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Executive Summary

Therapeutic radiographers are critical in the prostate cancer patient pathway – they have specialist, technical expertise to plan and deliver treatment combined with intense patient contact over several weeks. Their knowledge, skill, care and support are essential to ensuring that the outcomes and experiences of men are as successful and as positive as possible. 

National work to raise radiotherapy standards has been ongoing since the publication of the National Health Service (NHS) Cancer Plan in 2004.1 This work has been aided by major developments in technology that have enabled high-dose radiotherapy to be planned and delivered more accurately and for treatment to be monitored and verified using diagnostic imaging systems. The outcome of these initiatives is that radical, high-dose radiotherapy has become the treatment of choice for many early stage cancers, including prostate, as well as being an important tool for palliative care. 

The expansion of the use of radiotherapy has generated opportunities for therapeutic radiographers to develop new roles beyond registration. The recommendations of the recently published cancer strategy for England 2015 – 20202 include increasing access to radiotherapy as well as investment in a radiotherapy equipment replacement programme. There is also emphasis on the patient experience and there should be at least as much effort and energy offered  and focus given to delivering an excellent patient experience alongside the goal of continually improving patient outcomes from the treatment, recognising that patients should have access to a specialist practitioner/key worker with advanced or consultant level knowledge and skills.   

The number of men diagnosed with prostate cancer continues to increase3,4,5,6,7 alongside the availability of complex radiotherapy and this needs to be matched to prostate-specific knowledge and expertise in both external beam radiotherapy and brachytherapy. In cancer centres across the United Kingdom (UK), there are a growing number of prostate/urology specialist radiographer roles, with post holders being responsible for streamlining and focussing care and support across radiotherapy pathways.

It has been demonstrated that cancer patients see the benefits of having access to a key worker, normally in the guise of a specialist nurse,8 but recent research suggests that urology/uro-oncology specialist nurses are time poor, often with vast caseloads and complex and varied responsibilities.9 The shared view of Prostate Cancer UK and the Society and College of Radiographers (SCoR) is that prostate/urology specialist radiographers potentially have a vital role in co-ordinating care for these patients, as well as in ensuring their centres are providing the best treatment and support possible, deploying the appropriate and most advanced planning and treatment techniques.

Prostate Cancer UK therefore commissioned the Society and College of Radiographers  to carry out a service mapping and development project in order to understand and strengthen the growing prostate site-specialist workforce. The overall aim of the project was to describe the current situation in relation to the United Kingdom (UK) prostate/urology specialist radiographer workforce and to understand the specific nature and value of these roles. The support and development needs of practitioners were to be identified in order to create an online community forum and framework for collaborative practice with associated resources, opportunities for networking and future role developments.

A mixed methodology was developed comprising quantitative data collection from key stakeholders in every cancer centre in the UK through an online survey, and qualitative data via workshops with identified individuals working in the field. The survey was sent to all radiotherapy service managers (RSMs) in the UK and comprised 14 questions covering the volume of work associated with prostate cancer, treatments offered, the number and scope of the specialist radiographer workforce and future plans for development of additional roles. Managers were also asked to provide any relevant job descriptions. 

The workshop and interview topics were pre-identified by the project team to obtain practitioners’ views about their role in the care and treatment offered to men with prostate cancer, using the domains of advanced/consultant practice. The nature and scope of the specialist role was explored under the following headings; key relationships including service users, barriers to change, the scope of practice and service development, education and training and opportunities for research. The chance was also taken to identify particular expertise and resources that might contribute to a sustainable online forum. Following preliminary qualitative analysis of the workshop data, a dissemination conference was organised in June 2015 for practitioners, service managers and others. The programme included sharing the initial key findings from the project and a discussion about future directions for the service and the role and contribution of the specialist radiographer workforce.  

The number of cancer centres and personnel participating in the project was:

  • 46 cancer centres responded to the survey from a total number of 72;
  • 17 prostate/urology site specialists from 14 cancer centres attended the two designated workshops; 
  • 13 information, support and review radiographers with experience of caring for men with prostate cancer from 12 cancer centres attended a session at the radiotherapy information, support and review forum;
  • 50 delegates, including speakers, together with SCoR and Prostate Cancer UK staff attended the dissemination conference.

The project has demonstrated that prostate/urology specialist roles are reliably in place in 18 cancer centres, mostly in England, and their numbers are increasing. The majority of posts have been created out of the existing radiographic establishment. The role is not yet sustainably embedded and might best be described as ‘emerging’.  Practitioners’ core functions are generally similar but there are differences, which can probably be attributed to the isolated way in which they have developed. Most of the domains of advanced and consultant practice are represented but under-developed; there is a lack of consistency about what the role should be and no robust sense of identity or professional ownership of the role. There are valuable insights into the role that should be taken forward in the development of a consistent, standardised, specialist key worker role to optimise radiotherapy and support for men with prostate cancer. 

Particular themes highlighted by the project are:

  • the need to address sustainability;
  • the need for a more consistent understanding of the core functions of the role;
  • the lack of clarity about the limits of the role, ie where it should begin and end;
  • the expressed ambivalence about the value of professional supervision;
  • the need for support for relevant education and skills development, especially prescribing;
  • a lack of engagement with research both in relation to the role and radiotherapy practice.

