Projects

CSRT DEMONSTRATION PROJECT

This report summarizes the recent history of the Clinical Specialist Radiation Therapist (CSRT) Demonstration Project.

PHASE I

The Advanced Practice for Radiation Therapy (APRT) Project was officially launched in August 2004 after the Ontario Radiation Therapy Advanced Practice Steering Committee (ORTAP) of Cancer Care Ontario (CCO) concluded that there was interest and value in piloting advanced practice roles in radiation therapy.  The initial Developmental Phase of the APRT project was designed to pilot test five proposed advanced practice positions for radiation therapists in a variety of settings.  Seven investigators at each of the four regional cancer centres (in Hamilton, Kingston and two Toronto sites) established the possible competency profile for proposed positions against local service needs, outlined the required competencies for the positions, identified and quantified (where possible) the potential benefits of these new positions to the patient and the system, and assessed the readiness of members of the health care team in terms of their ability and willingness to accept these new positions of these professionals as part of the inter-discipline health care team.

At the end of the Development Phase, the Project Oversight Committee for the APRT Project prepared an Evaluation Report [1] on the Developmental Phase of the Project.  The evaluation findings supported further investigation of the APRT role.  The Evaluation Report for the Developmental Phase described in some detail the environmental context and systemic challenges which led Ontario to explore advanced practice roles, defined advanced practice, and discussed experiences with, and potential benefits of, advanced practice roles in cancer care.  The content of that report provides useful background and context for those requiring additional information.

Phase I of the CSRT Demonstration Project delivered on a variety of expectations including the development of standardized metrics packages, the creation and evaluation of a prior-learning assessment and recognition process, the development of a CSRT Tool Kit for positions development, and the collection and interpretation of outcome data aligned with the following Ministry of Health and Long-term Care (MOHLTC) priorities:

  • Decreased wait times
  • Improved access to radiation therapy treatment
  • Improved patient satisfaction
  • Team acceptance of the CSRT role

The evaluation Report for Phase I of the CSRT Demonstration Project [2] was submitted to the (MOHLTC) in July 2008.  Based on the promising results reported in this document, the MOHLTC has approved funding in support of the 2 key recommendations in the report: 1/ the extension of the existing 5 CSRT positions until March 2009, and 2/ the development and implementation of 5 ADDITIONAL CSRT positions throughout Ontario until March 2010.

These two activities are focused on continuing to collect data against the MOHLTC key objectives, to enrich the data set upon which the future decisions will be made, explore the transferability of the competency profile currently used to define advanced practice for radiation therapist, and understand the educational/academic/training needs to become a clinical specialist radiation therapist.

In July 2008, the MOHLTC approved funding to extend the existing CSRT positions to March 31st, 2009, Phase I (extension) in order to continue collecting valuable data that could add to the robustness of the existing data set.

PHASE II

In July 2008, in response to the recommendations made to the MOHLTC, Phase II of the CSRT Demonstration Project has now selected and implemented five additional CSRT positions in cancer centres outside the GTA.  The successful sites and positions are as follows:

  • Juravinski Cancer Centre - Bone Mets CSRT and Head and Neck CSRT
  • Kingston Regional Cancer Centre - Palliative CSRT
  • The Ottawa Hospital - Palliative CSRT and Tomotherpy/Adaptive CSRT

Phase II will examine how the CSRT role can be modified to create positions that meet different system and population needs.  Consistent with the broader health human resources strategy for Ontario, the MOHLTC hopes these therapists will help smaller centres improve access to service, including traditionally "Harder to reach" populations such as francophone or aboriginal.

Phase I (extension) and Phase II  (expansion) studies will build upon existing data, address gaps, determine whether the draft competency profile can be used to create positions relevant to different geographic and demographic needs of Ontario.  The new CSRTs will also participate in the collection of the standard project data to enhance the CSRT dataset.

The analysis of the evidence gathered during the Demonstration Project shows eight key findings:

  • Finding 1: CSRTs can be educated and trained to competently and safely undertake advance practice involving specific activities traditionally performed by radiation oncologists, through delegation of activities or the creation of medical directives.

