Dana-Farber/Brigham and Women's Cancer Center Weymouth, MA
G. H. Boyd1, T. J. Dilling2, I. C. Gibbs3, D. W. Golden4, R. H. Mak5, K. Olivier6, C. C. Pinnix7, R. D. Tendulkar8, C. M. Yashar9, A. R. Yeung10, S. S. Yom11, and R. B. Jimenez12; 1Harvard Radiation Oncology Program, Boston, MA, 2Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, 3Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, 5Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 6Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 7Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 8Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, 9Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 10Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 11University of California San Francisco, San Francisco, CA, 12Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Purpose/Objective(s): Checklists in medicine are widely used and known to improve patient safety. We developed a consensus method for systematic radiation treatment plan review for use by radiation oncology physicians to improve efficiency and safety of plan review for external beam electron and photon-based treatments. Materials/
Methods: 11 nationally recognized disease-site experts in radiation oncology involved in educational initiatives from diverse institutions were invited to participate in a consensus development panel. Ten physicians joined the panel, representing subspecialists in all major disease sites for radiation oncology. Median number of years in practice for panelists was 16.5 (range 11-24). A nominal group technique (NGT), which is an established consensus development process in health professions literature, was employed for iterative development of the guideline. NGT consists of four steps for consensus development: 1. Idea generation, 2. Idea sharing, 3. Moderator-led group discussion, and 4. Consensus voting. Prior to panel meetings, all panelists were provided with multiple relevant publications on systematic plan review for independent evaluation and asked to create a detailed checklist of items that should be reviewed by a physician for all treatment plans prior to approval for patient care. They were instructed to create a list that reflected what each believed should be reviewed for every plan under ideal circumstances. Consensus development took place over the course of three months, including three hours of virtual meetings with all panelists in attendance to discuss the merits of all participant submissions. A preliminary checklist representing all submitted ideas was created. All panelists voted on each individual line-item in checklist using a 4-point Likert Scale (“strongly disagree” to “strongly agree”). A “moderate consensus” was pre-defined by the expert panel as 60% of panelists ranking a line-item as “agree” or “strongly agree”. A “strong consensus” was defined as at least 80% of panelists making the same determination. Results: All panelists participated in the consensus voting process. 54 line-items were evaluated, 49/54 (91%) reaching the level of “strong consensus”. “Strong consensus” line-items were consolidated into a finalized 36-item checklist, organized in a logical stepwise manner, and edited for clarity. All panelists discussed and agreed upon an organizational structure for the finalized checklist. Conclusion: Utilizing a NGT approach, an expert panel of ten academic radiation oncologists representing a diversity of disease site specialties, technical expertise, and years in practice successfully developed the first consensus checklist for radiation oncologists to facilitate systematic treatment plan evaluation in all clinical scenarios. Validation of this guideline in diverse clinical settings is anticipated.
