# Provider Practices and Perceived Barriers and Facilitators in Improving Quality Practices in Radiation Oncology Peer Review

## TL;DR

This study explores how radiation oncology professionals view peer review practices, identifying factors that help or hinder their effectiveness in improving treatment quality.

## Contribution

The study provides new insights into stakeholder perspectives on peer review in radiation oncology, highlighting differences in perceived benefits among roles.

## Key findings

- Nonphysicians rated the importance of peer review and education significantly higher than physicians.
- Participants emphasized education and reducing practice variation as key benefits of peer review.
- Barriers to implementing peer review recommendations included resource limitations and lack of prospective data.

## Abstract

Radiation oncology peer review evaluates case-specific qualitative treatment planning decisions. We sought to understand interdisciplinary perspectives on peer review to identify factors affecting stakeholder engagement and implementation of recommendations.

Semistructured interviews and Likert surveys (scaled, 0-10) with radiation oncology peer review participants were audio-recorded and transcribed. Two independent coders utilized a grounded theory approach to extract dominant themes.

Participants included 6 academic and 3 community radiation oncologists, 2 residents, 2 medical physicists, 2 radiation therapists, 4 dosimetrists, and 1 industry representative. Thematic priorities of peer review included adherence to institutional guidelines, clinical background to inform decision-making, detection of rare errors, and education. Key facilitators included pretreatment peer review, clear planning guidelines, and feedback on peer recommendations. Barriers to recommendation adoption included resource limitations and a lack of prospective data guiding qualitative recommendations. Participants perceived benefits of peer review were assessed with Likert surveys with higher values placed on reducing practice variation (8.0) and education (7.6) and a lower value placed on the detection of medical errors (7.4) and reduction of treatment delivery incidents (6.9). When comparing Likert scores by participant role, nonphysicians rated the overall importance of peer review (mean, 9.8 vs 6.5, P = .03) and education (mean, 9.0 vs 6.7, P = .02) significantly higher than physicians.

Participants in radiation oncology acknowledged the importance of peer review, but there was significant variation in the perceived benefits. A higher value was placed on the alignment of clinical practice and nonphysician participant education. Future processes to improve communication and prospective plan review were identified as beneficial to peer review-mediated plan changes.