Robin Milne

Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study

PURPOSE Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile. METHODS AND MATERIALS A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥ 7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile. RESULTS Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥ 7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items). CONCLUSIONS We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs.

Differences in perceptions of smoking and second-hand smoke (SHS) in palliative and nonpalliative patients with cancer.

251 Background: With improvements in cancer therapies, palliative patients with cancer now enjoy improved and sometimes prolonged survival. Continued smoking after a cancer diagnosis negatively impacts treatment response/toxicities, survival and quality of life and is influenced by SHS exposure. Little is known about the perceptions of palliative patients with cancer in comparison to patients who are considered potentially curative, on smoking after a cancer diagnosis and of SHS exposure. We assessed such potential differences in perception. METHODS Patients with cancer across all sites were surveyed with respect to their smoking habits and perceptions on how smoking and SHS influences cancer-related QofL, fatigue and overall survival (OS). Review of patient charts confirmed which patients were considered palliative versus potentially curative. Multivariable logistic regression models assessed for associations between treatment intent and patient perceptions, adjusted for significant co-variables. RESULTS Among 985 patients with cancer, 22% were considered palliative; 23% of surveyed patients smoked at diagnosis; 10% continued smoking at follow-up. Most patients perceived that continued smoking and SHS exposure negatively impacted QofL (continued smoking: 83%, SHS: 82%), fatigue (83%, 79%) and OS (86%, 81%). Palliative patients were more likely to believe that SHS worsened their cancer-related fatigue (adjusted odds ratio (aOR) = 1.65, 95% CI [1.05-2.56], P = 0.03) and worsened OS (unadjusted OR = 1.92, [1.12-3.33], P= 0.02; aOR = 1.56 [0.98-2.50], P = 0.06). Yet palliative/non-palliative status was not found to be associated with perceived benefits of smoking cessation on QofL, fatigue, or OS (P > 0.10, all comparisons). CONCLUSIONS When compared with non-palliative patients, palliative patients with cancer perceived a greater negative impact of SHS on fatigue and survival, but had similar views of continued smoking after a cancer diagnosis. We are encouraged that palliative status did not lead to patients having diluted perceptions on the negative impact of smoking on cancer outcomes. Health care providers should continue to focus on the positive impacts of smoking cessation and SHS in this setting.