research, is research mentoring. The authors of this paper share a common interest in enhancing research capacity through research mentoring within the health workforce, and came together to run a workshop on this issue at the 11th Annual Scientific Meeting of Medical Imaging and Radiation Therapy (ASMMIRT 2016) conference in Brisbane. Theory, clinical insights and issues regarding research mentoring were raised in the workshop as were the benefits of having dedicated research positions embedded within the health workforce to help provide support and build capacity. Key elements from this workshop are shared within this article, with the objective to encourage clinicians and clinical researchers to invest the time and effort into seeking and providing good quality research mentoring. A single service example is used to demonstrate how this can lead to enhanced research engagement and productivity.

Research culture in allied health: a systematic review

Research evidence is required to guide optimal allied health practice and inform policymakers in primary health care. Factors that influence a positive research culture are not fully understood, and nor is the impact of a positive research culture on allied health professionals. The aim of this systematic review was to identify factors that affect allied health research culture and capacity. An extensive search of 11 databases was conducted in June 2015. Studies were included if they were published in English, had full-text availability and reported research findings relating to allied health professions. Study quality was evaluated using the McMaster Critical Review Forms. Fifteen studies were eligible for inclusion. A meta-analysis was not performed because of heterogeneity between studies. Allied health professionals perceive that their individual research skills are lower in comparison to their teams and organisation. Motivators for conducting research for allied health professionals include developing skills, increasing job satisfaction and career advancement. Barriers include a lack of time, limited research skills and other work roles taking priority. Multilayered strategies, such as collaborations with external partners and developing research leadership positions, aimed at addressing barriers and enablers, are important to enhance allied health research culture and capacity.

Patient enrollment and logistical problems top the list of difficulties in clinical research: a cross-sectional survey

Background

Many medical research projects encounter difficulties. The objective of this study was to assess the self-reported frequency of difficulties encountered by medical researchers while conducting research and to identify factors associated with their occurrence.

Methods

The authors conducted a cross-sectional survey in 2010 among principal investigators of 996 study protocols approved by the Research Ethics Committee in Geneva, Switzerland, between 2001 and 2005. The authors asked principal investigators to rate the level of difficulty (1: none, to 5: very great) encountered across the research process.

Results

588 questionnaires were sent back (participation rate 59.0 %). 391 (66.5 %) studies were completed at the time of the survey. Investigators reported that the most frequent difficulties were related to patient enrollment (44.3 %), data collection (26.7 %), data analysis and interpretation (21.5 %), collaboration with caregivers (21.0 %), study design (20.4 %), publication in peer-reviewed journal (20.2 %), hiring of competent study personnel (20.2 %), and getting funding (19.2 %). On average, investigators reported 2.8 difficulties per project (SD 2.8, range 0 to 12). In multivariable analysis, the number of difficulties was higher for studies initiated by public sponsors (vs. private), single center studies (vs. multicenter), and studies about treatment, diagnosis or prognosis (i.e., clinical vs. other studies).

Conclusions

Medical researchers reported substantial logistical difficulties in conducting clinical research.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-016-0151-1) contains supplementary material, which is available to authorized users.

Research capacity and culture of the Victorian public health allied health workforce is influenced by key research support staff and location

OBJECTIVE

The aim of the present study was to identify and understand the self-rated research capacity and culture of the allied health workforce. METHODS. The present study was a cross-sectional survey. The Research Capacity and Culture tool was disseminated to all Victorian public health allied health departments. General demographic data were also collected, including the presence of an organisational allied health research lead.

RESULTS

Five hundred and twenty fully completed surveys were returned by participants; all allied health disciplines and all grades were represented. One hundred and eighty-six participants had an organisational allied health research lead and 432 were located in a metropolitan-based health service. There were significant differences (P < 0.05) within all organisational and team research skills between those with and without a research lead, together with those in different service locations (metropolitan vs non-metropolitan). Higher self-ratings in individual research skills (P < 0.05) were primarily associated with more senior and metropolitan-located clinicians.

