2637 - Ethics-Guided Radiation Therapy (EGRT): Knowledge, Attitude, Practice (KAP) Global Survey
Presenter(s)
L. Mula-Hussain1,2, E. Alsrayheen3, M. Rajaraman4, M. Al-Ghazi5, S. Abai6, A. Porter7, L. Boldrini8, S. J. Wadi-Ramahi9, S. Salem10, A. Alhasso11, A. Saito12, D. R. Wilke4, A. Kamal Uddin13, A. M. Fairchild14, C. Samaha Jabbour15, H. Haddad16, H. Zhu17, I. A. Mohamad18, I. Lalya19, M. Tolba7, M. S. Zaghloul20,21, M. Sayan22,23, N. Pervez24, O. Abdihamid25, M. U. Karim26, S. Alfaifi27, M. N. Ha28, R. A. Olson29,30, A. N. N. Abbasi31, and R. Pearcey32,33; 1Faculty of Medicine - Dalhousie University, Halifax, NS, Canada, 2College of Medicine - Ninevah University, Mosul, Iraq, 3Nova Scotia Health Authority, Sydney, NS, Canada, 4Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, NS, Canada, 5University of California, Irvine, Orange, CA, 6Cure Oncology Center, Abha, Saudi Arabia, 7Dalhousie University, Halifax, NS, Canada, 8Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy, 9Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, 10International Atomic Energy Agency, Vienna, Austria, 11Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom, 12Juntendo University, Tokyo, Japan, 13Department of Radiation Oncology, National Institute of ENT, Dhaka, Bangladesh, 14Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, AB, Canada, 15Mount Lebanon Hospital, Beirut, Lebanon, 16Tübingen University Hospital and Medical Faculty, Tübingen, Germany, 17Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China, Shanghai, China, 18Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan, 19Faculté de Médecine de Rabat, Rabat, Morocco, 20Children's Cancer Hospital, Cairo, Al Jizah, Egypt, 21National Cancer Institute, Cairo University, Cairo, Egypt, 22Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, 23Harvard Medical School, Boston, MA, 24Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates, 25Garissa Cancer Center, Garissa, Kenya, 26Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada, 27Cleavland Clinic Ohio, Cleavland, OH, 28Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada, 29University of British Columbia, Vancouver, BC, Canada, 30BCCA - Prince George, Prince George, BC, Canada, 31Aga Khan University Hospital, Karachi, Sindh, Pakistan, 32Cross Cancer Institute, Edmonton, AB, Canada, 33University of Alberta, Edmonton, AB, Canada
Purpose/Objective(s): Rapid advancement of radiotherapy (RT) practice introduced complex ethical challenges, including patient autonomy, conflicts of interest, resource allocation, equity, and medical and financial toxicities. This initial work aims to develop an Ethics-Guided Radiation Therapy (EGRT) baseline to address these challenges and start refining ethical decision-making in modern RT.
Materials/Methods: A structured administrative survey was distributed via data collection web application to assess radiation oncologists' (ROs) knowledge, attitudes, and practices (KAP) regarding EGRT. Nova Scotia Health Research Ethics Board fully approved the study questionnaire. The survey included 10 demographic questions and 49 KAP closed-ended questions utilizing a 5-point Likert scale and dichotomous formats. Before distribution, it underwent expert validation and pilot testing to ensure clarity and relevance. Participants were recruited through purposive and snowball sampling, targeting radiation oncologists worldwide. Data analysis included descriptive statistics, chi-square tests, and Cramer’s V to examine associations between demographic variables and KAP responses.
Results: A total of 384 ROs accessed the KAP survey, with 255 completing it (67% response rate). Participants were from 57 countries across six continents (median 2 [IQR 1-6]). Respondents showed global support for EGRT, with =91% agreeing on its relevance to treatment decisions, quality assurance, and RT safety. Among them, 8.7% rated their EGRT knowledge as "very good", while 40% considered it "acceptable", highlighting educational gaps. Anticipated implementation challenges emerged, with 60% finding EGRT easier to apply in public rather than private settings, suggesting financial and institutional obstacles. Furthermore, 72% of participants indicated that financial factors influenced their treatment choices. Support for the integration of EGRT was robust, with 89% in favor of including it in guidelines and 81% expressing willingness to engage in EGRT educational courses. Despite strong adherence to ethical principles, there are areas for improvement, such as professional conflicts (39%), lower engagement in the peer-review process (43%), and quality assurance (51%).
Conclusion: This study demonstrates global support for EGRT while highlighting knowledge gaps and ethical challenges. For broader adoption, targeted education, standardized guidelines, and policy reforms are needed. DELPHI approach will be utilized in the second phase of this project to prioritize EGRT actions by systematically engaging RO experts to refine EGRT statements and outline implementation strategies.