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  • American Society of Clinical Oncology (ASCO)  (8)
  • Foxcroft, Sophie  (8)
  • 1
    Online Resource
    Online Resource
    ReCAP: Improving the Quality of Radiation Treatment for Patients in Ontario: Increasing Peer Review Activities on a Jurisdictional Level Using a Change Management Approach
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Oncology Practice Vol. 12, No. 1 ( 2016-01), p. 81-82
    Details
    In: Journal of Oncology Practice, American Society of Clinical Oncology (ASCO), Vol. 12, No. 1 ( 2016-01), p. 81-82
    Abstract: QUESTION ASKED: What is the impact of the Cancer Care Ontario (CCO) strategy (designed with guidance from a change management framework) to accelerate the use of peer-review processes in radiation oncology (ie, review of a radiation oncologist’s proposed treatment plan by a second radiation oncologist with or without additional multidisciplinary input) across all of its 14 cancer treatment centers? SUMMARY ANSWER: By following a number of key change management principles for organizational transformation, the proportion of radical-intent radiation therapy courses peer reviewed province-wide increased from 43.5% (April 2013) to 68.0% (March 2015), with some centers reaching over 95%. METHODS: The initiative design was guided by the Kotter eight-step process for organizational transformation, including the creation of a multidisciplinary leadership team, site visits to individual centers, the development of education and implementation processes (done in collaboration with each center), and the creation of new performance metrics for central reporting. Monitoring of these metrics enabled the leadership team to track the percentage of radiation therapy courses peer reviewed and the timing of peer review (before 25% treatment visits complete, after 25% treatment visits complete). Performance targets for the quality measures were arrived at by consensus that included engagement of all center radiation treatment program leaders. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Peer review has been shown to increase quality of care. However, it requires that resources be invested, including the time and effort of radiation oncologists, and the programmatic work required to organize, execute, and document peer-review activities. There is currently no way of confirming the quality of peer-review activities. REAL-LIFE IMPLICATIONS: A change management framework can be useful for planning and achieving substantial increases in peer-review activities on a jurisdictional basis. Ongoing work will capitalize on facilitators of peer review and on addressing barriers to its application that were identified as part of the initiative. Guidance for peer-review activities specific to common clinical cases is required and is under development. The principles of peer review could be extended to other oncological disciplines with the goal of improving individual patient care and overall program quality. [Figure: see text]
    Type of Medium: Online Resource
    ISSN: 1554-7477 , 1935-469X
    URL: Article
    DOI: 10.1200/JOP.2015.006882
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 3005549-0
    detail.hit.zdb_id: 2236338-5
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  • 2
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    Toward quality peer review: Outcomes of peer review across provincial radiation oncology programs.
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 7_suppl ( 2016-03-01), p. 205-205
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 7_suppl ( 2016-03-01), p. 205-205
    Abstract: 205 Background: Review of treatment plans by a second radiation oncologist is an important quality indicator in radiation oncology. Peer review (PR) can improve quality of care in individual patients by detecting clinical and planning issues and recommending plan changes. This study reports the frequency and nature of these changes across all 14 radiation oncology programs (ROPs) in Ontario, Canada. Methods: We identified all peer-reviewed curative treatment plans delivered in Ontario within a 3-month study period between Dec 2013-Nov 2014 using Cancer Care Ontario’s Activity Level Reporting System, where data on treatment intent and date, disease site treated, PR status, timing of PR, and nature of recommended changes were available. Results: There was considerable variation in the proportion of plans peer-reviewed across ROPs (70.2%, range: 40.8-99.2%). Over the study period, 5,561 curative treatment plans were peer-reviewed and 3.3% had changes recommended. Of those, 21.0% had major clinical and re-planning implications. Recommended changes most often involved minor (63.1%) vs major (36.9%) re-planning implications. Highest proportions of changes were recommended for the treatment of the esophagus, uterus, upper limb, cervix, lower limb, H & N, bilateral lung, right supraclavicular nodes, rectum, and spine (5.0%-7.0%). Plans involving the left breast had slightly more changes recommended (3.0% [95%CI:2.0%-4.5%]) vs right breast (2.4% [95%CI:1.5%-3.8%] ). Recommendations were more frequently made when PR was conducted pre-radiotherapy (3.8%) vs during (1.4%-2.8%; p = 0.005), however the nature and implementation of changes were not statistically associated with the timing of PR (p = 0.91; p = 0.23, respectively). Proportion of recommended changes to treatment plans was not statistically associated with ROP patient volume (p = 0.08), proportion of plans peer-reviewed (p = 0.36) or academic status (p = 0.75). Conclusions: Significant variation exists in the proportion of recommended changes across all disease sites and ROPs. PR seems effective in detecting treatment plans with important clinical and planning issues; strategies should be developed to optimize its conduct in radiation oncology.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2016.34.7_suppl.205
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 3
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    Development and implementation of communities of practice at Cancer Care Ontario (CCO).
