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Case Expert Radiation Therapist Practice Model: Future of Patient- Centred Care

Purpose: At many institutions, distinct teams of Radiation Therapists (RT) perform specific tasks in the radiotherapy process (e.g. planning). This task-focused deployment of RTs results in technical expertise and high-quality aspects of treatment. However, the care as experienced by patients is fragmented by multiple RT handovers which may be strained with increasingly individualized treatment. Adaptive Radiation Therapy (ART), for example involves systematic monitoring of patient, tumor and environment variations during treatment to adapt the plan. Online ART requires simultaneous deployment of several technical and supportive skills, that the standard task-focused RT-model is not able to support. Therefore, our institution has been developing a novel patient-centered model of care in radiation therapy and its implementation is reported here.

Methods: Two 4-month pilot studies were conducted in 2017-2018 to prototype and refine the Case Expert Radiation Therapist (CERT) practice model. In this model, patients are partnered with a single RT at their first department appointment who, working within the clinical teams, performs and coordinates technical and patient support activities at priority points-of-care and along the treatment trajectory. Stakeholders and patients were surveyed using both in-house and validated tools for their input on the CERT model. Post-pilot implementation of the CERT model began with a 5-month RT skills refresh (simulation, planning, and delivery) in April 2019 and clinical deployment commenced in September 2019. Trained CERTs in the implementation phase accrue and follow patients from initial patient education, CT-simulation, through plan generation and will treat patients as often as is feasible, prioritizing first and last treatments and weekly assessment.

Results: Over 300 patients were treated in the CERT model pilots. Overall, ≥95% of patients (n=173 surveyed) were satisfied with their experience. Compared to the standard practice model, 20% more patients in the CERT model were satisfied with the information they received and with RT staff consistency. On average, CERTs performed 70% of the priority points-of-care for their patients versus 40% in standard practice. Notably, RTs reported significant deterioration of technical skills. Multi-disciplinary stakeholders (n=83) perceived improvements in patient support and workflow challenges with the model. Since the implementation phase commenced, 17 CERTs have completed skills refresh to date and training aims to include 75% of RTs. Remaining RTs will continue to specialize in specific tasks. Preliminary stakeholder data from the implementation phase are consistent with earlier pilot studies. The greatest benefit of the CERT model reported by RTs who previously only performed treatment delivery is their ability to now perform CT-simulation, design and optimize plans and feel confident performing patient work ups, image matching and quality assurance. Evaluation of CERT includes stakeholder satisfaction (e.g. staff burnout, patient-reported experience measures), continuity of care and the number of RTs competent across RT scope of practice and confidence to perform ART.

Conclusions:  Partnering patients with a single RT seems to enhance care coordination and patient experience as well as RT preparedness to perform ART. Planning for prospective clinical studies and economic analyses of the new patient-centered RT model is underway.