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.

What makes a good clinical practice experience in radiography and sonography? An exploration of qualified clinical staff and student perceptions

INTRODUCTION

Clinical practice can be a challenging experience for some healthcare students. The quality of the clinical experience can have a profound effect on the overall student learning experience in clinical practice and attrition. The aim of the study was to explore the perceptions of an optimal clinical practice experience by radiography and sonography students and qualified clinical staff.

METHODS

A qualitative research design was adopted utilising focus groups (n = 5). The study population comprised of qualified radiography/sonography staff (n = 10) from across a number of placement sites used by City, University of London and radiography and sonography students (n = 15) from the same institution. Full verbatim transcriptions were analysed thematically.

RESULTS

Four key themes emerged: 1) favourable/unfavourable traits, 2) creating an optimal learning environment 3) challenges and 4) considerations for clinical education. Key factors for a positive learning experience included clinical supervisors being approachable, whilst encouraging and empowering students. Qualified radiography/sonography clinical staff highlighted student motivation as an important aspect for successful placement learning.

CONCLUSION

The study has provided an insight into a number of positive attributes that enhance student learning experiences whilst on clinical placement. Unhelpful attributes and challenges, such as student motivation and time limitations, were also revealed. It is important that supervisors within the clinical departments actively work towards the provision of a positive learning experience.

IMPLICATIONS FOR PRACTICE

This study can better inform clinical staff regarding the importance of enhancing the student learning experience and facilitating high quality learning within the clinical department. Moreover, to encourage clinical staff to ensure robust "support" is established for students on placement.

Advanced practice roles amongst therapeutic radiographers/radiation therapists: A European survey

INTRODUCTION

Advanced Practice (AP) roles in Radiotherapy (RT) over time are variable, often locally developed and not underpinned by professional standards which leads to conceptual and practical gaps. This study aimed to assess AP roles amongst Therapeutic Radiographers/Radiation Therapists (TR/RTTs) and identify educational gaps for this level across Europe.

METHODS

An anonymous online survey was designed, validated, and distributed across Europe. Convenience sampling was used to recruit advanced TR/RTTs practitioners or TR/RTTs working in AP roles. Descriptive analysis from closed questions and thematic analyses from open questions are reported.

RESULTS

A total of 272 responses were obtained, of which 189 eligible participations were from 21 European countries. 42% of respondents acknowledged additional education required to perform AP, and 25% reported a minimum of five years of RT practice to perform AP roles/tasks. There is a trend to work more on the clinical practice domain with a low percentage of working time allocated to research. Inconsistency was found in job titles, scopes of practice, and educational backgrounds across and even within countries. Education needs regarding knowledge about image-guided and adaptive RT, multimodal imaging and technologies, and advanced treatment planning were found. Training needs on leadership and management skills and clinical site-specific expertise were identified.

CONCLUSION

This study clearly shows a gap in education support, a need for standardisation in job titles and scopes of practice across Europe.

IMPLICATIONS FOR PRACTICE

As the first large-scale assessment of current AP roles and educational support amongst TR/RTTs across Europe, this study recommends the establishment of governance structure and role regulation. It also informs the curricula for master programmes to align the education with current and future practice.

Knowledge, perceptions, and expectations of Artificial intelligence in radiography practice: A global radiography workforce survey

BACKGROUND

Artificial Intelligence (AI) technologies have already started impacting clinical practice across various settings worldwide, including the radiography profession. This study is aimed at exploring a world-wide view on AI technologies in relation to knowledge, perceptions, and expectations of radiography professionals.

METHODS

An online survey (hosted on Qualtrics) on key AI concepts was open to radiography professionals worldwide (August 1st to December 31st 2020). The survey sought both quantitative and qualitative data on topical issues relating to knowledge, perceptions, and expectations in relation to AI implementation in radiography practice. Data obtained was analysed using the Statistical Package for Social Sciences (SPSS) (v.26) and the six-phase thematic analysis approach.

