Abstract：
BACKGROUND: Dedicated palliative radiation oncology programs (PROPs) within radiation oncology (RO) practices have been shown to improve quality and decrease costs of radiation therapy (RT) in advanced cancer patients. Despite this, relatively few PROPs currently exist, highlighting an unmet need to understand characteristics of the few existing PROPs and the potential barriers and facilitators that exist in starting and maintaining a successful PROP. We sought to assess the attributes of existing PROPs, the facilitators and barriers to establishing these programs, and the resources needed to create and maintain a successful program.
METHODS: A 15-item online survey was sent to 157 members of the Society of Palliative Radiation Oncology (SPRO) in July 2019.
RESULTS: Of the 157 members, 48 (31%) responded. Most practiced in an academic center (71% at main center and 15% at satellite) and 75% were from a larger group practice (≥6 physicians). Most (89%) believed the development and growth of a dedicated PROPs was either important (50%) or most important (39%) to the field of RO. Only 36% of respondents had a PROP, 38% wanted to establish one, and 13% were currently developing one. Of those with PROPs (N=16), 75% perceived an increase in the number of referrals for palliative RT since starting the program. A majority had an ability to refer to an outside palliative care specialist (64%), an outpatient RO service (53%), and specialized clinical processes for managing palliative radiotherapy patients (53%), with 41% having an inpatient RO consult service. Resources considered most essential were access to specialist-level palliative care, advanced practice provider support, a radiation oncologist with an interest in palliative care, having an outpatient palliative RO clinic, an emphasis on administering short radiation courses, and opportunities for educational development. Of those with a PROP or those who have tried to start one, the greatest perceived barriers to initiating a PROP were committed resources (83%), blocked out clinical time (61%), challenges coordinating management of patients (61%), and support from leaders/colleagues (61%). Perceived barriers to sustaining a PROP were similar. For those without a PROP, the perceived most important resources for starting one included access to palliative care specialist by referral (83%), published guidelines with best practices (80%), educational materials for referring physicians and patients (80%), educational sessions for clinical staff (83%), and standardized clinical pathways (80%).
CONCLUSIONS: PROPs are not widespread, exist mainly within academic centers, are outpatient, have access to palliative care specialists by referral, and have specialized clinical processes for palliative radiation patients. Lack of committed resources was the single most important perceived barrier for initiating or maintaining a PROP. Best practice guidelines, educational resources, access to palliative care specialists and standardized pathways are most important for those who wish to develop a PROP. These insights can inform discussions and help align resources to develop, grow, and maintain a successful PROP.
METHODS: A 15-item online survey was sent to 157 members of the Society of Palliative Radiation Oncology (SPRO) in July 2019.
RESULTS: Of the 157 members, 48 (31%) responded. Most practiced in an academic center (71% at main center and 15% at satellite) and 75% were from a larger group practice (≥6 physicians). Most (89%) believed the development and growth of a dedicated PROPs was either important (50%) or most important (39%) to the field of RO. Only 36% of respondents had a PROP, 38% wanted to establish one, and 13% were currently developing one. Of those with PROPs (N=16), 75% perceived an increase in the number of referrals for palliative RT since starting the program. A majority had an ability to refer to an outside palliative care specialist (64%), an outpatient RO service (53%), and specialized clinical processes for managing palliative radiotherapy patients (53%), with 41% having an inpatient RO consult service. Resources considered most essential were access to specialist-level palliative care, advanced practice provider support, a radiation oncologist with an interest in palliative care, having an outpatient palliative RO clinic, an emphasis on administering short radiation courses, and opportunities for educational development. Of those with a PROP or those who have tried to start one, the greatest perceived barriers to initiating a PROP were committed resources (83%), blocked out clinical time (61%), challenges coordinating management of patients (61%), and support from leaders/colleagues (61%). Perceived barriers to sustaining a PROP were similar. For those without a PROP, the perceived most important resources for starting one included access to palliative care specialist by referral (83%), published guidelines with best practices (80%), educational materials for referring physicians and patients (80%), educational sessions for clinical staff (83%), and standardized clinical pathways (80%).
CONCLUSIONS: PROPs are not widespread, exist mainly within academic centers, are outpatient, have access to palliative care specialists by referral, and have specialized clinical processes for palliative radiation patients. Lack of committed resources was the single most important perceived barrier for initiating or maintaining a PROP. Best practice guidelines, educational resources, access to palliative care specialists and standardized pathways are most important for those who wish to develop a PROP. These insights can inform discussions and help align resources to develop, grow, and maintain a successful PROP.
