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Toward Canadian Benchmarks

Toward Canadian benchmarks for waiting times for radiotherapy for cancer: Synthesizing the evidence and establishing research priorities.

Radiation Oncology pan-Canadian Peer Review Initiative

This pan-Canadian Initiative is lead by Dr. Michael Brundage.

Here are some answers to commonly asked questions regarding the National Peer Review Initiative. If you have a question you would like answered please send an email to peerreview.initiative@queensu.ca

Further information can also be found in the booklet that has been developed for the National Peer Review Initiative.

I’m not sure that we have the right infrastructure to support Peer Review? Is this expensive to implement?

There is no specific equipment that is required for peer review, although some centres have found it useful to have a designated room set up in a way that facilitates viewing of patient plans by those participating in the review. Organization of the peer review session is critical and this requires staff time, which of course, has associated costs. As a participant in the National Peer Review Initiative, your centre will receive funding intended to offset some of these costs.

I’m the only Rad. Onc. at our centre who sees patients with certain less common forms of cancer. Who is going to act as my peer reviewer?

There are examples of cancer centres with large numbers of specialists accepting cases for peer review from smaller centres via a teleconnection. Clearly this process takes both relationship building and the working through of some organizational processes to succeed, but it can work very well. New tools are under development to facilitate this type of inter-centre collaboration.

I’m concerned about the legal implications of recording anything about peer review. Reassure me that peer review is not going to land me in hot water.

Peer review is a process that protects both patients and physicians by catching potential errors before they cause harm. The Canadian Physician Protection Association (CMPA) has been contacted and is forming an opinion regarding the reporting of peer review activities. We expect that they will suggest a solution to reporting peer review which is very similar to what happens on pathology reports, that is, a simple statement of agreement, such as “This case was peer reviewed and there was consensus on the treatment plan”. In the unlikely event that consensus cannot be reached between the attending physician and the reviewing physician, then the review process will require a third opinion (a tumour-board type of scenario) until consensus on the patient’s treatment plan can be reached.

Key Point: Participation in the National Peer Review Initiative does not require reporting of peer review outcomes but rather, simply a report of the percentage of cases peer-reviewed. The details of managing the recording process will be left to individual cancer centres.

Has any provincial cancer system in Canada been successful in implementing peer review?

Yes, Ontario has successfully implemented peer review, and captured peer review data, at 14 cancer centres. Not only are we capturing data about the % of cases being peer-reviewed in Ontario, but also the outcomes of those peer review processes.

Many other provinces are undertaking peer review in at least some of their cancer centres.

Is peer review more critical for some cancer sites than for others?

Yes, we think that the data we are collecting in Ontario will be informative in this regard and will make the review process more efficient by indicating where review efforts should be focused.

I need a brief document about Peer Review to inform the staff in my department about what is happening with the national initiative. What is available?

We have a brochure that may be helpful to you, it can be found in pdf below. If you would like hard copies, just send us a request for the numbers you need, and an address to send them to, and we’ll make sure you receive them.

Who should attend peer review sessions?

Peer review provides an opportunity for multi-disciplinary input and education. RTs, physicists, residents, and nurses frequently attend these sessions in addition to Radiation Oncologists.

Why should we record and monitor the outcomes of peer review over time?

Monitoring peer review outcomes over time may allow you to revise policies and to make efficiencies. For example, after reviewing breast cases for a year, you may find that no changes are ever recommended. This knowledge may allow you to decrease the number of breast cases routinely peer reviewed, thereby allowing more time for the review of different and perhaps more problematic/complex cancer sites.

We want a provincial coding system to collect data on peer review in order to monitor progress within our cancer system over time. What do you suggest?

Ontario has used the following set of codes relating to peer review, which are based on NHPIP codes; this list includes codes for peer review outcomes. However, u se of these codes is not mandatory; it is not necessary to change codes that you may already have in place to reflect peer review activities.

What any set of codes should attempt to capture is: whether the clinical implications of the recommended change was major or minor; whether replanning was necessary, and; whether the nature of the concern was tumour coverage or toxicity or both.

Should we capture peer review data by patient or by episode of treatment?

Each episode of treatment needs to be reviewed.