The Role and Development of Advanced Clinical Practice Within Allied Health Professions: A Mixed Method Study

To investigate the profiles of advanced clinical practitioners (ACPs) in the allied health professions (AHPs) and their skills, attributes, experiences and involvement in new models of care. A 2 phase, cross sectional, mixed method survey of AHP ACPs across London was conducted in 2018-2019. Online questionnaires were completed by 127 AHP ACPs and then semi-structured interviews were conducted with 15 AHP ACPs. The survey results gave a comprehensive overview of the attributes of AHPs in ACP roles across London. There was considerable variability between role titles, types and levels of qualification, and evolution of the roles. The respondents predominately worked in clinical practice, and less frequently in other ACP domains (research, leadership and management, education). The interview findings provided in-depth insights into the AHP ACP roles within four themes: being advanced, career pathways, outcomes of the advanced practitioner role and influencing and transforming. The "Being advanced" theme highlighted that expert practice comprised confident and autonomous practice, leadership, and applying specialist and expert decision-making skills. "Career pathways" highlighted the diversity within the participants' roles, titles, career opportunities and development. In the "Outcomes of the advanced clinical practitioner role" theme, the ACPs described their services as prompter, more accessible and providing an improved patient journey. The "Influencing and transforming" theme highlighted networking and dissemination and ideas for innovation, influencing and transforming services. This is the first comprehensive profile of ACP roles across AHPs and indicates that these roles are already having a positive impact on healthcare services and supporting new models of care. However, establishing the necessary infrastructure, standardization and governance for ACP roles across sectors, along with the career pathways, funding, sustainability and education, could increase impact in the future. [Abstract copyright: © 2020 Stewart-Lord et al.

Virtual training in patient information sessions prior to external beam radiotherapy

Purpose or Objective: The aim of the study was to explore the prostate patients’ perceptions of Virtual Environment for Radiotherapy Training (VERT) as an information giving resource prior to radiotherapy delivery

From education to research: A journey of utilising virtual training

© 2015 Cambridge University Press.Background London South Bank University (LSBU) has successfully implemented Virtual Environment for Radiotherapy Training (VERT) across the therapeutic radiography training curricula and are now supporting the use of VERT for patient education in clinical departments. A number of publications have reported on the use of VERT in education and training; more recent literature has focused on the use of VERT for patient education. Materials and methods The successful introduction of VERT before students' first clinical placements resulted in the development of a 'Pre-Clinical week' where students practice and improve their technical skills, using the hand controls without a patient present, leading to increased confidence in clinical practice. Other examples of VERT curriculum integration at LSBU focused on the use of VERT for anatomy teaching. The more recent innovation at LSBU relevant to VERT integration has been the design, development and implementation of collaborative research projects where the aims of the studies were to explore patients' perceptions of VERT as an information giving resource before radiotherapy delivery. Summary The introduction of VERT as education tool has enabled academic staff to develop a range of teaching methods to embed virtual training into the traditional classroom setting, demonstrating innovation and collaboration

How may shorter fractionation schedules affect patient care

This session aims to explore the use of hypofractionation in the radiotherapy management of different cancer types and how this ultimately can affect patient care. Hypofractionation has shown to be beneficial in the management of a wide range of cancers including other advantages such as cost savings3. Trials over the last decade have demonstrated the advantages of hypofractionation compared with a standard radiotherapy regimen3. Covid-19 significantly impacted the way in which cancer patients are managed and even though the use of hypofractionation is well established in some cancer types; the application thereof during the pandemic has been widely expanded to minimise treatment time. Even though the treatment outcomes have been well defined, there is limited evidence to suggest changes in patient care. Some oncology centres advocated for a reduced contact time between patient and staff. Hypofractionation in an ageing population is particularly advantageous in allowing people to receive treatment in a shorter time demonstrating treatment outcomes similar to younger age groups however; greater consideration should be given to performance status and comorbidities associated with these treatment outcomes11. Fractionation schedules which allow delivery in less fractions, can be highly effective with limited treatment-related toxicity. Studies have shown that the late consequences of radiotherapy in these patient groups are seldom an issue even with larger fraction sizes. However more recent studies suggest that a reduction in treatment time should not be the only reason for selecting this approach. Moderate hypofractionation should therefore be considered for those patient who are younger and who might experience long terms effects. More studies are now investigating the tolerability of ultra-hypofractionated radiotherapy in an attempt to improve the therapeutic gain in the management of cancer suggesting that these approaches are well-tolerated and showed no statistical difference in toxicity. Hypofractionation in radiotherapy may be a good alternative to conventional fractionation however patience care remains paramount in the management of all toxicities related the radiotherapy delivery. There is no evidence to suggest the patient care of these patients have changed, however the tolerability and outcomes of this method of delivery requires constant review. Patient care needs to consider the site of treatment, age of the patient, performance status, and tolerability. A model of shared decision making in managing care is advocated with greater emphasis on self-care

