Paediatric Radiotherapy Service

Assessment of a department's paediatric radiotherapy service against the recommendations of the Good Practice Guide for Paediatric Radiotherapy (2018).

In 2012, the first edition of the Good Practice Guide for Paediatric Radiotherapy was published. This has been recently revised and updated, and published in 2018 under the joint auspices of the Royal College of Radiologists, the Society and College of Radiographers, the Institute of Physics and Engineering in Medicine and the Children's Cancer and Leukaemia Group. The purpose was to bring together guidance relevant to paediatric radiotherapy practice from various sources, and to set expectations. Some of the recommendations are recognised to be aspirational, and not universally available. It is hoped that these may allow departments to leverage extra resources to enable them to become compliant. This audit is based around the ten key themes set out in the guidance.

The standard: 

1. Top quality clinical outcomes

2. Excellent patient safety

3. Good patient experience

4 . Information and communication with families

5. Communication and multiprofessional relationships

6. Child- and family-friendly environment

7. Radiotherapy equipment and techniques

8. Human and financial resources

9. Education and training

10. Research and development

Target: 

To compare local resources and practice with the Good Practice Guide for Paediatric Radiotherapy recommendations. The target is that all recommendations should be met, and that an action plan should be developed for any criteria which are not met.

Indicators: 

See the subsections of the standards decribed above in the 'Ten Key Themes' on pages 4-6 of the Guide, and the more detailed 'Recommendations' on pages 38-44. Ask yourself whether your department meets these criteria, fully, partially or not at all.

Data items to be collected: 

It is anticipated that most departments will meet most recommendations fully. List those aspects where your department meets the criteria only partially, or not at all. The data items to be collected are not listed here in full - see the Guide for details. As examples, the following questions may be asked:

*If you cannot provide a specialist service such as stereotactic radiotherapy or brachytherapy locally, do you advise and facilitate referral of selected patients to another centre?

*Are you able to open all relevant clinical trials for children involving radiotherapy in your centre?

*Is your department adequately staffed with respect to clinical oncologists, specialist radiographers, radiotherapy physicists and dosimetrists, play specialists and anaesthetic teams to provide a good service at all times?

*Do your clinical oncologists have adequate time specified in job plans and available in practice to devote to the paediatric radiotherapy component of work including the ability to attend all relevant MDTs?

Suggested number: 

(As this is an audit of a clinical service not an audit of individual patients, no number is suggested)

For each criterion which is not met fully (or at all), an assessment should be made as to whether there is any justification not to attempt to meet it. A plan for meeting each unmet criterion should be developed, in discussion where necesary with managers at an appropriate level.

Examples of such a plan might be:

*To develop a business case for the appointment of a new consultant clinical oncologist to allow cross cover during periods on leave, and to support attendance at all relevant MDTs. The Guide can be used to support this case.

*To address the need for additional CPD activity in the area of paediatric radiotherapy at an individual's appraisal and personal development plan formulation.

*To work with colleagues in the hospital's clinical trials unit and radiotherapy physice team to prioritise and facilitate timely opening of relevant clinical trials.

Staff time: Establishment of a departmental working group with representation from all relevant professions. Members to prepare by reading the Guide and making a peliminary assessment of the various criteria and whether or not they are being met. Meeting together to go through the recommendations item by item, and documenting compliance. Development of a plan to deal with areas of non-compliance.

1. The Royal College of Radiologists. Good practice guide for paediatric radiotherapy, second edition. London: The Royal College of Radiologists, 2018. Ref No. BFCO(18)2

Mark Gaze