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Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO).

ABSTRACT: PURPOSE:Radiation oncologists are frequently involved in providing palliative and supportive care (PSC) for patients with advanced cancers through delivery of palliative radiation. Whether they are confident in their ability to assess and initiate treatments for pain, nonpain, and psychosocial distress is unknown. The American Society for Radiation Oncology surveyed its practicing members in the United States on self-assessment of their primary PSC skills and access to continuing medical education on PSC. METHODS:We electronically surveyed 4093 practicing radiation oncologists in the United States. The survey consisted of 16-questions in 5 sections1: demographics,2 PSC training,3 domains of PSC,4 perceived barriers as a radiation oncologist to initiate advanced care planning, and5 discussion of prognosis. RESULTS:The survey was e-mailed to 4093 American Society for Radiation Oncology members, and 649 responses were received (response rate 16%). The majority (91%) of radiation oncologists surveyed believe PSC is an important competency for radiation oncologists. Most radiation oncologists reported that they are moderately confident in their ability to assess and manage pain and gastrointestinal symptoms, but less confident in their ability to manage anorexia, anxiety, and depression. Despite areas of decreased confidence, a large number (42%) of radiation oncologists do not receive any additional PSC education beyond their residency training. Lastly, a perceived fear of upsetting referring medical oncologists and lack of clinic time are concerns for radiation oncologists who may want to initiate goals of care/advance care planning discussions with patients and their families. CONCLUSION:Radiation oncologists are more confident in their ability to assess and manage pain than in their ability to manage depression, anxiety, anorexia, and fatigue. There is a need for increasing continuing medical educational efforts in PSC for practicing radiation oncologists, and strengthening PSC training in residency programs.

SUBMITTER: Wei RL

PROVIDER: S-EPMC5538013 | biostudies-literature | 2017 Mar - Apr

REPOSITORIES: biostudies-literature

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Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO).

Wei Randy L RL Mattes Malcolm D MD Yu James J Thrasher Adrienne A Shu Hui-Kuo HK Paganetti Harald H De Los Santos Jennifer J Koontz Bridget B Abraham Christopher C Balboni Tracy T

Practical radiation oncology 20160907 2

<h4>Purpose</h4>Radiation oncologists are frequently involved in providing palliative and supportive care (PSC) for patients with advanced cancers through delivery of palliative radiation. Whether they are confident in their ability to assess and initiate treatments for pain, nonpain, and psychosocial distress is unknown. The American Society for Radiation Oncology surveyed its practicing members in the United States on self-assessment of their primary PSC skills and access to continuing medical ...[more]

PMID: 28274395

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Project description:PurposeTo assess US radiation oncologists' views on practice scope and the ideal role of the radiation oncologist (RO), the American Society for Radiation Oncology (ASTRO) conducted a scope of practice survey.Methods and materialsIn spring 2019, ASTRO distributed an online survey to 3822 US RO members. The survey generated 984 complete responses (26% response rate) for analysis. Face validity testing confirmed respondents were representative of ASTRO's RO membership.ResultsNearly all respondents agreed that "ROs should be leaders in oncologic care." Respondents indicated the ideal approach to patient care was to provide "an independent opinion on radiation therapy and other treatment options" (82.5%) or "an independent opinion on radiation therapy but not outside of it" (16.1%), with only 1.4% favoring provision of "radiation therapy at the request of the referring physician" as the ideal approach. Actual practice fully matched the ideal approach in 18.2% of respondents. For the remaining majority, actual practice did not always match the ideal and comprised a mix of approaches that included providing radiation at the referring physician's request 24.0% of the time on average. Reasons for the mismatch included fear of alienating referring physicians and concern for offering an unwelcome opinion. One-fifth of respondents expressed a desire to expand the scope of service though interspecialty politics and insufficient training were potential barriers. Respondents interested in expanding scope of practice were on average earlier in their career (average years in practice 13.3) than those who were not interested (average years in practice 17.2, P < .001). Radiopharmaceuticals administration, medical marijuana and anticancer medications prescribing, and RO inpatient service represented areas of interest for expansion but also knowledge gaps.ConclusionsThese results provide insight regarding US ROs' scope of practice and attitudes on the ideal role of the RO. For most ROs, to provide an independent opinion on treatment options represented the ideal approach to care, but barriers such as concern of alienating referring physicians prevented many from fully adhering to their ideal in practice. Actual practice commonly comprised a mixed approach, including the least favored scenario of delivering radiation at the referring physician's request one-quarter of the time, highlighting the influence of interspecialty politics on practice behavior. Advocacy for open communication and meaningful interdisciplinary collaboration presents an actionable solution toward a more balanced relationship with other specialties as ROs strive to better fulfill the vision of being leaders in oncologic care and being our best for our patients. The study also identified interest in expanding into nontraditional domains that offer opportunities to address unmet needs in the cancer patient's journey and elevate radiation oncology within the increasingly value-based US health care system.

Project description:PurposeThe study objective was to determine the representation of women in Canadian radiation oncology (RO) trainees and the radiation oncologist workforce over time.Methods and materialsGender data for Canadian RO trainees (residents and fellows) and radiation oncologists were collected from the Canadian Post-MD Education Registry (1994-2021) and Canadian Medical Association (1994-2019). Visa trainees were excluded. Gender parity was defined as a 1:1 female-to-male ratio. Descriptive statistics were used to summarize the data.ResultsFemale trainee proportions varied with 2 rising trend periods (1994-1998: 38%-43%, P = .93; 2002-2014: 35%-51%, P = .53) and 2 regression trend periods (1998-2002: 43%-35%, P = .83; 2014-2021: 52%-35%, P = .011). Gender parity was observed in RO trainees between 2012 and 2016. The annual number of RO trainees ranged from 66 to 173 with 2 near-parallel periods of gender-associated growth (1994-1996; 2002-2008) and regression (1997-2001; 2009-2016) followed by gender divergence (2017-2021) with increasing male and decreasing female trainees. Nearly all Canadian regions, except Ontario, reached 50% or higher female representation in RO trainees during the study period. In the radiation oncologist workforce, female representation increased from 20% (54/271) to 37% (217/582) between 1994 and 2019, and all regions and age groups demonstrated higher female representation over time. Within radiation oncologist subgroups, age <35 years old and Quebec region cohorts reached gender parity.ConclusionsRepresentation of women varied in Canadian RO trainees and has fallen since 2014, whereas female representation generally increased in the radiation oncologist workforce over time. Gender parity was observed in RO trainees, radiation oncologists <35 years old, and radiation oncologists in Quebec. Recent declining female representation among RO trainees is worrisome, and further study is warranted to identify potential gender-based barriers in attracting women to the specialty.

Dataset Information

Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO).

Publications

Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO).

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