Original ArticleA Multidisciplinary Evaluation of a Web-based eLearning Training Programme for SAFRON II (TROG 13.01): a Multicentre Randomised Study of Stereotactic Radiotherapy for Lung Metastases
Introduction
Quality assurance during technically demanding radiotherapy trials has been shown by such trials as the TROG 98.02 phase III [1] and the RTOG 9704 [2] to critically affect cancer outcomes and the likelihood of trial success. As more multicentre clinical trials of advanced technologies open, a high-quality credentialing programme can ensure that treatment techniques are delivered according to protocol. The importance of the credentialing process has been highlighted in the Gynecologic Oncologic Group Protocol 165 trial, which found that major protocol deviations were observed only in centres that did not receive credentialing compared with those centres that were credentialed [3].
In establishing a radiotherapy credentialing programme, a challenge for the trial management committee is to provide a clear protocol that can be interpreted in the same way by all participating hospitals. Co-operative clinical trials groups, such as the Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer, have published recommendations [4], [5] for establishing credentialing requirements. These recommendations for radiotherapy-based clinical trials emphasise the participation in a dosimetry audit as well as a planning dry-run exercise. For stereotactic ablative body radiotherapy (SABR), the challenge is the various levels of SABR experience in participating centres. Provision of education and training can therefore appeal to institutions where SABR is new. By mandating participation in a knowledge credentialing process, a minimum educational benchmark is ensured.
Web-based training is attractive because it can be easily delivered to large groups of participants in a relatively cost-effective way. The effectiveness of web-based training in a multicentre clinical trial setting has been reported by Foroudi et al. [6]. This report described the effectiveness of an eLearning platform that was part of the credentialing programme for the multicentre study of online adaptive radiotherapy (TROG 10.01) [7]. However, the effectiveness of such an education platform for a multidisciplinary audience has yet to be presented. Based on the success of this platform, our study will report on the effectiveness of web-based training in a trial of lung stereotactic radiotherapy. The TROG 13.01/ALTG 13.001 SAFRON II trial is a randomised phase II multicentre clinical trial comparing the toxicity of a single 28 Gy in one fraction regimen of SABR versus a 48 Gy in four fraction regimen (clinicaltrials.gov NCT01965223) [8]. The study target accrual is 84 patients in order to investigate the primary end point, which is the number of participants experiencing less than or equal to 5% toxicity at 12 months after treatment. As part of the development phase of this multicentre study, training and education for the multidisciplinary team (radiation oncologist, medical physicist and radiation therapist) was a component of the participating centre credentialing process.
The aims of this study were to investigate among radiation oncologists, medical physicists and radiation therapists: (i) knowledge retention of stereotactic body radiotherapy principles and (ii) individual self-confidence rating before and after eLearning intervention.
Section snippets
Participants
Institutional ethics board approval was received for this study. Radiation oncologists, medical physicists and radiation therapists from Australian and New Zealand centres who expressed interest in the SAFRON II study were invited to participate in the eLearning programme. A full protocol was provided to all participants who agreed with the eLearning programme.
Module Development
Training modules for lung SABR radiotherapy were developed to cover all aspects of the clinical pathway of a patient undergoing SABR
Results
In total, 130 participants from over 12 hospitals across Australia and New Zealand consented to participate in the eLearning study. Of this total, 104 (80%) participants completed their core modules, the remaining number started but did not complete various percentages of the entire curriculum. The predominant profession to enrol into the programme was radiation therapists (62.3%), followed by medical physicists (20.8%) and then by radiation oncologists (16.9%). There was a relatively even
Discussion
Protocol non-compliance can lead to inferior patient outcomes. Some notable examples include the study by Peters et al. [1] in head and neck malignancies; lack of protocol compliance translated to a 20% absolute overall survival detriment at 2 years. Similarly, in a multicentre phase III study of pancreatic cancer (RTOG 9704) [2], protocol compliance was associated with a statistically significant improvement in median survival from 1.46 years to 1.76 years, being a stronger predictor of
Conclusion
A web-based eLearning platform can be successfully completed in a multicentre clinical trial setting for SABR treatment of the lung. This knowledge credentialing process is feasible and shows knowledge improvement for the radiation oncologists, medical physicists and radiation therapists who participated. The improvement in knowledge is observed at both short-term and long-term testing. Confidence level was significantly improved in all core modules completed.
Acknowledgements
This research was supported by Cancer Australia's Priority Driven Collaborative Cancer Research grant APP1082399. For participation or further information about the SAFRON II eLearning programme, registration can be enquired through the Trans-Tasman Radiation Oncology Group at [email protected]
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