A study has found Therapeutic Radiographers more confidently assess, manage and teach radiation-induced skin reactions in white patients than black and brown patients.
Published in the latest edition of Radiography journal and entitled “Understanding therapeutic radiographers’ confidence in assessing, managing & teaching radiation induced skin reactions (RISR): A national survey in the UK”, the study was carried out by radiographers Naman Julka-Anderson, Corinne Thomas, Rachel Harris and Heidi Probst.
Overall, respondents in the study reported higher confidence in assessing RISR in white (74 per cent) then brown and black skin (42 per cent). Reports of confidence in managing skin reactions showed similar trends to those reported for assessment.
Radiation Induced Skin Reactions
Radiation Induced Skin Reactions (RISR) are one of the most common side effects of external beam radiotherapy.
The SoR produced an extensive practice guideline on skin care in 2020 along with patient and staff RISR guidance leaflets, and recommended gathering baseline data to help classify risk of patients developing severe RISR.
In a survey distributed via radiotherapy department managers in the UK, and the Society of Radiographers advertising campaigns through social media channels, SoR radiotherapy specific special interest groups (SIGs) and via email to SoR members, the authors asked Therapeutic Radiographers about their confidence in RISR assessment and management.
Lack of confidence
Research found confidence in assessing and managing RISR in white skin was higher than that in brown and black skin, and that most respondents (74.2 per cent) reported use of locally produced patient information on skin care, rather than the Society of Radiographers evidence-based patient leaflets.
While confidence does not necessarily mean competence, the survey concluded more exploration and support on the topic was needed.
It provided four key recommendations for future investigation into the topic:
- A greater understanding is needed in how educational establishments teach students how to assess acute radiation skin toxicity across different patient skin tones.
- Research is needed to objectively evaluate the consistency (inter-rater and intra-rater reliability) of existing acute RISR scoring tools alongside patient reported outcome measures.
- Further research to understand the barriers or challenges for practitioners in implementing the SoR skin care patient and staff leaflets along with wider recommendations in the guidance.
- The main recommendation from this service evaluation is to develop a special interest group on RISR to help take forward in a coordinated manner best practice and standardised practice on the measurement, assessment, management and training in RISRs.
Greater understanding is needed
The study said: “The standard toxicity tools adopted for assessing RISR do not currently reflect how skin changes occur across all skin tones. A one size fits all approach is adopted currently for RISR assessment… A greater understanding of the reasons for these differences is required but this study aims to instigate change and positive growth within this area.”
Researchers also found that, of the journal articles and randomised controlled trials reviewed for the guidance (33 in total), only one study incorporated skin tone within their results.
“This highlights the need to understand skin tone differences and seek a wider evidence base to ensure inclusivity,” the study emphasised.
Responses were received from 88 managers, who shared the survey link with all of their qualified staff, resulting in respondents from 74 (96 per cent) of UK radiotherapy departments.
Complete responses were received from 408 Therapeutic Radiographers.
Mr Julka-Anderson, the primary author, is also host of radiotherapy podcast Rad Chat, which was featured in the April edition of Synergy.
(Image: Naman Julka-Anderson)