Exploring end of life care provision during medical imaging in hospitals: Analysis of survey data from the UK radiography workforce.

INTRODUCTION: Patients receiving end-of-life care often undergo medical imaging examinations in hospitals to inform symptom management and care. Yet little is known about the experiences of the radiography workforce who deliver it. This study aims to describe and explore experiences of the UK radiography workforce delivering medical imaging as part of patients' end-of-life care. METHODS: A mixed method cross-sectional online survey disseminated via social media and national organisations from September 2023 to January 2024. Diagnostic radiographers, assistant practitioners and radiology assistants involved in the medical imaging of patients receiving end-of-life care in UK hospitals. RESULTS: 120 valid responses were received. Most respondents received no education/training (91.6%) on the role of medical imaging in end-of-life care, despite 87.7% expressing a need for education, particularly around adopting supportive/palliative-centric communication techniques. Although most respondents (89.2%) had heard of end-of-life care, some had difficulty understanding the role of medical imaging in end-of-life care. Insufficient information provided on imaging requests hindered the workforces' ability to determine and understand the appropriate use of medical imaging during end-of-life care. These uncertainties exacerbated negative emotions, with 80.8% of respondents indicating that they felt emotional during or after imaging patients on end-of-life care. CONCLUSION: Educational and policy needs were identified around facilitating more supportive/palliative-centric communication techniques and providing the radiography workforce with the knowledge to better understand, explain, deliver and where necessary, challenge the use of medical imaging in end-of-life care. IMPLICATIONS FOR PRACTICE: This study has evidenced the important role the radiography workforce play in generalist end-of-life care. However, there is a need for training to support practitioners as well as appropriate policies to develop supportive and high-quality end-of-life care in medical imaging.

Understanding experiences of the radiography workforce delivering medical imaging as part of patients' end of life care: An exploratory qualitative interview study.

INTRODUCTION: People nearing the end of life often require medical imaging in hospitals to manage symptoms and care, despite this little is known about the experiences of those delivering it. The aim of this study is therefore to explore the experiences of the radiography workforce delivering medical imaging as part of patients' end-of-life care. METHOD: Qualitative design using semi-structured interviews and thematic analysis. A total of 8 participants participated in the study including registered diagnostic radiographers (n = 5), imaging assistants (n = 2) and assistant practitioners (n = 1). All have been involved in the medical imaging of patients receiving end of life care in UK hospitals. RESULTS: Findings identified an absence of end of life care policy guidance and education accessible to radiography staff, limiting their ability to provide evidenced based care for those nearing the end of life during medical imaging examinations. Findings also suggest difficulty in identifying patients receiving end of life care further hindered staffs' ability to adapt their care to provide a more person-centred approach. Lastly, the workforce felt an accumulative emotional burden following their interactions with patients nearing the end of life. CONCLUSION: There is a clear need to develop policy and education to support the radiography workforce to ensure care is appropriately identified and adapted to those nearing the end of life. Furthermore, staff support and wellbeing needs to be considered. IMPLICATIONS FOR PRACTICE: Future research is required exploring the patient perspective to understand their experiences so that the education and practice provision is driven by patient need. International exploration of end of life care in medical imaging is recommended to explore whether similar challenges related to clinical practice exist in other countries.

Optimising care and the patient experience for people living with dementia: The perceptions of radiography practitioners.

