Attitudes and access to resources and strategies to improve quality of radiotherapy among US radiation oncologists: A mixed methods study

Introduction We aimed to assess contouring‐related practices among US radiation oncologists and explore how access to and use of resources and quality improvement strategies vary based on individual‐ and organization‐level factors. Methods We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi‐structured interview. Kruskal–Wallis and Wilcoxon rank‐sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis. Results Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring‐related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease‐site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2–14.8) and younger physicians (OR 1.33 for each 5‐year increase, 95% CI 1.08–1.67). Common physician‐reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease‐site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease‐site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour‐specific review, which is more common in academic centres (P = 0.02). Conclusion Potential opportunities to improve radiation contour quality include improved access to disease‐site specialists and contour‐specific peer review. Physician time must be considered when designing new strategies.