Caicedo-Martínez María, Li Benjamin, González-Motta Alejandro, Carlson Caroline, Zhu Hong, Bobadilla Iván, Martínez David
Rayos Contra Cancer, San Francisco, California.
Department of Radiation Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.
Adv Radiat Oncol. 2022 Dec 27;8(3):101165. doi: 10.1016/j.adro.2022.101165. eCollection 2023 May-Jun.
Access to radiation therapy in low- and middle-income countries (LMICs) could be improved with modern hypofractionated radiation therapy schedules, although their adoption remains limited. We aimed to evaluate perceptions regarding hypofractionation and the effect of a dedicated curriculum in an LMIC.
We developed a pilot e-learning hypofractionation curriculum focused on breast, prostate, rectal cancer, and high-grade glioma in Colombia. International educators taught 13 weekly, 90-minute sessions. Participants completed pre- and postcurriculum questionnaires regarding hypofractionation attitudes, 1 to 5 Likert-scale self-confidence, and practices for 12 clinical scenarios. Physicians' responses were categorically scored "1" (for hypofractionation or ultrahypofractionation) or "0" (for conventional fractionation). We used the paired test to measure pre- versus postcurriculum differences in self-confidence and the McNemar test to detect differences in hypofractionation selection.
Across 19 cities in Colombia, 147 clinicians enrolled: 61 radiation oncologists, 6 radiation oncology residents, 59 medical physicists, 18 physics residents, and 3 other staff. Among physicians, education was the greatest barrier to select hypofractionation, common in ultrahypofractionation for prostate (77.6%) and breast cancer (74.6%) and less common for moderate hypofractionation of prostate (61.2%) and breast cancer (52.2%). Additional perceived barriers included unfamiliarity with clinic protocols (7%-22%), clinical experience (5%-15%), personal preference (3%-16%), and lack of technology (3%-20%), with variation across different clinical settings. After the curriculum, paired (n = 38) physicians' selection of hypofractionation increased across all disease sites (mean aggregate score 6.2/12 vs 8.2/12, <.001). Self-confidence among paired clinicians (n = 87) increased for prostate ultrahypofractionation (+0.45), rectal ultrahypofractionation (+0.43), breast hypofractionation (+0.38), and prostate hypofractionation (+0.23) ( ≤ .03).
In an LMIC with a bundled payment system, lack of education and training was a perceived barrier for implementation of hypofractionation and ultrahypofractionation. A targeted e-learning hypofractionation curriculum increased participant confidence and selection of hypofractionated schedules.
尽管现代短程放疗方案在低收入和中等收入国家（LMICs）的采用率仍然有限，但采用这些方案可以改善这些国家获得放射治疗的情况。我们旨在评估在一个低收入和中等收入国家对短程放疗的看法以及一门专门课程的效果。
我们在哥伦比亚开发了一门关于乳腺癌、前列腺癌、直肠癌和高级别胶质瘤的短程放疗试点电子学习课程。国际教育工作者每周授课13节，每节90分钟。参与者完成了关于短程放疗态度、1至5级李克特量表自信度以及12种临床场景实践的课程前后问卷。医生的回答被分类评分为“1”（代表短程放疗或超短程放疗）或“0”（代表常规分割放疗）。我们使用配对t检验来测量课程前后自信度的差异，并使用麦克尼马尔检验来检测短程放疗选择的差异。
在哥伦比亚的19个城市，共有147名临床医生报名参加：61名放射肿瘤学家、6名放射肿瘤学住院医师、59名医学物理学家、18名物理住院医师和3名其他工作人员。在医生中，教育是选择短程放疗的最大障碍，在前列腺癌（77.6%）和乳腺癌（74.6%）的超短程放疗中常见，而在前列腺癌（61.2%）和乳腺癌（52.2%）的中等短程放疗中较少见。其他感知到的障碍包括不熟悉临床方案（7%-22%）、临床经验（5%-15%）、个人偏好（3%-16%）和缺乏技术（3%-20%），不同临床环境存在差异。课程结束后，配对的（n = 38）医生在所有疾病部位选择短程放疗的比例均有所增加（平均总分从6.2/12提高到8.2/12，P <.001）。配对临床医生（n = 87）在前列腺癌超短程放疗（+0.45）、直肠癌超短程放疗（+0.43）、乳腺癌短程放疗（+0.38）和前列腺癌短程放疗（+0.23）方面的自信度有所提高（P ≤.03）。
在一个实行捆绑支付系统的低收入和中等收入国家，缺乏教育和培训被认为是实施短程放疗和超短程放疗的障碍。一门有针对性的短程放疗电子学习课程提高了参与者的自信度和对短程放疗方案的选择。
