Gap analysis of role definition and training needs for therapeutic research radiographers in the UK

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.

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.

Interprofessional research teams in radiography - where the magic happens

Based on publications and professional experiences, this article, intended for academic and clinical therapy/diagnostic radiographers, considers conducting research in interprofessional teams, including its values and how to go about achieving it. Whilst there is a growing number of journal papers published by interprofessional teams, almost nothing is published about how best to build interprofessional research relationships or harness the potential of the different professional experience to deliver novel research within the radiography literature. Thus, this article draws heavily on our experiences of creating, working within and leading interprofessional teams which have a specific focus on conducting radiography-related research. Suggestions are proposed about how to create an interprofessional research team and how to get the best out of it. Values of working within an interprofessional research team, to self, to research quality and to the end users of the research are considered.

Evaluating the effectiveness of the clinical research radiographer undertaking the on-treatment review of clinical trial patients receiving radiotherapy for prostate cancer

Background

Radiotherapy clinical trials are at the forefront of modern-day prostate cancer patient management. Patients are reviewed during treatment by clinical oncologists or competent on-treatment review radiographers to minimise treatment toxicities. Clinical Research Radiographers (CRRs) routinely monitor and gather research data from patients participating in clinical trials.

Purpose

The aim of this article is to evaluate the effectiveness of the CRR undertaking the on-treatment review of clinical trial patients.

Method

An experienced CRR within the Northern Ireland Cancer Trials Network was supervised by a clinical oncologist to undertake the role of the on-treatment review of patients receiving radiotherapy for prostate cancer. The CRR explored published literature and compiled this written evaluation as part of their advanced practice learning.

Results

The supervising clinical oncologist verified, following the planned period of supervised practice and academic study, that the CRR was competent to fulfil the role. Evidence of the beneficial synergistic impact of co-joining the roles was experienced at first hand during the undertaking of supervised practice.

Conclusion

Co-joining the roles and responsibilities of the CRR and the on-treatment review radiographer enhanced the quality of care offered to the patients participating in clinical trials.

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."

Australian radiation therapists rank technology-related research as most important to radiation therapy

Background and purpose: Research is increasingly important in radiation therapy, but radiation therapists (or therapy radiographers) (RTs) are relatively new to research and may have difficulty defining research topics. Our aim was to identify the group interests and focus research priorities of Australian RTs. Although not measured, an additional aim was to make RTs more aware of the relevance of RT research.

Materials and methods: An Australia-wide Delphi process was used, examining the problems related to patient care, working with colleagues, and radiotherapy in general, that RTs experienced in their daily work. In an initial study, 374 problems were identified. These were translated into 53 research areas which were prioritised in the second stage of the study. Agreement between groups was analysed using a hierarchical cluster procedure and post hoc Scheffe multiple comparisons.

Results: There were three groups of responders with varying degrees of research interest. There was agreed high importance (p > 0.01) for the technical aspects of radiation therapy, such as image guidance, intensity-modulated radiation therapy (IMRT) and patient positioning. There was significant disagreement (p < 0.001 to p = 0.023) between groups on the importance of patient care research.

Conclusions: The strong interest in technical research is consistent with the rapid influx of technology, particularly in imaging. The disagreement on patient-related research may be of concern. The list of potential research areas specific to radiation therapy will be useful for new RT researchers to consider.

Radiation therapists and the Internet: a perspective from Australia

The Internet is an important information source for health practitioners; yet little is known of how radiation therapists (RTs) are currently using this vast information resource for their professional learning. In 2007, a four-page postal survey was sent to a random sample of 1,142 Medical Radiation Science practitioners with a response rate of 32.8%, which included 76 RTs. This paper reports and analyses the questionnaire responses from RTs on the use of the Internet to update their professional knowledge and issues affecting accessibility to the Internet in the workplace. This research provides an initial data set on the professional use of Internet-based tools and resources by Australian RTs. It has been shown that the Internet is an important information source widely used by RTs as they search the Internet (89%), access specific web pages (85%), use e-mail (84%) and listservs (49%) to update their professional knowledge. Although all RTs reported Internet access within their workplace, a number of factors have been identified which at present limit accessibility of current quality health and medical information through the Internet to RTs. A large number of RTs were unaware of Internet-based resources, such as Cochrane Library (48%) and GoogleScholar (42%), which support evidence-based practice (EBP) and research. RTs in teaching environments had greater access to computers with Internet access than their colleagues in non-teaching environments (p = 0.044). More RTs in the private sector (22%) reported they had ‘no’ access to the Internet in their workplace than their public sector colleagues (4%, p = 0.037). In addition, RTs in metropolitan workplaces had greater access to protected time during work hours for professional reading or study than their non-metropolitan colleagues (p = 0.000). These issues of non-uniformity of resources across workplaces and knowledge gaps within the profession must be addressed so that all RTs can avail themselves of high quality resources available through the Internet that support them in implementing EBP and meeting the mandatory requirement of updating their professional knowledge.

Radiotherapy research activity and radiographer involvement in the UK

In the UK, radiotherapy research is being conducted at national and international levels which include multi-centre clinical trials. Local initiatives and trials are also ongoing where work is being performed to develop techniques or protocols for new technologies and service development. Active participation within these studies is now leading to a culture change with radiographers (radiation therapists) becoming an integral part of the research process. There are currently 70 radiographers in the UK participating in research. This accounts for 2.5% of the UK profession. With the extension of role diversification, research radiographers are undertaking many new roles; however, there is still scope for further development. The therapists’ role in working within this research environment is to ensure improved standards of care focussed on evidence-based practice.

The research agenda and the role of the therapeutic radiographer: The College of Radiographers perspective

This article reflects on the influences on current radiotherapy practice and the key role that Therapeutic Radiographers have in the management of cancer care and the delivery of treatments. In particular the Cancer Reform Strategy is discussed which clearly highlights the many challenges related to cancer. Changes in societal and scientific understanding will demand that the most appropriate and evidence-based care is provided for patients, underscoring the need for evidence through research, to underpin every aspect of daily work if patient outcomes are to continue to improve. In October 2005, the Society and College of Radiographers published: ‘Research and the Radiography Profession—A Strategy and Five Year Plan’. This is an ambitious document, which sets out expectations for the appreciation and use of substantiated research involvement at all levels of practice. Sections of this document and the relevance to radiotherapy practice are discussed. Alongside this, the career progression model for radiography continued to be driven forward with support from the Department of Health. This model describing higher levels of practice for radiographers, at advanced and consultant levels, clearly identified research as a key requirement for the profession. The guidance document in 2006, from the Society and College of Radiographers ‘Positioning Therapeutic Radiographers within Cancer Services: Delivering Patient Centred Care’, further articulated these expert roles, in response to the changing drivers within cancer and across the radiotherapy pathway. In conclusion, research must become a fundamental component of everyday radiotherapy practice as it will verify professional standards of care and sustain the future of the profession. To contribute to the wider cancer agenda it is imperative that all therapeutic radiographers, from practitioner to consultant level, participate in and lead research.