CONCLUSION

The allied health workforce identifies as a group that is ready to build the evidence to support clinical practice yet requires a whole-systems approach to do so. The results of the present study suggest that the development of key people to build capacity at a higher organisational level has a flow-down effect on research capacity and culture.

10 Years Of Exposure to a Radiation Therapist Research Culture: Where Are We Now?

INTRODUCTION

Over the past 10 years, various programmatic changes have been implemented in our radiotherapy department to increase radiation therapist (RT) research activities. The aim of this qualitative study was to investigate the attitudes of RTs who have been working in a research-rich environment concerning current research activities and the presence of enablers and inhibiters.

MATERIALS AND METHODS

After obtaining research ethics approval, 5 focus groups and 6 interviews were conducted with a group of 30 RTs with varying levels of clinical experience, who were currently employed in our department. Data were audiotaped, transcribed, then analyzed independently by two investigators using a thematic approach. Emerging themes and categories were captured and evaluated.

RESULTS

RTs most frequently engaged in research activities from a desire for patient service improvement and professional development. The main enablers identified were a system of process support and mentorship, and access to useful research tools and databases (e.g., patient imaging databases). The most commonly noted inhibitor to research activities was securing protected research time.

CONCLUSIONS

After 10 years of developing a research-rich environment, this study found that the majority of RTs were directly involved in some form of research, although the definition of research varied significantly. Enablers were identified as factors that support the practical aspects of RT research, rather than the gaining of theoretical knowledge. Although some of the inhibitors noted are similar to those working in research-naive departments, they also add the practical considerations of balancing research and clinical practice. The practical nature of both the enablers and inhibitors found in this study support the hypothesis that generating a research-rich environment for RTs has shifted their priorities from "thinking about research" to "doing research."

Clinical Research Made Easy-A Guide for Research in Radiation Therapy

Research in radiation therapy is important in promoting evidence-based practice and improving both patient care and quality of clinical practice. However, many barriers have been encountered that have prevented or at least deterred radiation therapists from conducting their own research. These include lack of funding, lack of resources, and lack of knowledge on how to start a research project. The aim of this review article is to outline the basic steps involved in conducting research in the hopes to overcome some of these barriers. The processes of establishing a research question, the literature search and review, writing a proposal, obtaining research ethics board approval, data collection, and disseminating the research results will all be reviewed. It will end with a brief synopsis of drug-related clinical trials and the additional requirements to conduct them. Although many articles have been written on each step specifically, the goal of this article is to give a brief overview to help the reader get started in conducting their own research. After reading this article, radiation technologists may realize that conducting research may not be as daunting a task as one may have previously thought, and perhaps consider embarking on their own journey into the research world. Although this article cites many examples from radiation therapy literature, the actual research steps themselves translate to any research conducted by all radiation disciplines.

Preferences for outcomes of treatment for rectal cancer: patient and clinician utilities and their application in an interactive computer-based decision aid

PURPOSE

To quantify the importance that patients and clinicians assign to specific quality-of-life outcomes associated with the treatment of rectal cancer and to demonstrate a clinical application of these data in a computer-based multidimension decision aid (Annalisa).

METHODS

For patients, a researcher-administered questionnaire using the time trade-off method was used to quantify the importance of nine outcomes. Information was ascertained from clinicians by use of a self-administered questionnaire. Responses were ranked and compared between groups. Mean values for each outcome were entered into Annalisa.

RESULTS

Overall, 103 patients, 87 colorectal surgeons, 97 medical oncologists, and 80 radiation oncologists participated. For all groups, local cancer recurrence in the pelvis and fecal incontinence (mean utility scores 0.53 and 0.57, respectively) were the two outcomes to most avoid. In Annalisa, the "best fit" treatment for patients and surgeons was a low anterior resection with postoperative chemotherapy, whereas for medical and radiation oncologists the best-fit treatment was surgery alone.

CONCLUSION

Local recurrence and fecal incontinence are considered the worst outcomes by patients and clinicians alike, but values for other outcomes vary. Decision aids that incorporate patients' individual values with evidence-based data hold considerable potential to optimize treatment decision-making.