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Attitudes and Beliefs Towards Medical Checklists in Radiation Oncology. Int J Radiat Oncol Biol Phys 2021 Nov 01;111(3S):S112-S113



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PURPOSE/OBJECTIVE(S): Pre-procedural medical checklists have been robustly shown in the surgical literature to be associated with numerous clinical improvements, including reductions in postoperative complications and death. The use of pre-procedure checklists within radiation oncology is poorly understood. We sought to assess the use of checklists by radiation oncologists in the U.S. and identify factors associated with their use.

MATERIALS/METHODS: A survey consisting of seven questions was created using Qualtrics (an online survey platform). Each question followed a multiple-choice format, with some questions allowing multiple responses. These questions aimed to examine radiation oncologists' perceptions regarding the value of checklists in medical practice. This survey was distributed to radiation oncology residents and attending physicians. Responses to each question along with demographic data from each respondent were collected and examined. Where applicable, univariate analysis via Fisher's exact test was performed. Incomplete surveys were excluded from data analysis. The survey and methods of collection were approved by institutional review board.

RESULTS: A total of 349 respondents completed the survey. The majority of respondents were physicians who have been in practice for "greater than ten years" (78.5%). The majority of respondents work in private practice (47.6%), followed by academic institutions (42.7%). Of these, 296 respondents indicated that they used checklists (84.8%). Of those individuals, 207 reported routine use (69.9%). Neither amount of time in practice nor type of practice were found to be significantly associated with use of checklists (P-values 0.344 and 0.715, respectively). Most respondents felt that checklists played an important role in ensuring patient safety, accountability, and procedure efficiency (92.8%, 88.8%, 88.2%), but significantly fewer respondents felt that checklists played a role in decreasing mortality (75.6%). The majority of respondents believed that the usefulness of checklists is supported by retrospective quality assurance studies (64.1%). Significantly fewer respondents believed that randomized clinical trials supported their usefulness (35.3%) and some believed that checklists have not been formally evaluated (13.4%).

CONCLUSION: We present data characterizing radiation oncologists' perceptions of medical checklist use, demonstrating significant interest and frequent use across the community. Given widespread interest in checklists, initiatives within radiation oncology professional societies may facilitate advancement of medical checklists while increasing awareness of the data supporting their use. Additional studies exploring automated methods of checklist creation and outcomes following implementation within radiation oncology are warranted. IRB approval: PRO00036824.

Author List

Feng J, Erickson BA, Currey AD, Shukla ME, Desai N, Bergom C, Hall WA


Monica E. Shukla MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin