An investigation of the potential roles and scope for advanced practice radiation therapists in Tasmanian public radiation oncology departments

A growing and ageing population has led to an increased number of cancer diagnoses in Australia. Coupled with this, increasing numbers of patients survive their initial diagnosis but live with recurrent cancer requiring ongoing treatment. The mounting numbers of patient requiring cancer treatment will put increasing pressure on the health system and, in particular, on dedicated cancer services such as radiation therapy. Radiation therapy is a safe and highly effective treatment for many types of cancer, in both the curative and palliative settings. Examination of the radiation therapy workflow might identify opportunities to streamline processes and enhance patient outcomes. This may include changes to traditional roles and scopes of practice of those who deliver care. Advanced practice radiation therapist (APRT) roles have been shown to provide improvements in service delivery. There are few APRT roles in Australia and none in regional and rural radiation oncology centres. This study seeks to investigate whether APRT roles may be an acceptable approach to addressing gaps or delays in radiation therapy departments in Tasmania and whether implementation of APRT roles might be a strategy to meet rising demands. The primary aims of this study were: to map the current literature on APRT in Australia; to examine the patient journey and explore the current opportunities for, and perceptions toward APRT roles of professionals working in a regional radiotherapy setting, including radiation therapists, radiation oncologists and radiation oncology medical physicists. This explanatory sequential mixed methods study commenced with a scoping review to examine the literature regarding the development, implementation, scope, and extent of APRT roles in Australia and was followed by three phases of research. The first phase of the study involved an examination of the pre-treatment pathway for patients receiving radiation therapy and a retrospective analysis of task duration with the aim of understanding the setting in which the research took place. The second phase was an anonymous online survey distributed to radiation oncology professionals (radiation oncologists, radiation therapists and radiation oncology medical physicists) in the three public radiation oncology departments in the state of Tasmania examining the perceptions and opinions of APRT roles. Phase three of the study involved semi-structured interviews with self-selected radiation oncology professionals, to gain richer data to augment that found in the first and second phases of the study. The findings of the original and follow up scoping review indicated that there was limited evidence exploring APRT roles in Australia and a paucity from regional and rural departments. The research setting for the collection of service data was typical of a regional radiation oncology department. Examination of six months of Carepath data comprising 394 patient pathways revealed that 35.7 % did not have valid time points for all tasks. An analysis of task duration in the pre-treatment pathway revealed that there was large variation in both individual tasks and overall duration of the pre-treatment pathway. Further examination of the three most frequent diagnosis groups (lung, breast, prostate) revealed that whilst there was no significant difference in overall path duration, significant differences were found in the contouring and RO review tasks. Survey results indicated that respondents were generally in favour of APRT roles but were not clear about the tasks they would undertake. Participants generally agreed that clinical expertise, leadership, communication, collaboration, and teaching were features of APRT roles. Contouring, image review and clinical research were the most commonly selected tasks suitable for APRTs. Whilst participants agreed that the role could lead to improvement in job satisfaction, opportunities, recruitment, and retention for RTs, they also felt that APRTs could be used to relieve workload of other professionals. These issues were further explored in semi structured interviews with 12 participants from all three disciplines. The APRT role was supported in principle in the interviews, however on interrogation, participants placed an emphasis on clinical expertise and envisioned the role as RTs working in extended roles rather than advanced roles. The participants of the interview phase identified where delays in the pre-treatment pathway may occur and areas of practice where radiation therapists could undertake delegated tasks to address these delays. This study illuminates the perceptions of APRT roles amongst radiation oncology professionals in Tasmanian public radiation oncology departments. Examination of the Carepaths found that there may be opportunities to reduce the duration of the pre-treatment pathway. This may include changing the scope of RT practice however this change was construed as a clinical offset rather than as fulfilling all the pillars of advanced practice. APRT roles offer an opportunity to improve delivery of services, patient experience and staff development. When examining suitability for regional and rural radiation oncology departments, a number of issues need to be considered, including the workload and case profile, areas of practice where APRT services would be needed, the training and professional development pathway and perceptions of the function of the role if implemented. While APRT were considered to be potentially beneficial to delivering clinical services in a regional public hospital setting, this study showed that they were perceived largely to have a role in addressing clinical workload issues rather than an opportunity for career advancement and service innovation