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 31_suppl ( 2013-11-01), p. 58-58
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 31_suppl ( 2013-11-01), p. 58-58
    Abstract: 58 Background: A “Community of Practice” (CoP) has been defined as a group of people who share a passion for something they do and learn to improve as they translate knowledge and interact together. Methods: The primary goal of the Radiation Treatment Program (RTP) at CCO is to improve the quality of care delivered to Ontario patients receiving radiation treatment. We identified variations in practice in the 14 Regional Cancer Centers (RCC) in Ontario and facilitated the development of 3 CoPs to share best practices and standardize care where appropriate. Through this initiative, two multidisciplinary [Radiation Oncologists, Physicists and Radiation Therapists (MRT(T)s)] CoPs have been established in Head and Neck (H & N) and Gynecological (GYN) Cancers and one discipline-specific CoP has been started in Radiation Treatment External Beam Delivery involving MRT(T)s alone . During initial meetings of each CoP key variations in practice affecting quality of care were identified. Results: Each CoP has developed recommendation documents for improving care: H & N Cancer – Nomenclature for anatomic structures in treatment volumes and Evaluation of Intensity Modulated treatment Plans; GYN Cancer – Imaging strategies for Intracavitary Brachytherapy of Cervical Cancer; Treatment Delivery – Protocol Development Toolkit and Image Guided Radiation Therapy Education Checklist. These recommendation documents are currently being piloted in each RCC with a view to standardizing care across the province. Conclusions: These CoP initiatives have enabled the development of recommendation reports by front-line staff to ensure evidence-based, high-quality radiation treatment to improve the safety and quality of care for all cancer patients across a jurisdiction of 13M people.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.31_suppl.58
    RVK:
    XA 52760
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    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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  • 4
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    “It looks good”: How a provincial radiation oncology program benefits from implementing peer review across cancer centers.
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 7_suppl ( 2016-03-01), p. 238-238
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 7_suppl ( 2016-03-01), p. 238-238
    Abstract: 238 Background: Peer review (PR) in radiation oncology (RO) has been endorsed as an indicator of treatment quality in North America and internationally. The direct benefits of PR include quality assurance (QA) on individual treatment plans. The indirect benefits for radiation oncology departments or programs (ROPs) have been postulated but not systematically evaluated. We used a rigorous and comprehensive qualitative approach to explore the indirect benefits of PR across a jurisdiction of cancer care, and to identify factors that facilitate PR, barriers to implementation, and strategies for expansion of PR across centers. Methods: Semi-structured qualitative interviews were held with all RO heads and Radiation therapy Managers (or delegate) in all 14 Radiation Oncology Programs (ROPs) in Ontario, Canada. The interview questions were developed using a Knowledge Translation Theoretical Domains Framework (TDF), guided by the results of a previous survey of Ontario cancer centers and by expert consensus. Interviews were audiotaped and abstracted for relevant themes by two independent analysts. Results: All interviewees endorsed numerous direct and indirect benefits of PR, and identified multiple facilitators and barriers to the implementation of PR. Thematic saturation was achieved. The structure-process-outcome model was used to categorize the results. Key findings included the identification of 34 independent benefits (structure n = 4, process n = 17, outcome n = 13), 40 key barriers (structure n = 9, process n = 26, outcome n = 5), and 22 facilitators (structure n = 4, process n = 15, outcome n = 3). Beyond QA, commonly endorsed benefits included enhanced knowledge sharing, efficiency, standardization, and education. Multiple potential strategies for the expansion of PR activities were revealed. Conclusions: The qualitative exploration of Ontario ROPs acknowledges that multiple barriers and facilitators to PR exist while clearly establishing the indirect benefit of PR on ROPs. Understanding reported barriers and facilitators and exploration of suggested strategies will inform continued implementation and expansion of PR activities, and seem generalizable to other jurisdictions.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2016.34.7_suppl.238
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 5
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    Online Resource
    Improving the quality of care for patients receiving radiation therapy: Increasing the proportion of radiation treatment plans undergoing peer review in Ontario.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 30_suppl ( 2014-10-20), p. 136-136
