Clinical Specialist Radiation Therapist Research Articles

Defining the Range of Standard Practice for Field Placement and Target Volume Definition for Bone Metastases at the Ottawa Hospital; Groundwork for Evaluating Skill Competency in a Clinical Specialist Radiation Therapist

Defining the Range of Standard Practice for Field Placement and Target Volume Definition for Bone Metastases at the Ottawa Hospital; Groundwork for Evaluating Skill Competency in a Clinical Specialist Radiation Therapist

Patient satisfaction with the role of a Clinical Specialist Radiation Therapist in palliative care

AbstractAimTo examine patient satisfaction with a Clinical Specialist Radiation Therapist (CSRT) in a palliative radiotherapy clinical environment.Materials and methodsA one-point dissemination design captured satisfaction scores from patients who did (n=19) and did not (n=14) receive palliative care from the CSRT. The ‘Patient Satisfaction Questionnaire’ included six common questions and four additional questions for patients seen by a CSRT. T-tests compared results from common questions and mean values, standard deviations were also calculated.ResultsFor questions ‘I was told everything that I want to know about my condition’ and ‘I felt that the problem that I came with was sorted out properly’, those who received care from the CSRT scored significantly (p<0·05) higher than those that did not (p=0·033, 0·037). For CSRT-specific questions, 89% of participants felt the experience with the CSRT was excellent, 78% strongly agreed/agreed having a CSRT on the care team was important, and 89% of participants strongly agreed/agreed having a CSRT on the care team was important to patients’ understanding of treatment.FindingsPatients receiving care from the CSRT had better understanding of treatment and an excellent experience with the CSRT. This interaction provided more opportunities to address patient questions/concerns, thus alleviating patient anxiety, increasing satisfaction with care, and demonstrating how new roles can develop new models of care within the current healthcare system.

The Role of the Clinical Specialist Radiation Therapist in Delivering Person Centred Care Across the Cancer Continuum

The Role of the Clinical Specialist Radiation Therapist in Delivering Person Centred Care Across the Cancer Continuum

Building a New Model of Care for Rapid Breast Radiotherapy Treatment Planning: Evaluation of the Advanced Practice Radiation Therapist in Cavity Delineation

AimsBreast radiotherapy treatment is commonly managed by a multidisciplinary team to ensure optimal delivery of care. We sought a new model of care whereby a clinical specialist radiation therapist (CSRT) delineates the cavity target for whole breast radiotherapy treatment planning and the radiation oncologist validates the contour during final plan review. This study evaluated the radiation oncologist's acceptance of these contours and identified characteristics of cavities suitable for CSRT-directed contouring. Materials and methodsFollowing specialised breast oncology education and training by the radiation oncologist, the CSRT prospectively delineated cavities in 30 tangential breast radiotherapy cases and consulted the radiation oncologist in ‘complex’ cases but directed ‘non-complex’ cases for treatment planning. Changes to CSRT contours were evaluated using the conformity index. Breast density, time since surgery and cavity location, size and visualisation score [CVS: range 1 (no visible cavity) to 5 (homogenous cavity)] were captured. ResultsOf the 30 CSRT delineated cavities contours, the CSRT directed 20 (66.7%) cases for planning without radiation oncology review; 19 were accepted (without changes) by the radiation oncologist upon final plan review and one was changed by the radiation oncologist (conformity index = 0.93) for boost treatment and did not affect the tangential treatment plan. Ten (33.3%) cases, all CVS ≤ 3, were reviewed with the radiation oncologist before planning (conformity index = 0.88 ± 0.12). CVS was inversely correlated with breast density and cavity size (P < 0.01). ConclusionsThe CSRT delineated cavities appropriate for clinical radiotherapy treatment planning in women with well-visualised cavities, whereas ‘complex’ cases with dense breast parenchyma, CVS ≤ 3, and/or cases needing boost radiotherapy treatment required review with the radiation oncologist before planning.

Clinical specialist radiation therapists (CSRT): Creating capacity while improving quality of care.

