肿瘤医学与实践杂志

Utility of a Real Time E-mail Assisted Group Consensus Forum for Regional Radiation Oncology Centres

Abstract

Sarah Leeson, Andrew Last, Tom Shakespeare and Patrick Dwyer

Purpose: Specialists in regional and remote areas face many challenges in the delivery of healthcare, including isolation and limited peer support. One consequence is the difficulty in obtaining informal second opinions from colleagues via “corridor consults”. The NSW North Coast Cancer Institute (NCCI) is a rural cancer service integrated across 3 centres. For the last decade the NCCI radiation oncologists (ROs) have utilised a real-time e-mail thread to gain informal opinions from their colleagues. This study aimed to evaluate the utility of the “Opinion Please” forum.

Methods: Using the state wide e-mail archive, “Opinion Please” e-mails were collected from the last 3 years. Emails were categorised according to the type of question. Endpoints included speed of response, the reaching of a consensus, and subsequent management plan.

Results: There were 140 Opinion Please emails sent, of which 119 were evaluable for outcome data. The main question for opinion was the general oncological approach (48.7%), and planning considerations including contouring and doses to target and organs at risk (43.6%). The requesting RO received their first response within 2 hrs 93.8% of the time, and within 10 minutes 46.0% of the time. All (100%) of Opinion Please emails received 2 or more responses, and in the vast majority of cases (86.6%), opinions were obtained from 4 or more colleagues. Group consensus was achieved 79.8% of the time. In 80% of cases a plan was proposed by the requesting RO, with consensus agreement for the proposed plan 36% of the time. This consensus was adhered to by the treating RO 87.4% of the time. A survey concluded that the vast majority of clinicians find the Opinion please forum to be very useful, and helpful to their continued learning. Conclusion: We have demonstrated the “Opinion Please” e-mail forum to be a regularly utilised, easy, and fast method for gaining peer support and advice for the geographically isolated RO. It functions as a teaching tool for trainees, and an archive for previously discussed controversies. Its value may also be extrapolated for use in the increasing remote work model that has emerged during the Covid-19 pandemic.