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 30_suppl ( 2014-10-20), p. 136-136
    Abstract: 136 Background: Peer review of radiation treatment (RT) plans is recognized as an essential component of quality assurance programs in radiation medicine (Marks et al., 2013). The benefits of peer review include: (1) identifying errors that may compromise treatment outcomes, (2) enhancing safety by promoting standardization, and (3) promoting greater attention to detail in RT staff. Current state analysis conducted in 2011 identified considerable variation in the proportion of cases undergoing peer review across Ontario’s 14 cancer centres (Brundage et al., 2013). In 2012, Cancer Care Ontario launched an initiative to ensure all patients receiving radical/adjuvant radiotherapy have the benefit of peer review of their RT plans. Methods: A multi-professional project team was established to conduct site visits to promote peer review at the cancer centres. They also provided guidance on the organization of peer review rounds so that the activity could be incorporated into local workflows. The education, training, methods, and a centralized reporting infrastructure were developed in collaboration with centres over a one year ramp-up phase and patient-level data was available to the centres for audit purposes. The reporting infrastructure enabled reporting of (1) the proportion of cases peer reviewed and (2) the timing of peer review – prior to treatment, 〈 25% dose delivered, 〉 25% dose delivered. Results: Data for each centre is now a key quality metric and is publicly reported (see Cancer System Quality Index at http://www.csqi.on.ca/). The target for year-one of the project (2013-14) – the proportion of cases to be peer reviewed – was set at 50% with the intent that 100% of cases will be peer reviewed within the next two years. In the ramp-up year, the proportion of cases peer reviewed increased across all centres, though high variation still exists between centres. Conclusions: This initiative demonstrates that it is possible to substantially increase peer review activities on a jurisdictional basis. Key success factors include: a dedicated project team, buy-in and confidence in data quality from centres, investment in education and training, and commitment to public reporting.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.30_suppl.136
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
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  • 6
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    Peer-review of radiation treatment planning in a provincial radiation oncology program: A survey of current practice.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 34_suppl ( 2012-12-01), p. 211-211
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 34_suppl ( 2012-12-01), p. 211-211
    Abstract: 211 Background: The use of peer-review activities in oncology is not well described as a quality improvement process. We sought to describe current patterns of practice of radiation oncology peer-review across a large Provincial Cancer program and to identifiy barriers to its use. Methods: Ontario cancer centres were surveyed. Survey item responses were typically scored using a 10-point Likert scale. The survey was administered electronically with follow-up reminders as required. The use of free-text for comments elaborating on responses was encouraged. Results: Fourteen (100%) centres responded. All rated the importance of peer-review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest-rated benefits of peer-review (each median 9/10). Four centres (29%) conducted peer-review in more than 80% of cases treated with curative intent; six (43%) peer-reviewed at least 50% of curative cases. Five centres (36%) reported “always” or “almost always” conducting peer-review prior to the initiation of treatment. Variation was seen in which aspects of a case were typically reviewed (e.g., GTV “almost always” reviewed in 67%; contouring of organs at risk in 50%). Five centres (46% of those with regular peer-review) reported that 5% to 9% of peer-reviewed cases were flagged as requiring a change, whereas 3 centres (27%) reported that 〈 2% of peer-reviewed cases required a change to be made. Five centres (36%) recorded the outcomes of peer-review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; the two factors rated as most limiting to expanding peer-review were a critical mass of radiation oncologists (median score 6/10), and prioritization of peer review by the program overall (median 5/10). Conclusions: Peer review in radiation oncology practices it is now widely used as a quality assurance activity in Ontario, identifies changes to improve quality in the individual case, and improves departmental process. The development of guidelines and standards for peer-review activities, coupled with effective knowledge translation activities are recommended.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.34_suppl.211
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
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  • 7
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    An approach to implementing meaningful change in a provincial health care system.
