Can-AP: Informing a system level model for advanced practice implementation in radiation therapy through global experience.

INTRODUCTION

This work sought insight from countries at various stages of advanced practice radiation therapy (APRT) implementation, focusing on five system-level elements: practice framework, regulatory structure, educational preparation, certification model, and role implementation.

METHODS

A key informant survey targeted six national academic APRT leaders: Australia, Canada, Singapore, United Kingdom, United States, and France. Likert scale and ranking items considered the order of approach and progress in proposed elements, with additional insight sought in open-ended items.

RESULTS

Practice framework was the most well-addressed element; 4/6 (66.7%) informants believing it was at least "well underway". The development of a regulatory structure was the least well advanced. Singapore's informant believed their country to be furthest along overall, while France was perceived to have progressed the least. Informants tended to believe regulatory structure should be addressed earlier than it had been, while certification could come later, though some noted broader system-level political considerations that might impact advancement. Four informants (66.7%) noted element interreliability, seen to challenge efforts to pursue any individual element alone. All informants noted the value of therapist-led committees to advance elements, and those earlier in APRT journeys (Singapore, United States, France) noted the value of practice frameworks from Canada and the United Kingdom in informing work. Australia, Canada, and the United States proposed adding economic analysis of APRT as a sixth element.

CONCLUSION

APRT integration demonstrates jurisdictional commonalities and nuances that can inform a system-level model. A 'Can-AP' model is proposed that integrates elements and builds clarity, acceptance, credibility, competence, viability, and a common implementation and process reporting standard for global APRT and other health professions exploring advanced practice.