124 Background: Ontario’s cancer system faces many challenges, including a rising incidence of cancer, aging population, increasingly complex cancer treatment, and health human resource (HHR) constraints. In response, Cancer Care Ontario and the Ontario Ministry of Health and Long Term Care collaborated on a project to assess whether a new advanced practice radiation therapist role – the ‘Clinical Specialist Radiation Therapist’ (CSRT) – could enhance access to high quality, innovative care by optimizing the use of HHR. Methods: This innovative model of care aims to enable radiation therapists with advanced training and accreditation (CSRTs) to assume responsibility for certain activities traditionally performed by radiation oncologists (ROs) while maintaining and improving the quality, accessibility and efficiency of radiotherapy (RT) for patients. To assess CSRTs’ impacts standardized metrics, including efficiency (access, wait times (WTs), team function) and quality (new/enhanced services, patient experience) measures, were used. Results: Currently there are 24 CSRTs in 9 of 14 regional cancer centres. 2014/15 data demonstrated that CSRTs can improve the efficiency of referral processes and clinic operations, decrease WTs, and increase capacity (2-28 additional patients seen in clinic/month). Optimized team function and time savings (5-66 RO hours/month) have been achieved through CSRTs’ assumption of certain patient assessment and treatment planning activities. Efficiencies have improved patient experience by facilitating quicker, more coordinated flow through the RT process, and greater continuity of care. Further, CSRTs have enhanced access to high quality RT, through &gt; 75 innovative initiatives (rapid access clinics, telemedicine consults). Conclusions: The CSRT role demonstrates how innovative models of care can improve patient access to high quality cancer care. With 24 CSRTs implemented, opportunities for analysis of factors which facilitate achievement of maximal impact and position sustainability exist. Such investigations could inform the refinement and further implementation of CSRTs in Ontario and other jurisdictions, improving patients’ access to RT more broadly.

Patient Pre Clinic Expectations of a Visit to Ontario’s Only Multidisciplinary Skin Cancer Clinic

Purpose/Aim: The Odette cancer centre runs a weekly multidisciplinary skin cancer clinic for patients diagnosed with non melanoma skin cancer. The clinic sees upward of 14 new patients and 14 follow up patients each week. The patients see 5 different clinicians each visit. They see a Pathologist, Dermatologist, Plastic Surgeon, Radiation Oncologist and a Clinical Specialist Radiation Therapist (CSRT). The majority of the patients are referred from outside dermatologists. We inform the outside clinics of the multidisciplinary nature of our clinic and the expected time a patient’s appointment may take. However we were noticing many upset patients, due to the wait time for their appointment, the time they spend in the clinic rooms being seen by the various practitioners and a general misunderstanding of why they were at this clinic. Method/Process: We decided to simply ask our patients 4 simple questions while we were doing their history and physical exam. We asked 20 patients: 1. What do you think you are here for today? 2. What did your referring dermatologist tell you about this clinic? 3. Are you aware you will be seeing several doctors today? 4. How much time have you allowed for your visit today? Anecdotal results from 20 patients: Correct answer, Wrong answer, Partial answer QUESTION 1: 8, 9, 3 QUESTION 2: 4, 14,2 QUESTION 3: 3, 16, 1 QUESTION 4: 12, 8, From here we decided to formalize our questions and give our patients a questionnaire with the same questions on it to allow them time to think about their responses. We gave these questionnaires to 35 patients in the next month. Results/Benefits/Challenges: RESULTS: From 35 patients: Correct answer, Wrong answer, Partial answer QUESTION 1: 16, 13, 6 QUESTION 2: 6, 22, 7 QUESTION 3: 6, 28, 1 QUESTION 4: 20, 11, 4. Conclusion/Impact/Outcomes: We saw that 63% of our patients were not receiving any information about our clinic from their referring dermatologists, which could account for some of their upset when they eventually get into the clinic room. Also 80% of the patients had no idea they would be seeing several physicians and more than 37% had no idea why they were even in a cancer center. These numbers were disturbing. We looked at ways to combat this, as educating the referring offices did not seem to be helping. We decided the skin site CSRT would call the patients a week before their appointment and give them the information they need. We will repeat the questionnaire with the expectation that the numbers will improve. We plan to re do the questionnaire once per year to ensure patients are receiving the information they require before they attend the clinic. We hope this will increase patient satisfaction and allay many of their fears.

