IMRT utilization in Ontario: qualitative deployment evaluation.

Area of Science:

• Radiation Oncology
• Health Services Research

Background:

• Intensity-modulated radiation therapy (IMRT) represents an advanced cancer treatment modality.
• Implementing complex technologies like IMRT requires strategic planning and evaluation.

Purpose of the Study:

• To describe the province-wide implementation and evaluation of IMRT in Ontario, Canada.
• To identify effective strategies and lessons learned during IMRT adoption.

Main Methods:

• A mixed-methods approach involving semi-structured interviews with administrators and a 40-question electronic survey distributed to all Ontario cancer centres.
• Selection of six cancer centres for in-depth evaluation based on utilization, geography, population, academic affiliation, and size.

Main Results:

• Effective implementation strategies included funding allocation, guidelines, expert coaching, and educational activities.
• IMRT utilization increased significantly between fiscal years 2008/2009 and 2012/2013 for prostate, thyroid, head and neck, sarcoma, and CNS cancers.
• The implementation facilitated hands-on training, knowledge exchange, and shared responsibility without adverse effects on wait times or safety.

Conclusions:

• A multifaceted, jurisdiction-wide strategy successfully integrated guideline-recommended IMRT into standard practice.
• Expert-based coaching emerged as a novel and effective training approach for complex techniques.
• The findings offer valuable insights for funding, implementing, and sustaining complex and evolving medical technologies.