摘要：
背景：放射肿瘤学（RO）实践中的专用姑息性放射肿瘤学计划（PROPs）已被证明可以改善晚期癌症患者的放射治疗（RT）的质量并降低其成本。尽管如此,目前存在的PROPs相对较少，强调未满足的需要，以了解少数现有PROP的特征以及启动和维持成功的PROP中存在的潜在障碍和促进者。我们试图评估现有PROPs的属性，建立这些计划的促进者和障碍，以及创建和维护成功计划所需的资源。
方法：于2019年7月向姑息放射肿瘤学会（SPRO）的157名成员发送了一项15项在线调查。
结果：在157名成员中，48（31%）回答。大多数在学术中心执业（主中心占71％，卫星占15％），75％来自较大的团体执业（≥6名医师）。大多数（89％）认为专用PROP的发展和增长对RO领域很重要（50％）或最重要（39％）。只有36%的受访者有PROP，38%的人想建立一个，13%的人目前正在开发一个。在那些有PROP(N=16)的人中，75％的人认为自开始该计划以来，姑息性RT的转诊次数有所增加。大多数人有能力转诊外部姑息治疗专家（64％），门诊RO服务(53%)，以及管理姑息性放疗患者的专门临床流程(53%)，41%的人有住院RO咨询服务。被认为最重要的资源是获得专家级的姑息治疗，高级实践提供商支持，对姑息治疗感兴趣的放射肿瘤学家，有一个门诊姑息性RO诊所，强调管理短期辐射课程，和教育发展的机会。在那些有PROP或试图启动PROP的人中，启动PROP的最大障碍是承诺资源(83%)，封锁临床时间（61%），挑战协调患者管理（61%），以及领导/同事的支持（61%）。维持PROP的感知障碍是相似的。对于那些没有道具的人来说，认为最重要的资源包括通过转诊获得姑息治疗专家（83％），已发布具有最佳实践的指南（80％），推荐医生和患者的教育材料(80%)，为临床工作人员举办的教育会议(83%)，和标准化的临床路径（80％）。
结论：PROPs并不普遍，主要存在于学术中心内，是门诊病人，可以通过转诊获得姑息治疗专家，并为姑息性放射患者提供专门的临床程序。缺乏承诺的资源是启动或维持PROP的最重要的障碍。最佳实践指南,教育资源,对于那些希望开发PROP的人来说，获得姑息治疗专家和标准化途径是最重要的。这些见解可以为讨论提供信息，并帮助调整资源以开发、成长,并保持成功的PROP。
方法：于2019年7月向姑息放射肿瘤学会（SPRO）的157名成员发送了一项15项在线调查。
结果：在157名成员中，48（31%）回答。大多数在学术中心执业（主中心占71％，卫星占15％），75％来自较大的团体执业（≥6名医师）。大多数（89％）认为专用PROP的发展和增长对RO领域很重要（50％）或最重要（39％）。只有36%的受访者有PROP，38%的人想建立一个，13%的人目前正在开发一个。在那些有PROP(N=16)的人中，75％的人认为自开始该计划以来，姑息性RT的转诊次数有所增加。大多数人有能力转诊外部姑息治疗专家（64％），门诊RO服务(53%)，以及管理姑息性放疗患者的专门临床流程(53%)，41%的人有住院RO咨询服务。被认为最重要的资源是获得专家级的姑息治疗，高级实践提供商支持，对姑息治疗感兴趣的放射肿瘤学家，有一个门诊姑息性RO诊所，强调管理短期辐射课程，和教育发展的机会。在那些有PROP或试图启动PROP的人中，启动PROP的最大障碍是承诺资源(83%)，封锁临床时间（61%），挑战协调患者管理（61%），以及领导/同事的支持（61%）。维持PROP的感知障碍是相似的。对于那些没有道具的人来说，认为最重要的资源包括通过转诊获得姑息治疗专家（83％），已发布具有最佳实践的指南（80％），推荐医生和患者的教育材料(80%)，为临床工作人员举办的教育会议(83%)，和标准化的临床路径（80％）。
结论：PROPs并不普遍，主要存在于学术中心内，是门诊病人，可以通过转诊获得姑息治疗专家，并为姑息性放射患者提供专门的临床程序。缺乏承诺的资源是启动或维持PROP的最重要的障碍。最佳实践指南,教育资源,对于那些希望开发PROP的人来说，获得姑息治疗专家和标准化途径是最重要的。这些见解可以为讨论提供信息，并帮助调整资源以开发、成长,并保持成功的PROP。