Cavity Delineation and Plan Review in Breast Radiotherapy: Concordance between Clinical Specialist Radiation Therapist and Radiation Oncologist

patients. Histopathological analysis was used to confirm clinical treatment response. Results/Benefits/Challenges: Clinical responders showed a significant increase (p<0.05) in QUS parameters after four weeks of treatments, relative to the baseline: MBF (+7.90 dBr 1.39 [SE]) and 0-MHz intercept (+8.55 dBr 1.84). Spectral slope was however invariant. At similar time intervals, clinical responders also demonstrated significant percent changes to DOSI markers, such as total hemoglobin (HbT, -32.84% 4.07%), water fraction (%Water, -53.97% 3.29%) and scatter power (SP, -45.25% 1.42%). The sensitivity (Sn) and specificity (Sp) for QUS demonstrated that the MBF and 0-MHz intercept were good predictors of response at week 4 (MBF; Sn1⁄492.9%, Sp1⁄4100%, p<0.05), and this also corresponded with HbT (Sn1⁄492.9%, Sp1⁄487.5%, p<0.05) at the same time interval. In addition, QUS and DOSI parameters demonstrated an increase in the Sn/Sp as early as after 1 week of treatment (0-MHz intercept + %Water), (Sn1⁄492.9%, Sp1⁄4100.0%). Conclusion/Impact/Outcomes: QUS and DOSI demonstrated potential, as coincident markers for treatment response and may potentially facilitate response-guided therapies.

The Development of a Clinical Specialist Radiation Therapist Role, Specializing in Palliative Care in a Non-dedicated Palliative Care Clinic Structure

The Development of a Clinical Specialist Radiation Therapist Role, Specializing in Palliative Care in a Non-dedicated Palliative Care Clinic Structure

Innovation: Development of a Virtual Radiation Oncologist Consultation Service

The purpose of this initiative is to facilitate timely care and increase access to stereotactic radiotherapy (SRT) services at the Juravinski Cancer Centre (JCC) for patients diagnosed with brain metastases, oligometastatic disease, and early stage lung cancer. This new service attempts to reduce transportation costs for out-of-LHIN patients by reducing the number of out-patient visits required for consultation, treatment and follow-up with the radiation oncologist. Using existing technology facilitated by the Ontario Telemedicine Network (OTN), the Palliative Clinical Specialist Radiation Therapist (CSRT) developed disease specific clinical protocols to provide this innovative service. Extensive planning and needs assessments were completed to achieve technical and clinical site readiness for patient consultations. The CSRT was responsible for the coordination and communication between the OTN Regional Manager, the director of radiation oncology, administration, management of information technology, patient referrals and registration, nursing, radiation oncology and the referring telemedicine program at the Windsor Regional Cancer Centre (WRCC). Virtual consultation has provided patients with advanced disease the opportunity to receive an expert SRT opinion without having to incur significant time and travel costs. The implementation of this new service required considerable planning and process testing. The greatest challenge continues to be the coordination and booking of an available consultation room with OTN equipment in conjunction with the availability of the radiation oncologist, the patient and family members and the referring host site. Fourteen patients who met appropriate indications have received virtual radiation oncologist SRT consultations. The distance between the referral and consultation site is approximately six hundred kilometers. Thus, each virtual consultation has provided an estimated time savings of seven hours per patient with a cost savings of one hundred dollars per patient estimated accounting for fuel, food and parking in comparison to an actual in-person SRT radiation oncologist consultation. In future, the development of a patient satisfaction questionnaire will help measure quality of life effects of this new service for patients and family members. A dedicated telemedicine suite within the JCC radiotherapy department will also minimize the difficulties with booking and coordination of all services required for the virtual consultation to occur.

Development of a Clinical Specialist Radiation Therapist Role in Supportive Care and Sexual Health: The Odette Cancer Center Experience

Beginning in May 2006, the Clinical Specialist Radiation Therapist (CSRT) project was approved by the Ministry of Health in Ontario as part of a project to investigate a new model for health care delivery. The aims were to provide optimum access to care as well as improve the quality of care provided to cancer patients. Our institutional priorities are aligned with the province and the CSRT role has been integrated into interprofessional practice with great success. Provincial reports from patient satisfaction surveys as well as institutional data identified areas for improvement in the delivery of supportive care with sexual health specifically as an area of unmet need for cancer patients.

A new model of care: An advanced practice radiation therapy role.