Assistant practitioners (APs) perceptions of their developing role and practice in radiography: Results from a national survey

Introduction: In 2000, the NHS Plan set out the government's plans for investment and reform across the NHS. Through the introduction of a new workforce at assistant practitioner (AP) level the Department of Health intended to implement new ways in which to deliver a more efficient service. At the time, little published information existed on the integration of these assistants into the contemporary radiography workforce. Publications were limited to experiences gained by various individual departments ranging in their perception of the role and education of APs. Further research was suggested to track the continuing implementation of the 4-tier structure, establish the precise nature and scope of the roles across Trusts and determine their impact on workload and patient care. Aim: To establish the number and employment locality of APs in radiography professions in England, and to explore their scope of applied practice. Method and materials: The study was conducted over three phases and employed a mixed methods design to address the aims and objectives. Phase I was a scoping exercise performed prior to data collection in which n = 226 radiography sites were identified for contact across England. Phase II utilized a questionnaire as data collection tool to investigate the role of APs in radiography and explore how their roles were integrated into the radiography workforce in England. Results from phase III of the study which utilized semi-structured qualitative interviews are not included in this paper. Conclusion and discussion: Key findings depict the nature and variety of roles and responsibilities undertaken by APs in radiography. This study was the first of its kind to identify the integration of APs in radiography across a sizable geographical region. There were mixed responses to the question asking APs if they were required to perform duties outside their scope of practice. Questionnaire data revealed that a high numbers of APs were working in areas under indirect supervision. Results from this study showed that APs, in some areas at least, were performing the roles of practitioners. Therefore further investigation is needed for new roles to develop criteria to determine which new roles should be the subject of statutory regulation. © 2011 The College of Radiographers

The Attitudes and Beliefs About Manual Therapy Held By Patients Experiencing Low Back Pain: A Scoping Review

Background Manual therapy (MT) is commonly used to manage low back pain (LBP) and involves a complex interaction between the practitioner and patient. Attitudes and beliefs about MT may play a role in the outcomes seen in patients experiencing LBP. However, knowledge of patients’ attitudes and beliefs regarding MT is currently limited. Objective To map the existing published literature on the attitudes and beliefs about MT in patients experiencing LBP. Design Scoping Review. Method A systematic search was conducted across the PubMed, CINAHL, PsycINFO and Scopus databases. Study selection involved screening 1) title and abstracts and 2) full text articles. Data was analyzed to provide a descriptive summary of the studies and to develop themes of patients’ attitudes and beliefs about MT. Results A total of 767 records were identified from the initial search strategy. Following study selection, 14 articles were included for data analysis. Five themes related to patients’ attitudes and beliefs about MT were developed from the existing literature. Attitudes and beliefs about MT are explored and measured inconsistently with only one validated tool available. Conclusion MT is believed to be a preferential and effective treatment with accepted levels of post-treatment soreness. This review indicated that patients believe that MT has a biomedical mechanism of action and is suitable for biomedical causes of LBP. Several gaps in the literature are present that require further investigation

The utilisation of virtual images in patient information giving sessions for prostate cancer patients prior to radiotherapy

© 2016 The College of RadiographersThe aim of the study was to explore the prostate patients' perceptions of a Virtual Environment for Radiotherapy Training (VERT) as an information giving resource prior to radiotherapy delivery. A survey design was used to determine the level of knowledge of those patients who attended VERT for a pre-treatment talk and identify the benefits and limitations of using VERT as pre-treatment information giving resource. Participants were invited to attend a VERT patient information session four weeks prior to their planning CT scan, and then complete a questionnaire two weeks after start of radiotherapy treatment. A sample of n = 38 patients were recruited over a five month data collection period. Results showed that patient perceptions on the use of VERT as information giving tool prior to radiotherapy treatment were very positive. The sessions enable patients to understand the potential impact of treatment volumes if the internal organ shape and location differed from that originally planned, enabling them to comply with radiotherapy treatment instructions. Additional key findings have demonstrated excellent levels of communication associated with the use of VERT emphasising the need for future patient preparation strategies to consider the use of virtual technology

Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation

Objectives To evaluate the End-of-Life and Bereavement Care model (SWAN) from conception to current use. Design A realist evaluation was conducted to understand what works for whom and in what circumstances. The programme theory, derived from a scoping review, comprised: person and family centred care, institutional approaches and infrastructure. Data were collected across three stages (May 2021 to December 2021): semi-structured, online interviews and analysis of routinely collected local and national data. Setting Stage 1: Greater Manchester area of England where the SWAN model was developed and implemented. Stage 2: Midlands. Stage 3: National data. Participants Twenty-three participants were interviewed: Trust SWAN leads, end-of-life care nurses, board members, bereavement services, faith leadership, quality improvement, medicine, nursing, patient transport, mortuary, police and coroners. Results Results from all three stages were integrated within themes, linked to the mechanisms, context and outcomes for the SWAN model. The mechanisms are: SWAN is a values-based model, promoting person/family-centred care and emphasising personhood after death. Key features are: memory-making, normalisation of death and ‘one chance’ to get things right. SWAN is an enablement and empowerment model for all involved. The branding is recognisable and raises the profile of end-of-life and bereavement care. The contextual factors for successful implementation and sustainability include leadership, organisational support, teamwork and integrated working, education and engagement and investment in resources and facilities. The outcomes are perceived to be: a consistent approach to end-of-life and bereavement care; a person/family-centred approach to care; empowered and creative staff; an organisational culture that prioritises end-of-life and bereavement care. Conclusion The SWAN model is agile and has transferred to different settings and circumstances. This realist evaluation revealed the mechanisms of the SWAN model, the contextual factors supporting implementation and perceived outcomes for patients, families, staff and the organisation

PO-1841 Infleunces of Interfractional changes of rectum/bladder on vagina motion in endometrium radiotherapy

Purpose or Objective To investigate the influence of interfractional position and volumetric changes of the bladder and rectum on vagina displacements during postoperative external beam radiotherapy (EBRT) of endometrial cancer. Materials and Methods In a single centre retrospective cohort study, measurements of interfractional displacements and volumetric changes of bladder, rectum and vagina were carried out for 28 patients that underwent EBRT for endometria tumours. Measurements were carried out on initial planning computer tomography (CT) scans and on daily cone beam computer tomography (CBCT) scans. Rectum displacements were determined by measuring anterior-posterior (AP) rectal diameters at S5 vertebrae and 4 cm inferior to S5 level. Bladder volumetric changes were determined via measure of AP bladder diameter and superiorinferior (SI) bladder diameter. Vaginal displacements were determined by measure of difference in distances from the pubic symphysis and from the S5 vertebrae at planning CT scans and daily CBCT scans. Wilcoxon signed-rank test was used to analyse the significance in displacement of the rectum/bladder and vagina between planning CT scans and daily CBCT scans. Spearman’s rank-order correlation was then used to analyse significance of the association of changes in rectum and bladder with the displacement of the vagina from planning CT scans to daily CBCT scans. Results 28 initial planning CT scans and 756 CBCT scans were analysed. Significant interfractional changes in rectum position, bladder volume and vagina position were determined between planning CT scans and daily CBCT scans. No statistically significant correlations were found between interfractional changes of bladder and vaginal displacements. Weak relations were found (i) between increase in rectal AP diameter and increase in vaginal displacement from S5 (rs=0.14 p value<0.0.1) (ii) between increase in rectal AP diameter and increase in vaginal displacement from 4cm inferior to S5 (rs=0.22 p value<0.05) Greater interfractional changes in vaginal positions were found in patients who had larger interfractional variations in rectal volumes. Conclusion The findings of this study highlight that better strategies to ensure reproducible rectal volume and position in postoperative endometrium EBRT are required. Patient specific relation between interfractional changes of the rectum with vaginal displacements reinforce the importance of individualised internal target volume (ITV) margins and online daily image guided radiation therapy (IGRT). Radiotherapy and Oncology, Volume 170, S1634 - S163

An examination of Advanced Clinical Practice: Qualitative insights from therapeutic radiography advanced and consultant practitioners based in England

Introduction: Therapeutic radiographers play a vital and changing role in the delivery of radiotherapy services treating patients with cancer. Advanced Practitioners (AP) and Consultant Practitioners (CP) in radiotherapy have developed advanced clinical skills and specialisms, enhancing the ability of the profession to offer a greater depth of cancer services and ease pressure elsewhere in the system. The aim of this study was to define the opportunity and potential for Advanced Clinical Practice (ACP) roles in oncology services. Specific objectives were to explore local profiles, role development and opportunities for standardisation of ACPs in therapeutic radiography and to determine resource requirements to roll out and ensure continuation of the existing and new roles. Material and methods: The research was addressed through a qualitative study design using focus groups. Convenience sampling was used to recruit therapeutic radiography advanced and consultant practitioners (N = 36) from the respective radiotherapy departments in England to participate in regional focus groups. Four regional areas were identified for inclusion. Data generated was analysed thematically. Results: The findings are presented in four themes: ownership of professional identity, desire for standardisation and guidance, drivers of role development and self-directed educational routes. Conclusion: Key findings from the focus groups indicated the need for standardisation in job descriptions, roles and responsibilities and a key understanding of career progression. The professional identity of the AP is acknowledged by independent, autonomous working; however, this can only be facilitated if the correct training is undertaken and the necessary support structures are in place to enable career progression. Challenges associated with role development are 1) lack of career and pathway guidance, 2) lack of clear educational routes, 3) lack of standardised roles