Canadian radiation oncologists' opinions regarding peer review: A national survey.

PURPOSE: To determine Canadian radiation oncologists' (ROs) views regarding the benefits, workload implications, and legal liability of the peer review quality assurance (QA) process. METHODS AND MATERIALS: A 26-item anonymous survey was electronically distributed to all current practicing ROs in Canada through the Canadian Association of Radiation Oncologists membership to obtain their opinions regarding peer review. RESULTS: The survey was completed by 145 (36%) of 404 ROs. Most (82%) reported their practice is moderately or very busy and more than two-thirds (69%) felt stressed by their workload. A peer review process is standard at 92% of respondents' institutions. The majority reported this consists of weekly meetings where ROs and other health care providers convene to review radiation treatment plans; some have tumor site-specific rounds while others have 1 meeting for all sites. Nearly all (97%) found this type of QA is beneficial for review of radical plans and 71% found it is beneficial for palliative plans. Incorporating peer review into their current work schedule for all sites was deemed by 37% of respondents to be not or slightly difficult, while 40% found it moderately difficult and 22% very or extremely difficult. The majority (91%) reported that creating a work code to document QA meetings would be helpful and 69% stated that extra resources such as scheduling protected time, designating other health care providers QA coordinators, and increasing overall RO manpower are needed to implement effective peer review. Over half (52%) felt documenting QA meeting minutes would increase legal liability. CONCLUSIONS: The majority of ROs who responded found that peer review is beneficial and participate in peer review for at least some of the tumor sites they treat. However, most stated that extra resources are required to effectively implement QA for all tumor sites in their current schedule.

Parents' perspectives of life challenges experienced by long-term paediatric brain tumour survivors: work and finances, daily and social functioning, and legal difficulties.

BACKGROUND: Paediatric brain tumour survivors (PBTS) are at high risk for medical, neurocognitive and psychological sequelea during adulthood. Details illustrating the types and breadth of these chronic sequelae are essential to fully comprehend their impact on daily living. PURPOSE: This study describes Canadian parents of PBTS perspectives of life challenges experienced by their now adult son or daughter related to work and finances, daily and social functioning, and legal difficulties. METHOD: Parents of PBTS completed an anonymous online exploratory survey. FINDINGS: Forty-six of 60 invited parents completed the survey. Parents reported that PBTS experienced difficulty gaining or sustaining employment (65 %) because of their health and/or a disability and employers reticence to hire and adequately support PBTS. Independent living was considered unaffordable for PBTS who received a disability allowance (82 %) and those who were employed (50 %). Thirty percent indicated their family experienced hardship because of PBTS medical expenses, which were usually paid for out of pocket (76 %). Although the majority of PBTS were independent with daily tasks and social functioning, a subgroup required continuous support. Forty percent of employed PBTS received limited assistance to accommodate their special needs. Parents indicated their son or daughter had been the victim of theft, fraud or assault (37 %), and commonly considered them vulnerable, in need of protection and feared for their future safety. CONCLUSION: Research that further illuminates the hardships facing PBTS and informs the development of support and resources to address PBTS vulnerabilities is warranted. IMPLICATIONS FOR CANCER SURVIVORS: PBTS are at risk for unemployment, financial challenges and legal difficulties, which appear to be poorly addressed by health and social programs.

Assessing the risk of inadvertent radiation exposure of pregnant patients during radiation therapy planning and treatment in British Columbia.

PURPOSE: To explore health care professionals' perceptions of, and experience with, the risk of inadvertent radiation exposure to pregnant patients in radiation therapy (RT) departments. METHODS AND MATERIALS: The survey was distributed to 342 health care professionals working in RT departments in British Columbia (BC), including radiation therapists, medical physicists, radiation oncologists, and radiation oncology residents. RESULTS: There were 119 responses, 65% of who were radiation therapists. Respondents' mean duration of experience was 13.9 years (range, 1-25), over which time the BC Cancer Agency has delivered at least one course of RT to an estimated 16,000 women under the age of 50. Of the responses, 11.6% indicated that they had ever, in their training or career, encountered a situation where RT was inadvertently given to a pregnant patient. Upon reviewing anonymous comments, at least 7 discrete incidents were described. Fifty-two percent of radiation oncologists never, or only occasionally, remembered to discuss the risk of RT in pregnancy; 53% did not believe there were signs posted in their cancer center warning patients or reminding staff of this risk. Furthermore, 61% did not know if there was any patient education material designed for this purpose. Establishment of a checklist to screen for potentially fertile females prior to RT was felt to be a useful intervention by 49% of respondents. CONCLUSIONS: There is a risk of RT exposure to pregnant patients. Procedures and policies to prevent inadvertent irradiation of pregnant patients appear to be inadequate in BC. Provincial policies should be introduced to help reduce the risk of inadvertent RT of pregnant patients.

Prospective evaluation of legal difficulties and quality of life in adult survivors of childhood cancer.

BACKGROUND: Adult survivors of childhood cancer (ASCC), especially those of the central nervous system (CNS), have increased risks of educational and social difficulties. It is therefore hypothesized they are more likely to encounter legal difficulties (LDs), such as workplace discrimination and disability insurance denials, which may negatively affect their quality of life (QoL). PROCEDURE: We developed a survey to collect information on patients' legal needs. QoL was assessed using the Functional Assessment of Cancer Therapy (FACT). RESULTS: We prospectively approached 112 ASCC, 111 (99.1%) of whom completed the survey. The median age of respondents was 7 years at diagnosis and 31 years at survey completion. CNS tumors were the most common malignancy (32.4%). LDs were common overall (40.7%), though more prevalent in patients with CNS versus non-CNS tumors (58.6% vs. 32.3%; P = 0.023). The most prevalent LD was workplace discrimination (58.3%). On multivariate analysis, CNS tumor was the only variable significantly associated with LDs (OR = 4.49, P = 0.041). Individuals with LDs had lower QoL scores compared to those without LDs (79.96 versus 91.83 on the FACT; P = 0.005). On multivariate analysis, individuals with LDs had lower QoL scores (14.95 points lower on the FACT), which is both clinically and statistically significant (P = 0.047). CONCLUSIONS: Legal difficulties are common in adult survivors of childhood cancer, especially those with brain tumors. Furthermore, individuals with legal difficulties have worse quality of life. Research is needed to develop effective and accessible legal resource programs.

Health care-associated hepatitis B and C viruses: legal aspects.

The risk of hepatitis B and C transmission in health care settings has generated considerable attention within the legal system. This article begins with an overview of the relevant sources of law and then explores legal duties and liability arising from two major categories of risk: occupational risks to health care providers and health care-associated risks to patients and other third parties.

Tort liability of xenotransplantation centers.

BACKGROUND: In the view of future clinical trials, defining possible legal theories under which xenotransplantation center could be held responsible for any adverse effect on public health is becoming increasingly important. METHODS: In order to better define the tort liability of xenotransplantation center, we reviewed the existing cases and statutes on tort and public health law. RESULTS: Xenotransplantation center could be sued under various tort actions, including negligence, public nuisance or strict liability for ultrahazardous activity. Prerequisites for each legal action are discussed and possible scope of tort liability is addressed. CONCLUSION: The promotion of positive public perception and the development of appropriate insurance system could prevent future class actions to succeed in abating the xenotransplantation industry.