Nicole Harnett

The evaluation of learner outcomes in interprofessional continuing education: A literature review and an analysis of survey instruments

Background: Interprofessional education (IPE) is thought to be important in fostering interprofessional practice (IPP) and in optimizing patient care, but formal evaluation is lacking. Aim: To identify, through review of IPE evaluation instruments in the context of Barr/Kirkpatricks hierarchy of IPE learner outcomes, the comprehensiveness of current evaluation strategies and gaps needing to be addressed. Methods: MEDLINE and CINAHL were searched for work relating to IPE/IPP evaluation published between 1999 and September 2010 that contained evaluation tools. Tool items were stratified by learner outcome. Trends and gaps in tool use and scope were evaluated. Results: One hundred and sixty three articles were reviewed and 33 relevant tools collected. Twenty-six (78.8%) were used in only one paper each. Five hundred and thirty eight relevant items were identified, with 68.0% assessing changes in perceptions of IPE/IPP. Fewer items were found to assess learner reactions (20.6%), changes in behaviour (9.7%), changes in knowledge (1.3%) and organizational practice (0.004%). No items addressed benefits to patients; most were subjective and could not be used to assess such higher level outcomes. Conclusions: No gold-standard tool has been agreed upon in the literature, and none fully addresses all IPE learner outcomes. Objective measures of higher level outcomes are necessary to ensure comprehensive evaluation of IPE/IPP.

Effectiveness of educational intervention on the congruence of prostate and rectal contouring as compared with a gold standard in three-dimensional radiotherapy for prostate.

PURPOSE To examine effects of a teaching intervention on precise delineation of the prostate and rectum during planning of three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. METHODS AND MATERIALS A pretest, posttest, randomized controlled group design was used. During pretest all participants contoured prostate and rectum on planning CT. Afterward, they participated in two types of workshops. The experimental group engaged in an interactive teaching session focused on prostate and rectum MR anatomy compared with CT anatomy. The control group focused on 3D-CRT planning without mention of prostate or rectal contouring. The experimental group practiced on fused MR-CT images, whereas the control group practiced on CT images. All participants completed the posttest. RESULTS Thirty-one trainees (12 male, 19 female) were randomly assigned to two groups, 17 in the experimental arm, and 14 in the control group. Seventeen felt familiar or very familiar with pelvic organ contouring, 12 somewhat, and 2 had never done it. Thirteen felt confident with organ contouring, 13 somewhat, and 5 not confident. The demographics and composition of groups were analyzed with chi(2) and repeated-measures analysis of variance with the two groups (experimental or control) and two tests (pre- or posttest) as factors. Satisfaction with the course and long-term effects of the course on practice were assessed with immediate and delayed surveys. All performance variables showed a similar pattern of results. CONCLUSIONS The training sessions improved the technical performance similarly in both groups. Participants were satisfied with the course content, and the delayed survey reflected that cognitively participants felt more confident with prostate and rectum contouring and would investigate opportunities to learn more about organ contouring.

The scholarly radiation therapist. Part one: charting the territory

As radiation therapy practice evolves with advancing treatment and planning technologies, merging of imaging modalities, changing working models and the advancement to higher education, radiation therapists are frequently finding themselves on the frontline of translating new knowledge into practice. To a large degree, this growing involvement in self-directed original research, with associated dissemination of completed results, has led to an increasing number of therapists being encouraged to pursue an academic path in addition to a clinical career. In Canada, radiation therapists are being appointed as faculty to university departments for the first time. It is heartening that such opportunities are increasing; therapists are able to play a profound role in developing an evidence-based professional body of knowledge while at the same time being recognised for scholarly endeavours. However, despite these many positive steps, barriers and challenges to the development of a scholarly culture for radiation therapists still exist. Part one of this two-part series explores the history of the profession and the subsequent development of a scholarly culture.

Barriers to accessing radiation therapy in Canada: a systematic review

IntroductionRadiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers.MethodsMEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context.Results535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n = 26, 34.7%), distance to treatment centre (n = 23, 30.7%), wait times (n = 22, 29.3%), and lack of physician understanding about the use of RT (n = 16, 21.6%).ConclusionsBarriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.

