From CT-Guided to MR-Guided Intracavitary Brachytherapy for Cervical Cancer: What Do the Key Stakeholders Have to Say About the Transition?

Abstract

International brachytherapy consortiums are advocating for the incorporation of magnetic resonance imaging (MRI) into the cervical brachytherapy process as a standard-of-care. Although some evaluations have been performed to quantify the effect on procedural time, little is known about the views and experiences of key stakeholders during the transition from CT to MR-guided brachytherapy. This qualitative research project explored insights from key stakeholders related to a change in the gynaecological brachytherapy process. Semi-structured interviews were designed using Lean Methodology principles and all key members in the gynaecological brachytherapy team were approached for participation: radiation oncologists, medical physicists, radiation therapists, lead MR technologist and the ward nurse manager. Interviews were recorded and transcribed, analysis was performed to identify themes from the data. Ten of twelve (83% participation rate) key members of the team were interviewed. Four themes emerged from the data: challenges to efficiency, staff availability, patient history & disease characteristics and team communication. The stakeholders expressed that the challenges during this transition was procedural inefficiency (sharing of the MRI scanner and increased procedure length due to increased complexity in contouring and planning), staff availability (radiation oncologist and transportation staff). The clinical team identified the value of communicating patient history & disease characteristics ahead of the brachytherapy procedure day, and also using an inclusive mode of communication during the procedure were beneficial. This research provides nuanced insights into process and practice changes that occur when one imaging technology is simply swapped for another, emphasizing how intertwined and complex brachytherapy procedures can be. It emphasizes that not all challenges to efficiency are considered Lean Wastes, and that seemingly simple procedural changes can result in unanticipated differences in staff availability, communication pathways, and knowledge requirements.