Open AccessCollaborative Model for International Telehealth: High Dose Rate Brachytherapy Training for Emerging Radiation Oncology Centers in Lower- and Middle-Income Countries
Author(s) -
Jeremy B Hatcher,
Adam Shulman,
Claire Dempsey,
Betty Chang,
Sameeksha Malhotra,
Oluwadamilola T. Oladeru,
Michael Tassoto,
Peter Sandwall,
Sonja Dieterich,
Benjamin Li
Publication year - 2020
Publication title -
jco global oncology
Language(s) - English
Resource type - Journals
ISSN - 2687-8941
DOI - 10.1200/go.20.47000
Subject(s) - brachytherapy , attendance , curriculum , medicine , confidence interval , likert scale , medical physics , radiation oncology , radiation therapy , family medicine , medical education , psychology , pedagogy , developmental psychology , economics , economic growth
PURPOSE High dose rate (HDR) brachytherapy is a critical treatment modality—both palliative and curative—for gynecologic malignancies that significantly burden low- and middle-income countries (LMICs). Many of these countries currently have limited capacity to provide necessary brachytherapy treatment. To bridge this gap in LMICs in North Africa and the Middle East, nonprofits Rayos Contra Cancer and Radiating Hope evaluated the efficacy, cost, and feasibility of a pilot HDR brachytherapy continuing medical education curriculum to selected regional cancer centers via videoconferencing.METHODS Rayos Contra Cancer and Radiating Hope recruited a global team of HDR brachytherapy content experts. They developed a 16-week curriculum and recruited 10 regional cancer center partners in LMICs throughout the Middle East, Africa, and Nepal. The curriculum included 17 sessions shared via live Zoom videoconferences. A lead correspondent was assigned for communication at each center. Attendance was taken during each call, and pre- and postsession Likert-scale (1 to 5 points) surveys were collected from participants that assessed their confidence in 15 practical competencies in HDR brachytherapy and overall confidence in their ability to provide services and teach others.RESULTS A total of 326 attendance hours was recorded during the curriculum. Among 46 participants, the average paired confidence scores increased pre- versus postcurriculum in all 15 practical competencies, with an average improvement of 1.2 out of 5 and significant P values in all 15 topics. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .0015), TPS commissioning (2.2 to 3.7, P = .0010), and commissioning an HDR machine (2.2 to 4.0, P = .00096). Participant confidence significantly increased in ability to provide services (3.5 to 4.2, P = .0023) and teach others (3.4 to 3.9, P = .013). There was no cost to provide this training, and more than 4,300 patients are treated annually with HDR brachytherapy at participating centers.CONCLUSION This novel low-cost telehealth model for HDR brachytherapy training is a promising vehicle for advancing cancer care in LMICs. Postcourse surveys demonstrated increased confidence in both providing care and teaching in HDR brachytherapy, and sessions were well attended. A video-based telehealth teaching platform enabled expert HDR brachytherapy providers and physicists to reach growing cancer centers worldwide.