RESULTS

A total of 314 valid responses were obtained with a fair geographical distribution. Of the respondents, 54.1% (157/290) were from North America and were predominantly clinical practicing radiographers (60.5%, 190/314). Our findings broadly relate to different perceived benefits and misgivings/shortcomings of AI implementation in radiography practice. The benefits relate to enhanced workflows and optimised workstreams while the misgivings/shortcomings revolve around de-skilling and impact on patient-centred care due to over-reliance on advanced technology following AI implementation.

DISCUSSION

Artificial intelligence is a tool but to operate optimally it requires human input and validation. Radiographers working at the interface between technology and the patient are key stakeholders in AI implementation. Lack of training and of transparency of AI tools create a mixed response of radiographers when they discuss their perceived benefits and challenges. It is also possible that their responses are nuanced by different regional and geographical contexts when it comes to AI deployment. Irrespective of geography, there is still a lot to be done about formalised AI training for radiographers worldwide. This is a vital step to ensure safe and effective AI implementation, adoption, and faster integration into clinical practice by healthcare workers including radiographers.

CONCLUSION

Advancement of AI technologies and implementation should be accompanied by proportional training of end-users in radiography and beyond. There are many benefits of AI-enabled radiography workflows and improvement on efficiencies but equally there will be widespread disruption of traditional roles and patient-centred care, which can be managed by a well-educated and well-informed workforce.

Research ethics systems, processes, and awareness across Europe: Radiography research ethics standards for Europe (RRESFE)

INTRODUCTION

The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs.

METHODS

A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe.

RESULTS

285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X² (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X² (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X² (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X² (1, n = 231) = 15.448, p = <0.001) within respondents' country.

CONCLUSION

Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements.

IMPLICATIONS FOR PRACTICE

Results are informative of the current status of research ethics within evidence-based radiography.

Research ethics training, challenges, and suggested improvements across Europe: Radiography research ethics standards for Europe (RRESFE)

INTRODUCTION

The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks.

METHODS

This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice.

RESULTS

There were 232 responses received across 33 European countries. Most (n = 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n = 72; 38%), diversity and inclusivity (n = 62; 33%), or research with healthy volunteers (n = 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p = 0.031) and with the establishment of EQF Level 6 training (p = 0.038). The proportion of formally trained researchers also varied by region (p = <0.001). Time-to-ethics-approval was noted as the biggest challenge for professionals making research ethics applications.

CONCLUSION

Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined.

IMPLICATIONS FOR PRACTICE

The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs in Radiography and has identified hurdles to obtaining research ethics approval for further investigation and address.

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.

The Role and Development of Advanced Clinical Practice Within Allied Health Professions: A Mixed Method Study

OBJECTIVE

To investigate the profiles of advanced clinical practitioners (ACPs) in the allied health professions (AHPs) and their skills, attributes, experiences and involvement in new models of care.

METHODS

A 2 phase, cross sectional, mixed method survey of AHP ACPs across London was conducted in 2018-2019. Online questionnaires were completed by 127 AHP ACPs and then semi-structured interviews were conducted with 15 AHP ACPs.

RESULTS

The survey results gave a comprehensive overview of the attributes of AHPs in ACP roles across London. There was considerable variability between role titles, types and levels of qualification, and evolution of the roles. The respondents predominately worked in clinical practice, and less frequently in other ACP domains (research, leadership and management, education). The interview findings provided in-depth insights into the AHP ACP roles within four themes: being advanced, career pathways, outcomes of the advanced practitioner role and influencing and transforming. The "Being advanced" theme highlighted that expert practice comprised confident and autonomous practice, leadership, and applying specialist and expert decision-making skills. "Career pathways" highlighted the diversity within the participants' roles, titles, career opportunities and development. In the "Outcomes of the advanced clinical practitioner role" theme, the ACPs described their services as prompter, more accessible and providing an improved patient journey. The "Influencing and transforming" theme highlighted networking and dissemination and ideas for innovation, influencing and transforming services.

CONCLUSION

This is the first comprehensive profile of ACP roles across AHPs and indicates that these roles are already having a positive impact on healthcare services and supporting new models of care. However, establishing the necessary infrastructure, standardization and governance for ACP roles across sectors, along with the career pathways, funding, sustainability and education, could increase impact in the future.