Lam Catarina, Tan Kieng, Flanagan Wendy, Kelly Valerie, Wenz Julie, Rosewall Tara
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
J Med Imaging Radiat Sci. 2013 Mar;44(1):31-36. doi: 10.1016/j.jmir.2012.09.002. Epub 2012 Oct 24.
Despite increased automation in the field of radiation therapy, the need to perform monitor unit calculations manually still exists for a small number of clinical situations. Challenges in maintaining the skill of performing infrequently occurring clinical tasks have been identified among other health professions, but no study has been performed for similar issues in radiation therapy. The aim of this study was to explore radiation therapists' (RT) perceived changes in comfort level to perform manual calculations (MC), an infrequently occurring clinical task, and to evaluate factors that may have influenced the change in comfort level.
The study sample consisted of RTs working within the radiation therapy department of a cancer hospital. A questionnaire soliticing RTs' comfort level with MC and potential influencing factors was sent to each participant. The difference in responses based on key study variables, including initial mastery of MC, ongoing exposure to MC, recent exposure to MC, and MC continuing education, was analyzed. In addition, a wave analysis was performed to determine whether the responses gathered with the questionnaire were representative of those who did not respond.
Fifty-one responses were obtained. The wave analysis suggested that our study results may reflect the views of those of RTs who were eligible to participate, but did not respond. Ninety percent of the participants reported that their comfort level in performing MC had decreased over the years. A significantly smaller proportion of participants reported being comfortable with orthovoltage MC (14%) compared to other types of MC (75-84%). Participants' years of work experience did not appear to influence their comfort level in performing MC. A higher proportion of participants that had recent or ongoing exposure to MC, including those that performed a MC within the last 12 months, worked in dosimetry, were engaged in on-call activities, or were engaged in continuing education on MC, reported being more comfortable in MC than those participants who did not engage in such activities (91%-92% vs. 47%-71%, P < .001).
DISCUSSION/CONCLUSION: Initial mastery and ongoing exposure were identified in the literature as important factors that influence practitioners' ability in performing clinical tasks. Although initial mastery was found to influence comfort level in performing MC, our study also revealed that ongoing exposure may be relatively more important. Lessons drawn from this study will become more important to the field of radiation therapy as more manually performed clinical tasks become less frequent over time. To address potential reduction in RTs' ability in performing this infrequent clinical task, individual radiotherapy departments have historically put in place effective strategies to assure accuracy. Yet, alternatives to performing MC should be explored in order to maximize safety, efficiency, and quality of patient care.
尽管放射治疗领域的自动化程度有所提高,但在少数临床情况下,手动进行监测单位计算的需求仍然存在。其他卫生专业领域已发现维持不常发生的临床任务技能存在挑战,但尚未针对放射治疗中的类似问题进行研究。本研究的目的是探讨放射治疗师(RT)对执行手动计算(MC,一项不常发生的临床任务)舒适度的感知变化,并评估可能影响舒适度变化的因素。
研究样本包括一家癌症医院放射治疗科的放射治疗师。向每位参与者发送了一份调查问卷,询问他们对MC的舒适度以及潜在影响因素。分析了基于关键研究变量(包括对MC的初始掌握程度、持续接触MC、近期接触MC以及MC继续教育)的回答差异。此外,进行了波分析,以确定通过问卷收集的回答是否代表未回答者的观点。
共获得51份回复。波分析表明,我们的研究结果可能反映了有资格参与但未回复的放射治疗师的观点。90%的参与者报告说,多年来他们执行MC的舒适度有所下降。与其他类型的MC(75%-84%)相比,报告对正电压MC感到舒适的参与者比例显著较小(14%)。参与者的工作年限似乎并未影响他们执行MC的舒适度。与未参与此类活动的参与者相比,近期或持续接触MC的参与者比例更高,包括那些在过去12个月内执行过MC、从事剂量测定工作、参与随叫随到活动或参与MC继续教育的参与者,报告在MC方面更舒适(91%-92%对47%-71%,P<.001)。
讨论/结论:文献中确定初始掌握和持续接触是影响从业者执行临床任务能力的重要因素。虽然发现初始掌握会影响执行MC的舒适度,但我们的研究还表明持续接触可能相对更重要。随着时间的推移,越来越多手动执行的临床任务变得不那么频繁,从本研究中吸取的经验教训对放射治疗领域将变得更加重要。为了解决放射治疗师执行这项不常发生的临床任务能力可能下降的问题,各个放射治疗科室历来都制定了有效的策略来确保准确性。然而,应探索执行MC的替代方法,以最大限度地提高患者护理的安全性、效率和质量。