SACME

1
Modeling IPP through IPE Preliminary
investigation on the impact for Radiation
Medicine

• SACME
• April 24th, 2009
• C. Gillan1, D. Wiljer12 ,(Presenter), P.
  Catton12, M. Gospodarowicz12, D. Jaffray12, N.
  Harnett12, G. Kane3, S. Urowitz1
• 1 Princess Margaret Hospital, University Health
  Network
• 2 University of Toronto, Department of Radiation
  Oncology
• 3 University Washington Medical Center Seattle

2
Princess Margaret Hospital

• Largest comprehensive cancer care program in the
  world
• One of the top 5 cancer treatment and research
  facilities in the world
• Over 10,000 cancer patients seen annually
• Treat 400 patients daily with radiation therapy

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Radiation Medicine Program

• Medical Physicist 28 FTEs at the interface of
  the technology and the biology
• Radiation Oncologist 36 FTEs at the interface
  of the biology and the patient
• Radiation Therapist 180 FTEs at the interface
  of the patient and the technology

• Largest radiotherapy department in the western
  world

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Radiation Medicine Program

• Basic patient care pathway in Radiation Therapy

Decision to treat
Plan creation
Planning imaging
Target delineation
FINISHED TREATMENT
Plan approval
Daily treatment
Plan QA
5
Radiation Medicine Program

• Modified pathway incorporating daily guidance

Decision to treat
Plan creation
Planning imaging
Target delineation
FINISHED TREATMENT
Plan approval
Plan QA

• Reassignment of duties and responsibilities

6
IGRT Education Course

• 2.5 day course
• Mix of theory and practice
• Implicit IPE approach
• Approximately 25 faculty per course from 5
  disciplines
• 15 offerings (since Nov/05)
• 332 attendees from over 30 organizations in more
  than 10 countries

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IGRT Course Evaluation / Research Overview

• Course Evaluation
• Pre-Test / Post-Assessment for practice change (1
  week pre 1 and 6 months post)
• Participant Interviews
• Outcome Assessment 3 Phases
• Phase I Environmental scan
• Phase 2 Instrument generation
• Phase 3 Validation

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IGRT Course Evaluation

• Results
• High faculty ratings across all disciplines
• In 2006, 25 of all attendees responded with
  interprofessional/ team approach (n 52)
• In 2007, 64 indicated the interprofessional
  practical/hands-on sessions (n 45)

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Pre-Test / Post-Test

• In the last 5 courses (n82), the participant
  response rate was 57 pre and 21 post.
• 57 of participants in the pre-questionnaire
  reported high levels of IPP in their practice
  compared with 53 in the post-Course
  questionnaire
• 57 pre to 60 post for oncologists,
• 65 to 50 for physicists, and
• 50 to 13 for radiation therapists

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Participant Interviews

• Benefits of IPE
• open communication
• holistic knowledge base
• appreciation for roles
• Challenges to IPE
• power relations
• time constraints

You know, if I understand what the therapists
are doing how theyre setting up, how theyre
making shifts off isocentre it enriches my
knowledge Oncologist
if you were trying to get into the nitty-gritty
of something, you couldnt cover what you wanted
to Physicist
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Participant Interviews (cont)

• Benefits of IPE ? IPP
• collaboration
• efficiency of care
• Challenges to IPE ? IPP
• acting as a change agent
• professional trust territorialism

I think weve had a much more collaborative
approach since taking the Course Therapist


Their task is such that they want to be sure
that other peoples tasks are not quite the
same Oncologist
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Outcome Assessment Issue

• There are very few tools to assess the level of
  inter-professional activity in clinical practice.
  
• Without a validated tool to assess IPP, there is
  a limited ability to quantitatively assess the
  level of IPP and the impact of CME initiatives.

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Solution

• Develop a validated instrument to measure levels
  of inter-professional practice
• Assess the impact of inter-professional practice
  on clinical practice and patient outcomes

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Suggested Methods

• A three phased, mixed-methods approach
• Phase I will focus on item generation through an
  environmental scan and retrospective review
• Phase II on the creation of a draft instrument
  and a cognitive walkthrough
• Phase III on piloting of the instrument to assess
  validity.

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Phase I(a) Environmental Scan

• Review literature
• 1) What are the primary elements or components
  of an inter-professional practice?
• 2) What domains of inter-professional practice
  are most commonly affected by IPE?
• Collate relevant questions from existing
  instruments.
• 1) All questions will be coded and analyzed
  using NVivo
• 2) Thematic categories will be developed
• 3) Two research associates will code each
  question into the appropriate category
• 4) A preliminary item list will be generated

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Phase I(b) Retrospective Clinical Review

• Identify potential objective measures of IPE/IPP
  changes in outcomes in the clinical environment
• Reported error and incidence rates
• Efficiency of treatment times
• Continuity of care
• Inter-professional participation in IPE
  educational course rounds, committee membership,
  and policy development

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Phase II Instrument Generation

• Create standardized, close ended instrument from
  the final item list
• Conduct cognitive walkthroughs
• Based on walkthrough analysis, the instrument
  will be finalized

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Phase III Instrument Validation

• Initialize psychometric validation
• Face validity through focus groups
• Content validity through an expert panel
• Factor analysis administer instrument to 200 past
  course participants
• Criterion / construct validity administer the
  instrument to 3 Course cohorts using sub-scale
  equivalents in key domains

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Conclusions

• IPP driving IPE resulted in a highly rated,
  relevant course
• Implicit IPE approach was noted and highly
  valued by participants and faculty
• Validated instruments to assess IPP and its
  impact on CME is a critical next step

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Project Team

• David Wiljer, PhD. Director / Researcher
• Jean-Pierre Bissonnette, MSc, PhD, Senior
  Physicist,
• Caitlin Gillan, BSc (Hons) MRT(T), Radiation
  Therapist
• Nicole Harnett, MRT(T), Med, Director, Radiation
  Skills Lab
• Gabrielle M Kane, MB EdD FRCPC, Oncologist,
• Sara Urowitz, MSW, PhD Manager / Researcher
• Pamela Catton, MD, MHPE, FRCPC, Oncologist
• Mary Gospodarowicz, MD, MHPE, FRCPC, Oncologist
• David Jaffray, MSc, PhD, Physicist (Head)
• This IGRT Education Course is funded in part by
  an unrestricted educational grant from Elekta
  inc.