Improving performance in radiation oncology: An international systematic review of quality improvement interventions

IF 4.9 1区 医学 Q1 ONCOLOGY
Joanna Dodkins , Georgia Zachou , Adil Rashid , Jan van der Meulen , Julie Nossiter , Alison Tree , Ajay Aggarwal
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Abstract

National cancer audits and registers have highlighted significant national and international variation in patient care and outcomes. Quality Improvement (QI) is mandated in radiation oncology but the interventions designed to support QI in this field remain poorly understood. This paper seeks to assess the types of QI interventions in radiation oncology, the QI evaluation design and their impact on process of care measures and patient-related outcomes. MEDLINE and EMBASE were searched systematically for studies of QI interventions in radiation oncology between 2000 and 2024. The studies needed to identify the quantitative or qualitative impact of the QI intervention on process of care measures or patient-related outcomes. Study results were summarised using narrative synthesis and appraised using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). 26 papers were included in the analysis. The majority of studies were conducted in the USA (n = 13) and in Europe (n = 7), with only two studies conducted at a national level. Ten studies covered all tumour types, with six specifically focusing on head and neck cancers, two each on prostate and nasopharyngeal cancers, and one study each examining lung, cervical, rectal, and breast cancers. The aspects of care evaluated most frequently were those relating to reducing waiting times or increasing utilisation of radiotherapy as per guidelines (n = 15), followed by those seeking to reduce radiotherapy contouring variability (n = 5) and those involving the management of symptoms during or after radiotherapy treatment (n = 6). Only 42 % of studies reported funding, with the most frequent funding source being national, government or federal (n = 6). All QI interventions across the 26 studies were successful as they resulted in an improvement in a process or patient-related outcome measure. The studies scored between 10 and 15 out of 16, according to the QI-MQCS criteria. Despite substantial investments in cancer research and development, there is a scarcity of information on how to enhance the quality of care in radiation oncology. While there are examples of national cancer audits and registers in a number of countries, much of the research in QI interventions is being conducted in the USA. This situation underscores the need for more comprehensive, well-funded studies and improved training for clinicians to conduct high-quality improvement activities and research. There should be a greater emphasis on the substantial gains that can be achieved by improving existing care in terms of access and outcomes, rather than solely focusing on innovation.
提高放射肿瘤学的绩效:质量改进干预措施的国际系统回顾。
国家癌症审计和登记突出了国家和国际在患者护理和结果方面的重大差异。质量改进(QI)在放射肿瘤学中是强制性的,但在该领域支持QI的干预措施仍然知之甚少。本文旨在评估放射肿瘤学中QI干预的类型,QI评估设计及其对护理措施过程和患者相关结果的影响。MEDLINE和EMBASE系统检索了2000年至2024年间放射肿瘤学中QI干预的研究。这些研究需要确定QI干预对护理措施过程或患者相关结果的定量或定性影响。采用叙述性综合方法总结研究结果,并采用质量改进最低质量标准集(QI-MQCS)对研究结果进行评价。26篇论文被纳入分析。大多数研究是在美国(n = 13)和欧洲(n = 7)进行的,只有两项研究在国家一级进行。10项研究涵盖了所有肿瘤类型,其中6项专门针对头颈癌,2项针对前列腺癌和鼻咽癌,1项研究针对肺癌、宫颈癌、直肠癌和乳腺癌。评估最频繁的护理方面是与根据指南减少等待时间或增加放射治疗利用有关的方面(n = 15),其次是寻求减少放射治疗轮廓变异性的方面(n = 5)和涉及放射治疗期间或之后症状管理的方面(n = 6)。只有42% %的研究报告了资助,最常见的资助来源是国家、政府或联邦(n = 6)。在26项研究中,所有的QI干预措施都是成功的,因为它们导致了过程或患者相关结果测量的改善。根据QI-MQCS的标准,这些研究在16分中的得分在10到15分之间。尽管在癌症研究和发展方面进行了大量投资,但关于如何提高放射肿瘤学护理质量的信息仍然缺乏。虽然许多国家都有国家癌症审计和登记的例子,但QI干预措施的大部分研究都是在美国进行的。这种情况强调需要进行更全面、资金充足的研究,并对临床医生进行更好的培训,以开展高质量的改进活动和研究。应该更加强调通过改善现有护理在可及性和结果方面所能取得的实质性成果,而不是仅仅注重创新。
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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