Attitudes and access to resources and strategies to improve quality of radiotherapy among US radiation oncologists: A mixed methods study - PubMed (original) (raw)

Attitudes and access to resources and strategies to improve quality of radiotherapy among US radiation oncologists: A mixed methods study

Y Helen Zhang et al. J Med Imaging Radiat Oncol. 2022 Oct.

Abstract

Introduction: We aimed to assess contouring-related practices among US radiation oncologists and explore how access to and use of resources and quality improvement strategies vary based on individual- and organization-level factors.

Methods: We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi-structured interview. Kruskal-Wallis and Wilcoxon rank-sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis.

Results: Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring-related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease-site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2-14.8) and younger physicians (OR 1.33 for each 5-year increase, 95% CI 1.08-1.67). Common physician-reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease-site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease-site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour-specific review, which is more common in academic centres (P = 0.02).

Conclusion: Potential opportunities to improve radiation contour quality include improved access to disease-site specialists and contour-specific peer review. Physician time must be considered when designing new strategies.

Keywords: peer review; radiation contouring; radiation oncology; radiotherapy planning; survey methodology.

© 2022 The Royal Australian and New Zealand College of Radiologists.

PubMed Disclaimer

Figures

Figure 1.

Figure 1.

A) How often do questions arise in the treatment planning process? (n=115) B) When you have a question about contouring, how often do you use the following resources? (n=114)

Figure 2.

Figure 2.

What barriers exist to optimizing the quality of contours and treatment plans in your practice? (Select all that apply; n=114)

*

less likely to make recommended changes to final contours after peer review (p<0.05)

References

    1. Ohri N, et al. , Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst, 2013. 105(6): p. 387–93. -PMC -PubMed
    1. Peters LJ, et al. , Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol, 2010. 28(18): p. 2996–3001. -PubMed
    1. Boero IJ, et al. , Importance of Radiation Oncologist Experience Among Patients With Head-and-Neck Cancer Treated With Intensity-Modulated Radiation Therapy. J Clin Oncol, 2016. 34(7): p. 684–90. -PMC -PubMed
    1. Palma DA, et al. , Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet, 2019. 393(10185): p. 2051–2058. -PubMed
    1. Small W Jr., et al. , Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys, 2008. 71(2): p. 428–34. -PMC -PubMed

MeSH terms

Grants and funding

LinkOut - more resources