title: A survey of radiation treatment planning peer-review activities in a provincial radiation oncology programme: current practice and future directions.
abstract: OBJECTIVE
  To describe current patterns of practice of radiation oncology peer review within a provincial cancer system, identifying barriers and facilitators to its use with the ultimate aim of process improvement.
  
  
  METHODS
  A survey of radiation oncology programmes at provincial cancer centres.
  
  
  METHODS
  All cancer centres within the province of Ontario, Canada (n=14). These are community-based outpatient facilities overseen by Cancer Care Ontario, the provincial cancer agency.
  
  
  METHODS
  A delegate from each radiation oncology programme filled out a single survey based on input from their multidisciplinary team.
  
  
  METHODS
  Rated importance of peer review; current utilisation; format of the peer-review process; organisation and timing; case attributes; outcomes of the peer-review process and perceived barriers and facilitators to expanding peer-review processes.
  
  
  RESULTS
  14 (100%) centres responded. All rated the importance of peer review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest rated perceived benefits of peer review (each median 9/10). Six centres (43%) reviewed at least 50% of curative cases; four of these centres (29%) conducted peer review in more than 80% of cases treated with curative intent. Fewer than 20% of cases treated with palliative intent were reviewed in most centres. Five centres (36%) reported usually conducting peer review prior to the initiation of treatment. Five centres (36%) recorded the outcomes of peer review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; a critical mass of radiation oncologists was the most important limiting factor (median 6/10).
  
  
  CONCLUSIONS
  Radiation oncology peer-review practices can vary even within a cancer system with provincial oversight. The application of guidelines and standards for peer-review processes, and monitoring of implementation and outcomes, will require effective knowledge translation activities.
authors.affiliation: Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Brundage
authors.forename: Sophie
authors.initials: S
authors.lastname: Foxcroft
authors.forename: Tom
authors.initials: T
authors.lastname: McGowan
authors.forename: Eric
authors.initials: E
authors.lastname: Gutierrez
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
keywords: Radiotherapy
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