131 Background: Due to the rising incidence of cancer, increasing complexity of cancer treatment and growing resource constraints, there is demand for innovative interprofessional models of care. Cancer Care Ontario (CCO), in collaboration with Ontario’s Ministry of Health and Long-Term Care, launched the Clinical Specialist Radiation Therapist (CSRT) project to investigate a new advanced practice (AP) radiation therapy (RT) role. Methods: A series of pilot phases commenced in 2004. A system wide implementation phase began in 2010. The overall goal of the project was to enable CSRTs to assume responsibility for certain key radiation medicine activities, optimize RT team functioning, and improve quality of care. This was to be achieved by applying advanced clinical, technical and professional RT competencies. A project team coordinated assessment of new position proposals, implementation activities, and data collection. Work towards formalizing the role is being conducted through partnerships with cancer centre administrations and the national professional association for RTs. Results: Currently there are 17 CSRTs in 6 of 14 Ontario cancer centres, practicing in palliative and disease-site specific positions. The provincial total will be 24 CSRTs in 10 centres by Fall 2014. Data show a major impact on patient throughput and wait times, with significant increased capacity in some clinics. CSRTs’ impact within their departments is being evaluated with regards to: 1) capacity building, 2) quality of care, and 3) knowledge translation (KT). In terms of role formalization, 6 positions are now considered permanent within their centres and the first iteration of a national certification process is anticipated for fall 2014. Conclusions: The CSRT project is aligned with CCO's priorities of improving Ontario’s cancer system performance by implementing innovative models of care and providing high quality care. This jurisdictional implementation project has demonstrated that an AP RT role can be successful in addressing system pressures and improving quality of care and innovation in Radiation Medicine. Further work is necessary to develop and formalize this AP role and leverage learnings for national implementation and future models of care work.

Patient Satisfaction with the Role of a Clinical Specialist Radiation Therapist in Palliative Care

Aim To examine patient satisfaction with a Clinical Specialist Radiation Therapist (CSRT) in a palliative radiotherapy clinical environment. Materials and methods A one-point dissemination design captured satisfaction scores from patients who did (n=19) and did not (n=14) receive palliative care from the CSRT. The ‘Patient Satisfaction Questionnaire’ included six common questions and four additional questions for patients seen by a CSRT. T-tests compared results from common questions and mean values, standard deviations were also calculated. Results For questions ‘I was told everything that I want to know about my condition’ and ‘I felt that the problem that I came with was sorted out properly’, those who received care from the CSRT scored significantly (p<0·05) higher than those that did not (p=0·033, 0·037). For CSRT-specific questions, 89% of participants felt the experience with the CSRT was excellent, 78% strongly agreed/agreed having a CSRT on the care team was important, and 89% of participants strongly agreed/agreed having a CSRT on the care team was important to patients’ understanding of treatment. Findings Patients receiving care from the CSRT had better understanding of treatment and an excellent experience with the CSRT. This interaction provided more opportunities to address patient questions/concerns, thus alleviating patient anxiety, increasing satisfaction with care, and demonstrating how new roles can develop new models of care within the current healthcare system.

Concordance of a Clinical Specialist Radiation Therapist and Radiation Oncologist: A Prospective Study involving Treatment Planning and Assessment of Patients Receiving Palliative Radiotherapy for Bone Metastases

Concordance of a Clinical Specialist Radiation Therapist and Radiation Oncologist: A Prospective Study involving Treatment Planning and Assessment of Patients Receiving Palliative Radiotherapy for Bone Metastases

The perception of radiation therapy students on a clinical specialist radiation therapist-led breast workshop

AbstractPurposeThe clinical specialist radiation therapist (CSRT) is a radiation therapist with advanced site-specific clinical skills and knowledge that can be utilised to enhance the education of radiation therapy (RT) students within an academic setting. The aim of this study is to assess the students’ perception of the teaching provided by a CSRT within a case-based learning workshop tailored for breast cancer.MethodsA workshop that followed the patient's RT treatment pathway (consultation, CT simulation, treatment planning and delivery) was led by a breast-site CSRT to 16 third-year students. Following completion of the workshop, a 4-point Likert-scale survey was distributed to explore the students’ didactic and clinical experiences and their general perceptions of the CSRT's contribution to their breast-site module education.ResultsThe median didactic experience reported by the students were ‘a lot’ in patient care and ‘some’ in treatment unit and treatment planning. In contrast, the students reported less clinical experience; the median response for patient care and treatment unit experience was ‘a little’ and ‘none’ for treatment planning. All 13 students who responded to the survey agreed that the CSRT enhanced their understanding of the material. The students felt engaged in the CSRT-lecture and perceived it as value added. The majority of the students (92%) indicated the CSRT to be a useful learning resource in their training and education. Additional comments provided by the students noted the utility of the CSRT-led lecture in consolidating their knowledge of the breast cancer treatment planning and delivery and suggest further expansion of this learning format to other disease sites.ConclusionsThird-year RT students commencing their clinical practicum will have had a greater proportion of their learning from didactic teaching as opposed to clinical experience. In transitioning to their final year, the focus of the curriculum shifts to the application of theory into the clinical environment. The students perceived the CSRT to be a useful resource to enhance their understanding of the breast-site module and their feedback supports the instructional quality and effectiveness of the CSRT in this clinical teaching role.

