title: What is access to radiation therapy? A conceptual framework and review of influencing factors.
abstract: OBJECTIVE
  Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in 'RT access'. We aimed to develop a conceptual framework for the consideration of 'RT access' by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing 'RT access'.
  
  
  METHODS
  Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for 'RT access'. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFO via OvidSP,1806 to October 2014.
  
  
  RESULTS
  The framework developed demonstrates that 'RT access' encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation.
  
  
  CONCLUSIONS
  'Access' is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of 'RT access' so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects.
authors.affiliation: The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email.
authors.forename: Puma
authors.initials: P
authors.lastname: Sundaresan
authors.affiliation: The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Stockler
authors.affiliation: The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Milross
mesh_terms: D001315:Australia; D003210:Concept Formation; D006297:Health Services Accessibility; D006801:Humans; D011878:Radiotherapy