INTRODUCTION: Despite abundant literature on the diagnosis of dementia, limited research has explored the lived experiences by radiography practitioners when delivering care to people living with dementia (PLWD). This study explored the perceptions and compatibility of current professional guidance by both radiography practitioners and key stakeholders involved in developing the Society and College of Radiographers clinical practice guideline document for caring for people with dementia. METHODS: This was a two-stage qualitative multi-method study. Fifteen diagnostic and two therapeutic radiography practitioners from across the UK participated with three asynchronous online discussion forums. One core member and three members from the key stakeholder group participated with individual semi-structured interviews. Data analysis included narrative and thematic analysis. RESULTS: Participants from both stages identified enablers and barriers to providing person-centred care (PCC) to PLWD. Three superordinate themes were identified linked to (1) Challenges in delivering person-centred care to people living with dementia, (2) The need for role specific education and training, and (3) Partnership working with carers. Challenges in delivering care included time and resource pressures. The lack of dementia specific education compounded these difficulties. Care partners were seen as an asset to providing care. CONCLUSION: Providing PCC to meet the individual needs of PLWD can be challenging in practice. This is often due to time and resource implications. There were also issues with the identification of PLWD prior to their attendance in the department. Carers could help to alleviate some challenges. There is a need for profession specific education and dementia awareness training to support the provision of PCC to PLWD. IMPLICATIONS FOR PRACTICE: Dementia training needs to be specifically tailored for radiography practitioners to bridge the gap between guidelines and clinical practice rather than being generalised from other disciplines.

The diagnostic value and accuracy of ultrasound in diagnosing hydatidiform mole: A systematic review and meta-analysis of the literature.

INTRODUCTION: Hydatidiform moles are the most common type of gestational trophoblastic disease. Internationally the incidence of hydatidiform moles is 1-2:1000 pregnancies. Early detection of women with hydatidiform moles is preferential, as these women are at a higher risk of developing other gestational trophoblastic disease. Despite Ultrasound being the most common modality used to diagnose hydatidiform moles, its diagnostic value and accuracy throughout all trimesters remains uncertain. Thus, the aim of this review was to explore and evaluate the diagnostic value and accuracy of Ultrasound in diagnosing hydatidiform mole throughout all trimesters of pregnancy. METHODS: The databases MEDLINE and CINAHL were searched between 2004 and 2021. Included studies were quality assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 8 studies were included. The narrative synthesis identified four themes: Misdiagnosis, Complete and Partial molar pregnancy, Operator dependency and Gestational age. The meta-analysis highlighted although the sensitivity of ultrasound for diagnosing hydatidiform moles is relatively low at 52.2%, the specificity was high at 92.6%. CONCLUSION: While histological examination remains the gold standard for detecting hydatidiform moles, our review made evident that ultrasound is a beneficial diagnostic tool in the detection of Hydatidiform moles, especially alongside other diagnostic investigations. This review has highlighted and collated the main barriers and facilitators to diagnosing hydatidiform moles using ultrasound. IMPLICATION FOR PRACTICE: Findings suggest that although sonographic detection of hydatidiform moles remains a diagnostic challenge, seeking a second opinion or repeating scans before making a final diagnosis should be embedded into clinical practice.

The role of the advanced clinical practitioner in breast diagnosis: A systematic review of the literature.

INTRODUCTION: Increasing prevalence in breast cancers, workforce shortages and technological advancements have increased the need to further develop advanced practice in breast diagnosis. The Advanced Clinical Practitioner training programme has been introduced to support this need. The aim of this work was to systematically review studies that explore advanced practice in mammography to assess the potential impact of the introduction of a specific Advanced Clinical Practitioner training programme in breast diagnosis within the UK. METHODS: A systematic PRISMA review of the literature published between 1999 and January 2020 was carried out. A total of 17 studies were included in the review. RESULTS: Four themes were identified in the literature in relation to advanced practice in breast imaging: multidisciplinary practice; roles and responsibilities associated with advanced practice; development and progression; embedding and sustaining advanced practice. It was evident across all themes that advanced practice is vital in supporting better care for patients attending breast imaging in light of workforce shortages. Although advanced practice and its benefits are well established in breast imaging, persistent barriers were acknowledged such as role ambiguity, recruitment issues, lack of support from some radiologists and poor funding. CONCLUSION: Findings suggest that introducing a more formalised pathway to advanced practice into breast imaging through the implementation of a specific Advanced Clinical Practitioner apprenticeship training programme may overcome many of the challenges evidenced in this review. IMPLICATIONS FOR PRACTICE: The findings of this review will help inform the development of the Advanced Clinical Practitioner apprenticeship programme specific to breast diagnosis.