Evaluation of Advanced Practice Radiation Therapist integration in an inpatient palliative radiation therapy service: a single-center prospective observational mixed-methods study

BACKGROUND: In the United States context, Advanced Practice Radiation Therapists (APRTs) are emerging roles designed to support time-sensitive, non-billable clinical tasks in complex radiation oncology settings. This study evaluated the integration of an APRT into an inpatient palliative radiation therapy (PRT) service at a large academic medical center. METHODS: This 24-month, single-center observational study assessed associations between APRT integration, clinician well-being, and departmental quality improvement/quality assurance (QI/QA) key performance indicators (KPIs). Clinician well-being was assessed at 6, 12, 18, and 24 months post-integration using the American Medical Association (AMA) Mini-Z 2.0 survey. Quantitative items were summarized descriptively with trend testing and correlation analyses. Free-text responses (including APRT integration prompts and workflow burden prompts) were analyzed using inductive qualitative content analysis appropriate for brief survey data. Departmental QI/QA KPIs-including simulation eligibility, simulation completion, treatment initiation, completion of the prescribed course, documentation compliance, and communication-related safety entries-are compared across intervals. RESULTS: A total of 23 clinicians [13 radiation oncologists (ROs), and 10 residents] were invited to participate in the survey. Response rates ranged from 48% to 79% across the four follow-up time points. Burnout decreased among respondents over time and perceptions of a supportive practice environment increased, while job satisfaction and perceived stress did not change significantly. The electronic medical record (EMR) burden was consistently associated with burnout. Departmental KPIs improved over time, including higher simulation eligibility, higher simulation completion, and higher completion of the prescribed course; treatment initiation remained consistently high. Documentation compliance remained high throughout the study period. Qualitative feedback described improved coordination, communication, and physician support, with most respondents reporting a positive APRT impact throughout the study period. CONCLUSIONS: APRT integration within an inpatient PRT service was associated with improved departmental KPIs and favorable clinician-reported trends, while persistent EMR burden remained a key correlation of burnout. Given the observational design and variable response rates, findings should be interpreted as associative and hypothesis-generating. These results support further evaluation of APRT models using designs with higher response capture and linkable longitudinal measurement.