"I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.
OBJECTIVE
Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs).


METHODS
Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus.


RESULTS
A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs.


CONCLUSIONS
Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans.
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada. Electronic address: michael.brundage@krcc.on.ca.
Michael D
MD
Brundage
Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Ontario, Canada.
Margaret
M
Hart
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada.
Jennifer
J
O'Donnell
Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada.
Lindsay
L
Reddeman
Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada.
Eric
E
Gutierrez
Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.
Sophie
S
Foxcroft
Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Padraig
P
Warde
D006801:Humans; D007407:Interviews as Topic; D010380:Peer Review; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*; D011795:Surveys and Questionnaires