Session Item

In order to ensure equitable access to up-to-date radiotherapy, it is important to assess how RT standards are implemented at a local, national and international level.  In this respect, assessment of Quality Indicators (QIs) not only contributes to both delivery of high-quality care and harmonisation of practice, but also helps in identifying target areas requiring improvement. We performed a systematic literature review to identify RT-specific QIs that are proposed and/or used in the RT community with the aim to generate consensus through a Delphi process on a minimum set of QIs that could be used at a European level. 

A literature review was carried out in Embase database using the search terms ‘radiotherapy, radiation oncology, quality indicators, quality improvement, quality assessment, quality measures and quality metrics’, limited to English from 2010 to March 2021. Identified QIs were classified according to the Donabedian model of structure, process or outcome measures. The following attributes of the QI were also extracted: definition and specifications, rationale, inclusion/exclusion criteria and its goals. We differentiated those QIs that had been collected from those that were only defined and we looked at the scope of the QI (monocentric, multicentric, national or international). All QI were taxonomized to identify common themes in which they could be grouped.

Out of 1133 articles, 101 were selected for analysis, and subsequently 28 papers were excluded when QIs were not clearly defined nor specific to RT. Unpublished consensus guidelines were also excluded, at this stage. The QIs proposed in 73 final papers were categorised: 25, 29 and 15 categories for the structural, process and outcome QI, respectively. Most papers originated from the USA (37), Europe (21) and Canada (7). In total 431 QIs specific to RT were reported: 51 on structure, 320 on process and 60 on outcomes. Most structural QIs focussed on staffing and workload and number of equipment while most of the process QIs focussed on specific dosimetric parameters, indications to treat and used fractionation/total dose. Outcome QIs focussed on toxicity grading and survival. The list of QIs by category as well as the number of papers in which they are suggested (N>1) are shown in Table 1. Sixty-seven percent of QIs were actually collected and analysed. Most were collected at a national (50%) and international level (19%). Finally, 30% of the QIs were general, and 70% were site specific (Figure 1).

The existence of numerous sources of information on QIs is encouraging but can be overwhelming for a RT department willing to implement them for quality improvement and benchmarking purposes. There is the need to find a consensus on a minimum set of general and site specific QIs to facilitate assessment, improvement and harmonisation of RT quality across Europe.