A step towards global understanding of advanced practice radiation therapist clinical activities: International...

Advanced practice radiation therapist (APRT) roles have expanded internationally to address cancer workforce shortages and improve service delivery. A Canadian consensus process previously established 20 standardized APRT clinical activities across five themes. This study evaluated the international applicability of these activities through expert consensus to establish a global framework for APRT practice.

A systematic three-round international Delphi consensus study was conducted following established quality framework recommendations. Expert panel members were recruited from an international Community of Practice using objective selection criteria ensuring recognized APRT expertise and diverse geographical representation. Participant anonymity was maintained throughout all rounds. Controlled feedback provided quantitative results and anonymized qualitative comments between rounds. Consensus threshold was defined a priori at 80% agreement, and activities were evaluated for inclusion in international APRT scope of practice across five themes: patient interactions, multidisciplinary consultation, virtual consultation, resource optimization, and technical activities.

Twenty-three international experts were invited to take part in the study with response rates of 81% (Round 1), 89% (Round 2), and 89% (Round 3). Twenty clinical activities were systematically evaluated. Five activities achieved immediate Round 1 consensus: Planning Consultation (83%), Multidisciplinary Pre-treatment Consultation (83%), Care Coordination (96%), Patient Navigation (87%), and Technical Consultation (87%). Following iterative three-round evaluation, 16 of 20 activities (80%) achieved final international consensus for APRT practice inclusion. Four activities failed to reach consensus: Patient Education/Informed Consent (75%), Follow-up Consultation (78%), Clinical Examination (78%), and MR Applicator Assessment (65%). The validated framework demonstrates substantial global alignment while identifying specific jurisdictional variations in advanced practice acceptance.

This study establishes international consensus on core APRT clinical activities, providing evidence-based foundations for standardized global APRT role development and implementation. These findings support healthcare systems in addressing workforce challenges through validated advanced practice frameworks while maintaining quality cancer care delivery.