Vienna, Austria

ESTRO 2023

Session Item

May 14
10:30 - 11:30
Strauss 3
Advancements in RTT practice
Loes Bulthuis, The Netherlands;
Michelle Leech, Ireland
Proffered Papers
10:30 - 10:40
The four pillars of advanced practice: perspectives from key radiotherapy stakeholders across Europe
Celeste Oliveira, Portugal


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

Celeste Oliveira1, Bárbara Barbosa2, José Guilherme Couto3, Isabel Bravo2, Ciara Hughes4, Sonya McFadden5, Ricardo Khine6, Helen A McNair7

1Instituto Português de Oncologia do Porto (IPO Porto), Radiotherapy, Porto, Portugal; 2Instituto Português de Oncologia do Porto (IPO Porto), Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Porto, Portugal; 3Faculty of Health Sciences, University of Malta, Msida, Malta., Radiography , Msida, Malta; 4Ulster University , School of Health Sciences, Belfast, Portugal; 5Ulster University, School of Health Sciences, Belfast, United Kingdom; 6 Buckinghamshire New University, School of Health Care and Social Work, Buckinghamshire, United Kingdom; 7The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Radiotherapy, Surrey, United Kingdom

Show Affiliations
Purpose or Objective

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.

Material and 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.


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.


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.