Exploring opportunities & pathways for advanced practice radiation therapy roles in the United States
Samantha Skubish, Clodagh Starrs, Danielle McDonagh
Abstract
The evolution of practice of Radiation Therapy in the United States (U.S.) is inevitable. The scope of a radiation therapists role has progressed with advancing technology, implementation of special procedures and patient care requirements. Internationally, Canada, Australia and the United Kingdom have formalized this evolution through the Advanced Practice Radiation Therapist (APRT) role to provide new models of care, to meet growing demands in the practice of Radiation Oncology, to increase efficiency, decrease cost and retain skilled staff (Harnett et al., 2018; Society of Radiographers; Linden et al., 2019; Coleman et al., 2014) [1Harnett N, Bak Kate, Lockhart E, Ang M, Zychla L, Gutierrez E, et al. The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada. J Med Radiat Sci 2018;65(2):86-96. doi: 10.1002/jmrs.281.Google Scholar, 2Society of Radiographers. 100 years edition https://www.sor.org/learning/document-library/consultant-radiographer-guidance-support-new-and-established-roles/advanced-clinical-practice.Google Scholar, 3Linden K. Renaud J. Zohr R. et al.Clinical specialist radiation therapist in palliative radiation therapy: Report of an orientation, training, and support program.J Med Imaging Radiat Sci. 2019; 50: 543-550Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 4Coleman K. Jasperse M. Herst P. Yielder J. Establishing radiation therapy advanced practice in New Zealand.J Med Radiat Sci. 2014; 61: 38-44https://doi.org/10.1002/jmrs.33Crossref PubMed Scopus (14) Google Scholar]. Through evidence based practice, the APRT role has proven to provide benefits for multiple stakeholders including service-reconfiguration to reduce wait times, developing and retaining highly skilled radiation therapists, treatment review and most importantly improving patient care within much needed patient cohorts such as the palliative population (Duffton et al., 2019) [[5]Duffton A, Devlin L, Tsang Y, Mast M, Leech M, ESTRO RTTC. Advanced practice: an ESTRO RTTC position paper. Tech Innovat Patient Support Radiat Oncol 2019;10:16–19.Google Scholar]. The U.S. is no exception to requiring innovative care models and solutions to similar complex, care delivery challenges experienced internationally. The U.S. is experiencing an increase in demand for cancer services and a rapid rate of technological and treatment advancements. Under the current infrastructure, this has impacted the daily tasks of physicians; increasing workload, increasing the complexity of clinical decision making, increasing movement toward site specific subspecialty practice and pushing the scope of radiation therapists informally toward maximization, increased autonomy and a higher level of education and specialized skills (American Society of Clinical Oncology, 2016; ARRT, 2020; Vu et al., 2018) [6American Society of Clinical Oncology The state of cancer care in America, 2016: A report by the American society of clinical oncology.J Oncol Pract. 2016; 12: 339-383Crossref PubMed Scopus (89) Google Scholar, 7Education requirements primary - ARRT. Arrt.org. Accessed October 19, 2020. https://www.arrt.org/pages/earn-arrt-credentials/initial-requirements/primary-requirements/education-requirements-primary.Google Scholar, 8Vu C.C. Lanni T.B. Nandalur S.R. Trends in Medicare reimbursement and work relative value unit production in radiation oncology.J Am College Radiol: JACR. 2018; 15: 870-875Abstract Full Text Full Text PDF Scopus (15) Google Scholar].ObjectiveThe following reviews the current radiation therapy practice and professional landscape in the United States as it relates to advanced practice, exploring opportunities and challenges under the U.S. health care infrastructure. This broad analysis provides comparison to other countries and disciplines such as the Radiologist Assistant and Nurse Practitioner for potential pathways to establishing the role and describes current needs and value of the expanding scope of RT’s practicing in the U.S.