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 7_suppl ( 2016-03-01), p. 120-120
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 7_suppl ( 2016-03-01), p. 120-120
    Abstract: 120 Background: Radiation treatment (RT) is essential to cancer management, contributing to cure and symptom control. With increasing cancer incidence and treatment complexity, health systems must adapt to ensure patients (pts) receive the highest quality of care. Methods: With the objective of ensuring equitable access to high-quality, safe care, Cancer Care Ontario (CCO), a provincial government agency, identified provincial variability in RT activities. As a result, CCO prioritized 3 quality initiatives over the past 7 years: 1) Access to Intensity Modulated RT (IMRT) (2008-2013); 2) Peer Review of RT plans due to increasing RT planning complexity and the existence of high-profile RT errors (2012-present); and 3) Ensuring equitable access to RT (RT Utilization) (2014-present). Strategic plans were developed using change management framework adapted from the Kotter process for leading change (Kotter, JP. Harvard Bus Rev 73:59-67, 1995). In each initiative, CCO created a climate for change, engaged the provincial RT community to move priorities forward, and worked to sustain achieved gains. Results: CCO found that building a project team, communicating a clear understanding of goals and objectives, providing sufficient resources to cancer centres, and public reporting of results were key contributing success factors. IMRT project: Currently in sustainability phase. IMRT rates increased from 20% in 2008/09 - full implementation and target attainment in 2012/13. Public reporting continues. Peer Review of RT plans: Currently moving from engagement to implementation phase. Increase from 44% of RT cases undergoing peer review in 2013/14 to 68% in 2014/15. RT Utilization Project: Currently in engagement phase. Provincial shortfall of 11% in annual RT rates correlates to roughly 2500 pts who do not receive RT as needed. Engaging data experts and consulting with regional administrators, RT utilization is the current change priority for CCO’s RT program. Conclusions: These projects demonstrate the possibility of using change management practices to achieve quality improvement in healthcare. Ongoing work continues to ensure that pts in Ontario receive the highest quality cancer care.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2016.34.7_suppl.120
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 8
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    Peer review in radiotherapy (RT): A national quality improvement initiative.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 30_suppl ( 2014-10-20), p. 221-221
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 30_suppl ( 2014-10-20), p. 221-221
    Abstract: 221 Background: Peer review (PR) in Radiation Oncology has been shown to be effective in improving quality of treatment by detecting and correcting deficiencies in proposed treatment plans prior to treatment. PR is also effective in: guiding departmental treatment planning policies and processes; reducing variation in practice; providing a venue for multi-disciplinary communication, and increasing staff and trainee awareness of evolving treatment processes. The importance of PR is reflected in the inclusion of 3 PR-specific quality indicators in the Canadian Partnership for Quality Radiotherapy QA Guidelines for Radiation Oncology programs. Given this endorsement, we aim to enhance PR implementation across all Canadian cancer centres using a knowledge-translation and implementation framework. Methods: This project will facilitate increased uptake of PR in Canadian RT programs by implementing the top-down model used with success in Ontario. This model has several key components, including: a) engaging the leadership of provincial cancer agencies to promote PR at every Provincial cancer centre; b) providing modest financial support for the acquisition of the required hardware and/or staff time for coordinating PR activities; c) systematic collection of each centre’s baseline PR activities, perceived barriers and potential facilitators of PR at each centre; d) creation of a continuous quality improvement cycle by monitoring PR quality indicators over time; e) systematic knowledge and information sharing regarding effective PR processes. Results: Funding for this initiative was obtained from the Canadian Partnership against Cancer (CPAC) in April 2014. A steering committee consisting of stakeholders from across Canada has been struck and provincial launches, based on the tenets used in Ontario, have commenced in 7 of 13 provinces with others expressing interest. A national survey to obtain baseline data relating to PR activities, perceived barriers, and facilitators is underway and will be reported. Conclusions: Preliminary evidence suggests a “snowball effect” of increasing PR uptake across Canada. The implementation model could be applied in other jurisdictions interested in increasing PR in radiation oncology.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.30_suppl.221
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
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