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      An evaluation of an advanced practice role in palliative radiation therapy

      research-article
      , MASMIRT, AP(RT) 1 , , , MBBS, FRANZCR 1 , 2 , , PhD 3
      Journal of Medical Radiation Sciences
      John Wiley and Sons Inc.
      Advanced practice, inter‐observer variability, palliative, quality improvement, radiation therapist

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          Abstract

          Introduction

          The purpose of the study was to evaluate the palliative advanced practice radiation therapy ( APRT) role with respect to the impact on waiting times for patients from referral to radiation treatment delivery, the ability of the APRT to define palliative radiation therapy fields and patient satisfaction. The evaluation of the impact of the APRT role and referral pathway on patient waiting times has been previously published.

          Methods

          Patients were allocated to two different pathways; APRT and standard. Patients in the APRT pathway had their radiotherapy treatment managed by the APRT including defining their palliative fields blinded to the radiation oncologist ( RO).

          Results

          Of the 150 palliative patients, 94 had their radiation therapy managed by the APRT and 56 were managed through the standard pathway. 82/92 APRT defined fields were accepted by the RO.

          Conclusions

          Inter‐observer variability between the APRT and the RO in defining palliative radiation therapy fields is similar to that reported in the literature between clinicians. With previously published reduced wait times from referral to treatment for palliative patients, the establishment of the APRT role is justified.

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          Most cited references24

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          Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases.

          To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis. Copyright © 2012 Elsevier Inc. All rights reserved.
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            Can Team-Based Care Improve Patient Satisfaction? A Systematic Review of Randomized Controlled Trials

            Background Team-based approaches to patient care are a relatively recent innovation in health care delivery. The effectiveness of these approaches on patient outcomes has not been well documented. This paper reports a systematic review of the relationship between team-based care and patient satisfaction. Methods We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and PSYCHOINFO for eligible studies dating from inception to October 8, 2012. Eligible studies reported (1) a randomized controlled trial, (2) interventions including both team-based care and non-team-based care (or usual care), and (3) outcomes including an assessment of patient satisfaction. Articles with different settings between intervention and control were excluded, as were trial protocols. The reference lists of retrieved papers were also evaluated for inclusion. Results The literature search yielded 319 citations, of which 77 were screened for further full-text evaluation. Of these, 27 articles were included in the systematic review. The 26 trials with a total of 15,526 participants were included in this systematic review. The pooling result of dichotomous data (number of studies: 10) showed that team-based care had a positive effect on patient satisfaction compared with usual care (odds ratio, 2.09; 95% confidence interval, 1.54 to 2.84); however, combined continuous data (number of studies: 7) demonstrated that there was no significant difference in patient satisfaction between team-based care and usual care (standardized mean difference, −0.02; 95% confidence interval, −0.40 to 0.36). Conclusions Some evidence showed that team-based care is better than usual care in improving patient satisfaction. However, considering the pooling result of continuous data, along with the suboptimal quality of included trials, further large-scale and high-quality randomized controlled trials comparing team-based care and usual care are needed.
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              An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy.

              Waiting for radiation therapy (RT) in Ontario has been a major problem for the past decade. In 1996, the Toronto-Sunnybrook Regional Cancer Centre (TSRCC) initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of patients with terminal cancer. This study reviews the clinical activity of the RRRP over the past 8 years to evaluate if we are meeting the objectives of the program. From the TSRCC oncology patient information system (OPIS) database, we retrieved the number of patients referred to the RRRP, their demographics, diagnosis and treatment for the calendar years 1996 to 2003 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of cases who started RT on their initial consultation for all new cases referred to the RRRP. From 1996 to 2003, the number of cases seen in consultation increased from just over 200 cases annually in the first 2 years to about 500 cases per year in the last 4 years, for a total of 3,290. There were 1,792 (54%) men and 1,498 (46%) women; median age was 69 years (range, 21-95 years). Breast, lung, genitourinary and gastrointestinal primaries accounted for over 80% of all referrals. The majority was referred for palliative treatment of symptomatic bone (70%) or brain (14%) metastases. The dose fractionation for bone metastases was a single 8-Gy fraction in 45%, 20 Gy in five fractions in 42%, 30 Gy in ten fractions in 4% and other dose fractionations in 9%. Nearly 90% were seen within 2 weeks of referral (38% within 1 week). Eighty-five percent were simulated on the day of their initial consultation. Sixty percent started their RT treatment on the day of their consultation visit. The overall median interval from referral to treatment was 8 days. Over the past 8 years, the annual number of new cases referred to the RRRP has doubled. The overall median interval from referral to consultation was 8 days. Sixty percent were simulated, planned and started treatment on the day of their initial consultation. We therefore are meeting our goal of providing rapid access to palliative RT for symptomatic cancer patients.
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                Author and article information

                Contributors
                mary.job@health.qld.gov.au
                Journal
                J Med Radiat Sci
                J Med Radiat Sci
                10.1002/(ISSN)2051-3909
                JMRS
                Journal of Medical Radiation Sciences
                John Wiley and Sons Inc. (Hoboken )
                2051-3895
                2051-3909
                26 February 2019
                June 2019
                : 66
                : 2 ( doiID: 10.1002/jmrs.2019.66.issue-2 )
                : 96-102
                Affiliations
                [ 1 ] Radiation Oncology Mater Centre Princess Alexandra Hospital Raymond Terrace South Brisbane, Brisbane Australia
                [ 2 ] University of Queensland Brisbane Australia
                [ 3 ] QFAB Bioinformatics Institute for Molecular Bioscience University of Queensland Brisbane Australia
                Author notes
                [*] [* ] Correspondence

                Mary Job, Radiation Oncology Mater Centre, Princess Alexandra Hospital, Raymond Terrace, 31 Raymond Terrace, South Brisbane 4101, Brisbane, Australia. Tel: +61 07 3840 3356; Fax: +61 07 3840 3399; E‐mail: mary.job@ 123456health.qld.gov.au

                Author information
                https://orcid.org/0000-0002-4904-1343
                Article
                JMRS318
                10.1002/jmrs.318
                6545471
                30809974
                8cb93ad9-c9ca-4322-abb9-f8a617ac097e
                © 2019 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 04 July 2018
                : 06 December 2018
                : 08 December 2018
                Page count
                Figures: 2, Tables: 3, Pages: 7, Words: 4175
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                jmrs318
                June 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:03.06.2019

                advanced practice,inter‐observer variability,palliative,quality improvement,radiation therapist

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