The Development of Practice Standards for Radiation Oncology in Australia: A Tripartite Approach

doi:10.1016/j.clon.2015.01.005

Clinical Oncology

Volume 27, Issue 6, June 2015, Pages 325-329

https://doi.org/10.1016/j.clon.2015.01.005 Get rights and content

Highlights

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16 practice standards were developed by a multidisciplinary group in Australia for radiation oncology.
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The standards are structured into three main groups: Facility management; Treatment planning and delivery; Safety and quality management.
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Including extensive consultation, workshops and a pilot compliance test the process took more than 5 years for completion.

Abstract

In many areas of health care, practice standards have become an accepted method for professions to assess and improve the quality of care delivery. The aim of this work is to present the development of practice standards for radiation oncology in Australia, highlighting critical points and lessons learned. Following a review of radiotherapy services in Australia, a multidisciplinary group with support from the Australian Government developed practice standards for radiation oncology in Australia. The standards were produced in a multistep process including a nationwide survey of radiotherapy centres and piloting of the standards in a representative subset of all Australian radiotherapy centres. The standards are grouped into three sections: Facility management (covering staffing, data management, equipment and processes); Treatment planning and delivery (providing more detailed guidance on prescription, planning and delivery); Safety and quality management (including radiation safety, incident monitoring and clinical trials participation). Each of the 16 standards contains specific criteria, a commentary and suggestions for the evidence required to demonstrate compliance. The development of the standards was challenging and time consuming, but the collaborative efforts of the professions resulted in standards applicable throughout Australia and possibly further afield.

Introduction

Quality assurance is an important aspect of clinical oncology in general and includes the safe delivery of radiation therapy. Many documents exist that provide guidance on how to implement or conduct quality activities in this field [1], [2], [3]. However, most of these guidelines focus on one or a few aspects of the overall services, with technical issues often being the centre of attention [4], [5]. As such, standards that capture the whole continuum of radiation therapy delivery from clinical documentation and treatment prescription to machine calibration and treatment delivery could be an important tool to provide guidance that can be adopted uniformly by all radiation therapy departments.

The need for standards was highlighted in a wide ranging review of radiation oncology services in Australia conducted in 2002 by P. Baume [6]. Similar reports, often unfortunately prompted by radiation accidents, are available from a variety of sources [7]. The Baume report identified a number of safety and quality issues affecting radiation oncology in Australia. One of the key tasks for the professions became the development of practice standards for radiation oncology that could inform and guide a quality programme in Australia. The aim of this report is to present the standards and briefly describe the process of their development, highlighting critical points and discussing lessons learned in the process.

Section snippets

Materials and Methods

Following the Baume report into radiation oncology in Australia [6], a Radiation Oncology Reform Implementation Committee (RORIC) was established with representation from all jurisdictions in Australia (state and federal government), a consumer representative and the three professions that make up the radiotherapy tripartite [radiation oncologists represented by the Royal Australian and New Zealand College of Radiologists (RANZCR); radiation therapists represented by the Australian Institute of

Results

As can be seen from Table 1, phase 1 of the process resulted in 16 standards with more than 300 indicators. As the standards were produced by different authors they displayed a variety of styles and approaches. These shortcomings were highlighted in two rounds of feedback from all stakeholders in 2007, about 2 years after the initial conception of the standards. Consequently, a smaller group was convened consisting of members of the main radiation oncology professions and additional experts, as

Discussion

The development of the standards has been a 6 year process and it would have been difficult to conduct it to conclusion without the financial support, administrative assistance and encouragement from the Australian Government's Department of Health. In hindsight, the process could have been significantly streamlined by tasking a small group of professionals directly with the development of the standards as per phase 2 of the present work. Regular feedback to and from the professions was

Conclusion

The development of the practice standards for radiation oncology in Australia proved to be a challenging and time-consuming process, which provided a useful forum for interaction between the professions. A set of 16 standards that focus on the treatment pathway and cover facility management, treatment planning and delivery, and safety and quality management was developed. The standards serve as a benchmark for quality improvement for existing facilities and provide guidance and support as new

Conflict of Interest

T. Kron is an advisor for the Australian Clinical Dosimetry Service, which is providing services to radiotherapy facilities that assist in meeting the requirements of standard 15.

Acknowledgement

The authors wish to thank the Department of Health of the Australian Government for financial support for this project.

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Citation Excerpt :
Efforts by other groups to construct an outcomes database, such as Oncospace, have similar overall objectives but have pursued a different implementation strategy.15 The importance of focusing first on the need for consensus in prescription and DVH metrics has been highlighted by several groups.9,11-13 By focusing first on finding a department-wide solution, we have been able to accumulate data for all patients treated in the practice, rather than for a specific subgroup.
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Short ReportThe Development of Practice Standards for Radiation Oncology in Australia: A Tripartite Approach

Highlights

Abstract

Introduction

Section snippets

Materials and Methods

Results

Discussion

Conclusion

Conflict of Interest

Acknowledgement

Radiother Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiother Oncol

Int J Radiat Oncol Biol Phys

Setting up a radiotherapy programme STI/PUP 1296

Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: work package 1

Radiother Oncol

Short Report
The Development of Practice Standards for Radiation Oncology in Australia: A Tripartite Approach