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Radiotherapy and Oncology ; 174(Supplement 1):S49, 2022.
Article in English | EMBASE | ID: covidwho-2132765


Purpose: Beyond patient symptom management during treatment, patient reported outcomes (PRO) play a critical role in oncology survivorship. Although considered standard of care, PRO collection and use is challenging for radiotherapy (RT) centres lacking electronic PRO (ePRO) infrastructure. This work outlines facilitators and barriers to the implementation of an ePRO program across a multicentre radiation oncology department. Material(s) and Method(s): Dalhousie University's Department of Radiation Oncology (DRO) is composed of four RT centres across three provinces. Department-wide implementation of ePRO was precipitated by several key events: In 2009, a Canadian Partnership Against Cancer (CPAC) grant enabled 2 centres to begin paper-based PRO using the Canadian Problem Checklist (CPC) and Edmonton Symptom Assessment System (ESASr). In 2015, the Department's research retreat set ePRO as a priority. In 2017, Accreditation Canada mandated routine evaluation of patient outcomes and in 2018, the Canadian Partnership for Quality Radiotherapy (CPQR) identified Dalhousie's DRO as an early adopter within the pan-Canadian PRO initiative. In 2019, three DRO centres were awarded CPAC funding to launch ePROs. The fourth centre now hopes to use lessons learned in order to facilitate their ePRO implementation. Result(s): ePRO was launched in September 2021 with a phased approach across centres and tumour sites so that user feedback can inform the roll out. Clinic workflows now includes ePRO at consultation, first and last RT review as well as follow-up. Within the ePRO application (Noona), CPQR-endorsed PRO tools include CPC, ESASr, and the Brief Pain Inventory (BPI), with use of other tumour-site specific questionnaires planned. Project charter included needs assessments (human resource, staff /patient education) and change management strategies required to obtain buy-in from front line staff. Although coordination of such a large-scale initiative was challenged by COVID restrictions, project priority was escalated with ePRO recognized as a powerful tool to assess patient symptoms in clinic or remotely. Research unit support was invaluable to navigate IT project complexities including vendor/collaborator contracts, processes of Privacy Impact Assessments and IT architectural reviews. From the advisory board to PRO working groups, mullti-stakeholder feedback and collaboration has been key, including representatives of patients, cancer program leadership, project managers/principle investigators, administrative staff, nurses, radiation therapists, radiation oncologists, industry, IT and legal. Conclusion(s): Multi-centre implementation of an ePRO program has been feasible but complex and time intensive. It is hoped that our lessons learned may benefit those RT centres aiming to transition from paper-based to ePRO systems. With critical electronic infrastructure now in place, we await data to analyze ePRO amongst other patient outcomes in ongoing RT Big Data initiatives. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (

Radiotherapy and Oncology ; 163:S50, 2021.
Article in English | EMBASE | ID: covidwho-1747458


Purpose: The six radiation therapy (RT) centres in Atlantic Canada (AC) are equipped with modern technology capable of stereotactic, hypofractionated radiation techniques (SRS, SRT, SABR). However, these techniques remain significantly underutilized. A grant-funded, collaborative, regional quality improvement project was designed to support the implementation of precision RT techniques through inter-professional learning. The objective of this report is to describe the program design and early deliverables. Materials and Methods: A team from the AC Cancer Centres and Princess Margaret Cancer Centre was convened. A needs survey of AC RT centres conducted in 2019 and updated in 2020 guided program development. Adapting to COVID-19 pandemic restrictions, a virtual CME program delivered in four phases over four months was planned. The program includes expertled presentations and discussions, sharing of knowledge and protocols, and the development of centre-specific teams, goals, and implementation plans. A coordinated formative evaluation, using a realist evaluation approach, was designed to monitor implementation and address centre-specific and region-wide challenges to achieve accelerated implementation of precision RT techniques. Quantitative and qualitative methods will utilize the following data to be collected: use of the implementation strategies;timelines and local adoption of stereotactic RT techniques;specialists' knowledge and comfort level;specialists' satisfaction and experiences with the education received;and specialists' and decision-makers' perspectives on implementation processes, barriers, and facilitators. Results: Phase I and II consisted of two half-day virtual meetings. One hundred twenty-six participants including radiation therapists (40), radiation oncologists (27), medical physicists (19), planners (15), trainees (10), administrators (six), nurses (four), and others (five) from all six AC RT centres. Centres with developed protocols for stereotactic RT techniques provided expert content. Virtual break-out rooms grouped centre-specific inter-disciplinary teams who determined customized goals and commenced the development of implementation plans with leadership approval. Follow-up meetings will be conducted at two and four months. Grant funding was used to support meeting organization, RTT participation, online communication platforms, and a project coordinator. The evaluation is ongoing. Conclusions: With a collaborative expert-guided approach, evidence-based advancements in RT delivery can be accomplished in an accelerated manner on an AC regional basis despite variations in centre size and mandates. Evaluation of this process will inform on enablers to accelerate technology and improvements in the care of patients undergoing RT.