The scholarly radiation therapist. Part two: developing an academic practice—the Princess Margaret Hospital experience

Part two of this two-part series presents the results of a departmental initiative implemented in 2003 at a large urban cancer centre, Princess Margaret Hospital (PMH) in Toronto, Ontario, Canada. This new model for radiation therapists was called Advanced Integrated Practice (AIP) and was developed, in part, to encourage and promote scholarship within radiation therapy. The AIP model incorporated integrated clinical specialty roles designed to blend exemplary clinical practice with focused academic activities. This paper discusses an evaluation of the AIP model undertaken to obtain a formal measure of how the model had evolved, how the radiation therapists and other stakeholders were responding to the new model, whether the initial outcomes were realized and to create plans for further development of the design. The evaluation utilized a mixture of traditional qualitative research methodologies such as focus groups, quantitative surveys and a variety of other available measurable outcomes. Outcomes from the model included increased opportunities for diverse roles that incorporated an element of academic practice and augmented career choice and scope for radiation therapists. In addition, academic output and research work also increased within the department. Lessons learned from the implementation and evaluation of the model are shared, and the authors offer some suggestions to increase scholarly activity within the profession.

Fears and misperceptions of radiation therapy: sources and impact on decision-making and anxiety.

Recent media attention about radiation has led to heightened public awareness and concern about radiation therapy (RT). An understanding of concerns and their potential role in patient decision-making can inform education efforts. A multiphase needs assessment survey was designed to ascertain broad public perceptions of radiation (phase I) and the more in-depth cancer patient perceptions of RT (phase II). One hundred forty-six phase I and 111 phase II surveys were completed. Data suggested a prevalence of negative connotations of the word “radiation,” often associated with information from the media or secondhand experience. Side effects during and after RT were reported as concerns, including misperceptions about becoming radioactive and impact on fertility. Rankings of quality and safety perceptions suggested confidence in staff training and equipment, though concerns regarding overdoses and protection of healthy tissue were higher amongst those who refused RT. In deciding whether or not to undergo RT, high value was placed on the reputation of the cancer centre and the expected effectiveness of RT. The importance of understanding RT was more highly regarded by those who underwent RT than those who refused it. Perceptions of RT should thus be addressed amongst those in a position to consider RT, to maximize RT utilization where appropriate.

Anatomic features of interest in women at risk of cardiac exposure from whole breast radiotherapy.

BACKGROUND AND PURPOSE Left-sided breast radiotherapy (RT) can result in cardiac exposure. This study aims to identify predictive anatomic features in women requiring breath-hold (RT(BH)) for cardiac sparing during adjuvant whole breast RT. MATERIAL AND METHODS We retrospectively reviewed free-breathing (FB) CT scans of 80 women previously treated with left-sided breast RT. Unfavourable cardiac anatomy was defined as the number of consecutive axial CT slices (2 mm) in which the anterior chest wall contacted the heart (Contact(Heart)) or left ventricle (Contact(LV)). The sternal angle and Haller Index (HI) were used to measure chest concavity. Position and volume of post-operative cavity was also quantified. RESULTS Heart mean dose (D(mean)) was strongly correlated with Contact(LV) (r=0.625, p<0.001) and Contact(Heart) (r=0.524, p<0.001) but not significantly correlated with tumor size, cavity volume, heart volume, cavity distance to chest wall, sternal angle, or HI. ROC analysis of Contact(Heart) was most predictive of the need for breath-hold (RT(BH)) technique [Area Under Curve=0.815 (SE: 0.048; 95% CI: 0.721-0.91)] and ⩾25 Contact(Heart) CT slices predicted for heart D(mean) ⩾1.7 Gy (68% sensitivity and 82% specificity). CONCLUSION Contact(Heart) on FB CT of ⩾25 axial slices (2 mm), ⩾50 mm of para-sagittal heart contact, was predictive of higher heart D(mean) and suggest a potential need for RT(BH).