Through the research a number of recommendations have been identified. These recommendations have been grouped by stakeholder as follows: 

Recommendations for prostate/urology specialist practitioners

  • Continue to develop the role to become the key worker for men with prostate cancer for a certain period in the patient pathway.
  • Engage more fully with all domains of advanced and/or consultant practice.
  • Contribute to research into the value and impact of the prostate/urology specialist role.
  • Seek opportunities to lead research into radiotherapy practice and patient experience.
  • Participate in the development of the online community forum. 
  • Share practice, knowledge and experience, both within the cancer centre and wider multidisciplinary team (MDT) as well as beyond the employing authority to help those looking to develop and advance roles in other centres.

Recommendations for service managers

  • Formulate site-specialist job descriptions that are clearly defined and include arrangements for cover for sickness and leave, and professional supervision.
  • Ensure that cancer centre workforce development plans reflect the strategic priorities of the Independent Cancer Taskforce strategy for 2015 - 2020.3
  • Undertake personal development and review (PDR) to support relevant professional development for prostate/urology specialist practitioners in post and identify potential successors.
  • Share with other service managers to learn from those who have already created these roles or support those who are embarking on it. 
  • Build in research component to site-specialist roles to include measures of impact that will evidence efficiencies, experiences, and outcomes.

Recommendations for the SCoR

  • Update the radiographic workforce advice and guidance to reflect the strategic priorities of the Independent Cancer Taskforce strategy for 2015-2020.3
  • Develop a model role descriptor to support service managers.
  • Provide advice and support to service managers for business case development, including sustainability and succession planning.
  • When possible, promote independent prescribing as the gold standard for prostate/urology specialist radiographers.
  • Develop a database of postgraduate education and training opportunities to support development of full professional autonomy.
  • Promote professional accreditation of advanced and consultant practitioners.
  • Develop and provide ongoing support for an online community forum and support network with resources for prostate/urology specialist radiographers. 
  • Deliver conference presentations to the profession and to relevant charities.
  • Share the project report with the wider radiotherapy workforce, the Radiotherapy Board, the cancer MDTs and via the Radiotherapy Clinical Reference Group in England, and equivalent groups in the UK.

Recommendations for Prostate Cancer UK

  • Share information about educational opportunities as well as funding available to support continuing professional development.
  • Use project findings to inform the development of Prostate Cancer UK’s education programme.
  • Promote relevant research opportunities and share findings from funded research projects.
  • Ensure widespread dissemination of evidence gained from funded prostate site-specialists.
  • Work in collaboration with SCoR to share the project report widely with key stakeholders.

Recommendations to national stakeholders 

  • Be aware of the developing role and contribution of therapeutic radiographers as key workers in the delivery of cancer services.
  • Consider the development of the site-specialist therapeutic radiographer role in workforce planning models for cancer services. 
  • Work with the Society and College of Radiographers to support further development of site-specialist roles and assessment of their impact on patient care.

References 

1. Department of Health. The NHS Cancer Plan and the New NHS; providing a patient- centred service.  London: Stationery Office; 2004. Available at: http://collection.europarchive.org/tna/20080107220102/dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4092531  [accessed 21.09.2015]

2. The Independent Cancer Taskforce. Achieving world-class cancer outcomes: a strategy for England 2015-2020. Available at: http://www.cancerresearchuk.org/sites/default/files/achieving_world-clas... ; [accessed 21.09.2015]

3. Bray F, Lortet-Tieulent J, Ferlay J, et al. Prostate cancer incidence and mortality trends in 37 European countries: an overview. Eur J Cancer 2010; 46:3040-52.

4. The Office for National Statistics, 19 June 2014  Available at: www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/index.html  [accessed 21.05.2015]

5. Information Services Division, NHS Scotland, 28 April, 2015. Available at: 

https://isdscotland.scot.nhs.uk/Health-Topics/Cancer/Publications/2015-04-28/2015-04-28-Cancer-Incidence-Report.pdf?92353457213  [accessed 21.09.2015]

6. The Welsh Intelligence and Surveillance Unit   Cancer in Wales  April, 2014.  Available at: http://www.wcisu.wales.nhs.uk/sitesplus/documents/1111/CANCERinWALESapri... - [accessed 21.09.2015]

7. The Northern Ireland Cancer Registry, 2012  Available at: 

http://www.qub.ac.uk/research-centres/nicr/CancerData/OnlineStatistics/  [accessed 21.09.2015]

8. Cancer Clinical Nurse Specialists Impact Briefs. Available at: http://www.macmillan.org.uk/Documents/AboutUs/Research/ImpactBriefs/ImpactBriefs-ClinicalNurseSpecialists2014.pdf   [accessed 21.09.2015]

9. Leary A et al. Prostate Cancer UK  The specialist nursing workforce caring for men with prostate cancer in the UK Research report 2014.   2014. Available at: http://prostatecanceruk.org/media/2491517/2631-urology-nurse-workforce-research-report__web.pdf  [accessed 21.09.2015]

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