  • Finding 2: CSRTs can improve the efficiency of the system by improving patient wait‐times across the patient care pathway, increasing patient throughput and facilitating time efficiencies for team members. These impacts combine to build system capacity in their specific programs.

  • Finding 3: CSRTs can improve quality and effectiveness of existing systems and processes by streamlining activities, eliminating redundancies and developing innovative approaches to program activities and adding new services to those systems.

  • Finding 4: Patients are highly satisfied with the care they received from CSRTs. Satisfaction with their care was rated as either equal to or higher than the care they received from the other team members.

  • Finding 5: CSRTs have become valued members of the teams in which they work facilitating improved workflows and enhanced team functioning and cohesiveness.

  • Finding 6: The CSRT competency profile allows for the development of diverse positions that align with specific local needs including improved effectiveness and efficiency and/or innovation and accelerated knowledge translation.

  • Finding 7: Maximum success for CSRT integration is achieved when positions are developed to clearly address specific local needs in the radiotherapy care pathway and when they include specific and measurable outcomes.

  • Finding 8: System wide implementation of advanced radiation therapy practice will be most successful through the establishment of formal and consistent graduate level educational requirements and formalized certification/registration processes.

For more detailed information on these finding please refer to the CSRT Demonstration Project Final Report

CSRT SUSTAINABILITY PROJECT

Based on the positive results of the CSRT Demonstration Project the next phase, the CSRT Sustainability Project, was approved in March 2011.

The CSRT Sustainability Project is funded for a three-year period, focusing on six key elements related to long-term sustainability of the CSRT role in Ontario:

  • Extending agreements with each employment site for the original (up to) nine FTE CSRTs that guides the ongoing relationship and oversees the continued data collection as they transition to full scope;

  • Creating and overseeing the “Integration Support Team” which will assist with the integration of original and new CSRTs into cancer care teams;

  • Supporting the hiring of (up to) nine FTE additional CSRTs and provide ongoing assistance with position implementation and assessment;

  • Formalizing the role through ongoing data collection and work with relevant organizations;

  • Developing comprehensive “models of care” for radiation medicine which capture the contributions of the CSRT and consider other roles that may be introduced to maximize system efficiencies; and

  • Conducting knowledge creation and dissemination activities including employer surveys to contribute to labour market knowledge.

Work of the Integration Support Team has begun and will focus initially on the communication strategy to inform provincial cancer programs about the success of the Project and upcoming activities that will include the creation of (up to) nine new CSRT positions system-wide.

Systems and processes are being implemented to guide and assist provincial sites with the identification of their needs and development of their site-specific position. The Project goal is to have all new positions operational for a minimum of one full year within the timeframe of the project.

Activities related to the formalization of the role continued in 2010/11. A formal relationship has been struck with the Canadian Association of Medical Radiation Technologists (CAMRT) and work has begun in towards the creation of a certification process and protected professional designation for advanced radiotherapy practitioners, with the first iteration tentatively scheduled for Spring 2013.

Progression towards the permanent integration of the CSRT role into the cancer care system in Ontario is evident on several fronts. Increasing alignment with Cancer Care Ontario’s (CCO) work on its Ontario Cancer Plan strategic priority for implementing innovative models of care, integration of the CSRT Sustainability Project under CCO governance and the inclusion of the CSRT role in the annual radiation therapy labour market survey, acknowledgment of the legitimacy of the CSRT role continues to escalate in Ontario.

Sustainability Project Timeline

CSRT Sustainability Report 2011

[1] Cancer Care Ontario, “Stepping up to the Challenge: Workplace Practice Models for Radiation Therapy in Ontario, Evaluation Report: Developmental Phase”, submitted to MOHTLC November, 2006.

[2]Cancer Care Ontario, “Evaluation Report for the CSRT Demonstration Project – Phase I”, May 2008, submitted to MOHLTC July 2008.