Image Guided Radiation Therapy: Unlocking the Future Through Knowledge Translation

Image Guided Radiation Therapy: Unlocking the Future Through Knowledge Translation Caitlin Gillan, MRT(T), BSc, MEd, FCAMRT,*,y Meredith Giuliani, MBBS, MEd, FRCPC,*,y Nicole Harnett, MRT(T), ACT, BSc, MEd,*,y Winnie Li, MRT(T), MSc,*,y Laura A. Dawson, MD, FRCPC,*,y Mary Gospodarowicz, MD, FRCPC,*,y and David Jaffray, PhD*,y *Princess Margaret Cancer Centre; and yDepartment of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada

179: It's Crunch Time: Finding Efficiencies With a New; APRT-mediated Model of Care

withdrawn 181 PATIENT EXPERIENCE SURVEY OF EARLY-STAGE BREAST CANCER PATIENTS UNDERGOING WHOLE BREAST RADIOTHERAPY Grace Lee, Robert Dinniwell, Anthony Fyles, Tatiana Conrad, Kathy Han, Wilfred Levin, Fei-Fei Liu, Susanne Lofgren, Alexandra Koch-Fitsialos, Gerald Devins, Nora Emad, Bethany Pitcher, Tony Panzarella, Anne Koch Princess Margaret Cancer Centre, Toronto, ON University of Toronto, Toronto, ON Purpose: Adjuvant breast radiotherapy (RT) is a standard treatment option in women with early-stage breast cancer following lumpectomy. Timeliness of RT treatment can impact patient satisfaction. The objectives of this study are to assess: 1) patient satisfaction of their whole breast RT; 2) patient preference for timing of RT start after CT simulation (CTSim); and 3) factors that influence patient stress and quality of life. Methods and Materials: Women undergoing whole breast RT were given a survey before RT treatment and at treatment completion. Patients were offered treatment either through the conventional process (ConvProcess), where RT starts typically within 1-2 weeks of CTSim, or the QuickStart (QS) process, where RT starts one day after CTSim. The pre-treatment (PRE-Tx) survey included questions to understand the social impact of RT, and the post-treatment (POST-Tx) survey included questions relating to social climate and patient satisfaction. Questions relating to RT start preference, stress (Perceived Stress Scale [PSS]) and quality of life (Illness Intrusiveness Ratings Scale [IIRS]), were assessed both at PRE-Tx and POST-Tx. An analysis of covariance was used to determine if the RT process impacted PSS and IIRS, and t-tests were used as a secondary analysis. Fisher’s Exact test was used where appropriate. Results: Ninety-six patients completed the PRE-Tx survey and 88 completed both surveys (QS process n = 28; ConvProcess n = 60). All patients indicated they had a positive experience with the RT

Communities of practice: A jurisdictional approach to improving the quality of care in radiation medicine in Ontario.

122 Background: The Radiation Treatment Program (RTP) at Cancer Care Ontario (CCO) established several Communities of Practice (CoPs), with the goal of improving radiation treatment (RT) quality and safety. The RTP identifies variation in practice and quality improvement (QI) opportunities in the 14 Regional Cancer Centres (RCCs) and facilitates the development of CoPs to share best practices and standardize care. METHODS Since 2010, the RTP has formed 7 CoPs ( > 185 members in total): 4 intra-disciplinary (Radiation Therapy, Medical Physics, Advanced Practice Radiation Therapy, Radiation Safety) and 3 inter-disciplinary (Head and Neck (HN), Gynecological (GYNE) and Lung Cancer). Members are recruited with the aim of securing engagement from all RCCs to ensure representation of regional diversity and to facilitate adoption of best practices. CoPs are supported with nominal funding and resources provided by CCO, but are led and driven by members, who identify and prioritize key quality issues and select corresponding QI projects to pursue. The RTP performs regular evaluation activities to assess initiative engagement and impact. RESULTS RTP CoPs have enhanced the quality and safety of RT delivery in Ontario through QI initiatives, advice documents and tools that have enabled: Improved RT safety (use of safety straps in RT delivery); Adoption of best practices (RT plan evaluation guidance); Education and knowledge transfer - (stereotactic body RT implementation and training framework); and Support for infrastructure improvements (recommendation for additional Magnetic Resonance-guided brachytherapy units) ( https://www.cancercare.on.ca/ocs/clinicalprogs/radiationtreatment/ ). Advice documents have improved alignment with recommended practice (40% and 50% absolute increases in two HN initiatives). Evaluation surveys indicate that members believe the CoPs have enhanced inter-regional communication and collaboration (89%), knowledge transfer/exchange (91%), and professional networking between RCCs (92%). CONCLUSIONS CoPs can be a highly effective model for improving quality of care. The establishment of CoPs should be considered for QI in other areas of the healthcare system.