Leveraging Advanced Practice: Building Capacity and Maximizing Impact

Abstract

The Stereotactic Body Radiation Therapy (SBRT) program at our institution has rapidly grown in both anatomic sites and patient numbers since 2008; treating over 700 patients last year to sites including lung, liver, spine, prostate, kidney, pancreas, head and neck , bone and nodes. With such a rapidly expanding program, a clinical specialist radiation therapist (CSRT) position was created in 2012 to ensure optimal, consistent care across the program. Since inception, the role has demonstrated significant impact in terms of time savings for physicians and improved quality of care for patients. The next logical step was to translate the expertise of the CSRT into programmatic efficiencies. An initial area of focus for the position was to have the CSRT assume responsibility of approval of day 1 cone beam computed tomography (CBCT) registrations in place of the radiation oncologist (RO). The CSRT attained competence through a combination of didactic and practical instruction. Concordance between the CSRT and RO with respect to CBCT registration assessment was established. As the department's experience in certain sites of SBRT matured, specific clinical scenarios were identified where, with appropriate training, treatment therapists could independently review day 1 CBCT images for SBRT treatments. The CSRT implemented a therapist led day 1 CBCT registration review policy and facilitated staff education through creation and delivery of an instructional module. A follow up audit was performed to ensure maintenance of quality standards and to quantify departmental impact. Benefits: Greater autonomy for radiation therapists; Eliminated need for calling a third party for treatment and resultant delays; Freed up CSRT to focus on more complex tasks. Challenges: Maintaining continued clinical competence throughout department; Consistent adherence to new guidelines; Managing challenging cases within sites identified for therapist review. The progression of the CSRT in SBRT role highlights how advanced practice radiation therapy roles should evolve continuously. To maximize impact, it is necessary to be cognizant of the changing needs of the department and to align the role accordingly. This process demonstrated how advanced knowledge, skills and judgment of CSRTs can be leveraged for wider departmental benefit.