“Relevant and Current”: Radiation Therapy Students' Perception of Clinical Credibility in the CSRT as Lecturer

PurposeTo examine how radiation therapy students' perceive the clinical credibility of the clinical specialist radiation therapist who is serving as a lecturer. This lecturer is a clinically based radiation therapy staff member. MethodsThird-year radiation therapy students (n=16) attended a workshop designed and delivered by the breast-site clinical specialist radiation therapist. A web-based survey was distributed to all students. The survey contained a series of statements that the participants were asked to rate along a 4-point Likert scale. In addition, there was one open-ended question asking “How would you define clinical credibility?” The responses for each question were collated and analyzed for content and theme. ResultsFifteen of the possible 16 students participated. All of the participants viewed the clinical specialist radiation therapist as clinically credible and that clinical credibility added value to the content being delivered. As well, 53.8% agree and 46.2% somewhat agree that the learning experience would be different if the lecture was delivered by someone non-clinical. ConclusionFindings from the study indicate that radiation therapy students view current clinical experience as important and relevant, impacting their perception of clinical credibility in the lecturer. The results support further development of lecturing opportunities for clinically based staff.

Radiotherapy Treatment Review: A Prospective Evaluation of Concordance between Clinical Specialist Radiation Therapist and Radiation Oncologist in Patient Assessments

PurposeThis study assessed the concordance of patient assessments performed during weekly radiotherapy treatment reviews between the breast site clinical specialist radiation therapist (CSRT) and radiation oncologist (RO). Methods and MaterialsA CSRT and RO independently assessed patients attending a breast radiotherapy review clinic and graded their toxicities according to the Common Terminology Criteria for Adverse Events v.3.0. Both observers were blinded to each other’s assessments. The concordance rates and agreement levels, indicated by the Kappa statistics, were calculated with the RO considered as the gold standard. ResultsTwenty-nine consecutive patients were prospectively reviewed over 12 weeks. High concordance occurred between CSRT and RO assessments, with an overall concordance rate of 96% for all evaluated toxicities. The concordance rates for non-zero grade toxicities ranged from 76% to 100%. There was almost perfect agreement between the CSRT and RO in toxicity grading for dermatitis (P < .05), whereas fair agreement was observed for hyperpigmentation (P < .05). Overall, there was increasing agreement between the CSRT and RO assessments over time. ConclusionCommon side effects experienced by patients receiving breast radiotherapy as detected and graded by the CSRT were highly comparable to those of the RO. This study lends support for CSRT involvement in treatment review assessments for this patient population.

Evaluation of variability in seroma delineation between clinical specialist radiation therapist and radiation oncologist for adjuvant breast irradiation

Breast cancer is managed by a multidisciplinary team with a goal for the timely provision of high quality care. Given radiation oncologist (RO) time constraints, an opportunity arises for task delegation of breast seroma target delineation to an advanced practice clinical specialist radiation therapist (CSRT) with clinical and technical expertise to facilitate treatment planning. To explore this further, we quantitatively evaluated the variability in post-surgical seroma delineation between the CSRT and ROs. Specialized site specific training was provided to the CSRT, who, with 7 ROs, independently contoured the seroma and graded its clarity, using the cavity visualization score (CVS), for 20 patients with clinical stage Tis-2N0 breast tumors. The conformity indices were analyzed for all possible pairs of delineations. The estimated "true" seroma contour was derived from the RO contours using the simultaneous truth and performance level estimation algorithm. Generalized kappa coefficient and center of mass metrics were used to examine the performance level of the CSRT in seroma delineations. The CVS of the CSRT correlated well with the mean RO-group CVS, (Spearman ρ = 0.87, P < .05). The mean seroma conformity index for the RO group was 0.61 and 0.65 for the CSRT; a strong correlation was observed between the RO and CSRT conformity indices (Spearman ρ = 0.95, P < .05). Almost perfect agreement levels were observed between the CSRT contours and the STAPLE RO consensus contours, with an overall kappa statistic of 0.81 (P < .0001). The average center of mass shift between the CSRT and RO consensus contour was 1.69 ± 1.13 mm. Following specialized education and training, the CSRT delineated seroma targets clinically comparable with those of the radiation oncologists in women with early breast tumors suitable for accelerated partial breast or whole breast radiotherapy following lumpectomy. This study provides support for potential task delegation of breast seroma delineation to the CSRT in our current multidisciplinary environment. Further study is needed to assess the impact of this role expansion on radiotherapy system efficiency.