Establishing Radiotherapy Quality Indicators for Lung Cancer: A Modified Delphi Study.

Although there are many published quality indicators (QIs) to assess the management of lung cancer, there is a paucity of relevant QIs specific to measuring the quality of radiotherapy (RT). We used the commonly accepted modified Delphi technique for structured consensus to develop a set of QIs and benchmarks designed to evaluate the RT process for lung cancer. This study used a modified Delphi technique composed of an international expert panel of radiation oncologists treating lung cancer, with a target of 40 participants, and intervening multidisciplinary steering committee review, with a minimum of nine stakeholders, that also included radiation therapists and medical physicists. The steering committee evaluated candidate QIs and benchmarks for inclusion in the first round from an initial systematic review with inclusion criteria of; QIs or guidelines with a potential to be developed into a QI and that were related to pre-treatment assessment, planning or delivery of radiotherapy. The expert panel ranked these in two rounds of electronic surveys for inclusion in the final set of QIs if a pre-defined consensus definition for importance was met by at least 70% of responses with a score of seven or more on a 9-point Likert scale. Feasibility and benchmarks met consensus criteria if at least 70% of responses are reported as three on a 3-point Likert scale. Systematic review resulted in 64 candidate QIs that were assessed by the steering committee, and it was concluded that 47 QIs and proposed benchmarks were needed for the initial survey round. There were 70 expert respondents over two surveys; 21.4% (n = 15), 30% (n = 21), and 48.6% (n = 34) were from Europe, the Americas, and Australasia, respectively. After the first survey round, 30 of 47 QIs met the criteria for inclusion in a second survey round. Consensus criteria and respondent comments were considered for QI inclusion and benchmarks, resulting in additional wording and benchmark amendments for the subsequent round. The final round survey resulted in 29 of 30 QIs reaching consensus (range 71-97%) for importance, with 12 of these QIs reaching a consensus of ≥90%. A QI for patients who underwent stereotactic ablative RT for non-small cell lung cancer having had a biopsy proven malignancy failed to reach consensus. Respondents assessed all 30 QIs as feasible and 27 suggested benchmarks met pre-defined inclusion criteria. The final set of QIs included descriptors for pre-treatment risk assessment, timing, treatment indications, treatment dose and fractionation, planning, treatment volumes, treatment delivery, and organization factors. Our developed RT-specific QIs offer a robust framework for evaluating and enhancing radiotherapy in lung cancer care. This initiative lays the groundwork for standardized quality assessments and improvements, aiming to elevate treatment outcomes across the board. [ABSTRACT FROM AUTHOR]