The four pillars of advanced practice: perspectives from key radiotherapy stakeholders across Europe.

Purpose
The study aims to explore perceptions of the four pillars of Advanced Practice (AP):
clinical practice, education, research, leadership and management in the current
practice and education of Radiation Therapists (RTTs) across Europe from
stakeholders' perspectives.
Methods
A qualitative descriptive study was conducted using individual semi-structured
interviews (online). Purposive and convenience sampling was used to recruit
stakeholders across Europe (advanced practitioners, RTTs, managers, educators,
postgraduate students, professional associations representatives and regulatory
bodies representatives). Interviews (n=33) were conducted between June and early
September 2022 (average: 47 minutes). Full verbatim independently transcriptions
were checked by both interviewer and interviewees. Four researchers independently
coded the transcriptions using inductive thematic analysis. The COREQ guideline
guided the study process.
Results
The interviewees' in-depth insights were from 16 European countries. Most
stakeholders valued all pillars of AP. However, gaps in the research pillar on the current
practice of advanced practitioners were highlighted, and a lack of leadership and
management content in the AP programmes was noted.
Sub-themes related to AP challenges were common between countries and included
staff recruitment and retention issues, lack of postgraduate education specific to AP in
radiotherapy, AP clarity and standardisation at national and European levels, lack of
recognition of “advanced practitioner” profile and regulation, educational and training
needs for specific AP roles, etc.
Conclusion
Efforts should be made to enhance the pillars of research, leadership and
management in the practice and education of RTTs. Standardisation of the AP level is
recommended for the sustainability of this workforce transformation demanded in the
European agenda. A legal framework including the four pillars of AP is urgently needed
to support the education and practice of AP roles amongst RTTs in the current and
future radiotherapy landscape. This study provides a sound basis for radiotherapy
advanced practice research whereby future research should include other
stakeholders, such as other healthcare professionals from the interprofessional teams,
policymakers, patients, and the public.
Keywords: Professional issues, Four pillars, Europe
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