Abstract

Background: Rising cancer incidence and improved survivorship are straining the oncology workforce, increasing reliance on Advanced Practice Providers (APPs). However, there is a lack of standardized educational resources for APP radiation oncology training across practice settings. Most APPs receive variable, resource-dependent, and on-the-job training. Evidence shows that the lack of standardized training leads to gaps in foundational knowledge, reduced confidence in toxicity management, inconsistent role development, and variable satisfaction with training and transition into practice.

Purpose: This quality improvement project evaluated the feasibility of implementing an 18-module Advanced Practice Radiation Oncology (APRO) asynchronous online curriculum to standardize APP radiation oncology education.

Methods: Guided by the Johns Hopkins Evidence-Based Practice framework and Plan-Do-Study-Act model QI model, a pre- and post-survey design was used to assess improvements in knowledge, confidence, disease-site familiarity, and training satisfaction. The 18-module asynchronous curriculum was delivered through the Advanced Practitioner Society for Hematology and Oncology (APSHO) learning management system. The courses provided standardized foundational and disease-specific radiation oncology education. Participants were recruited through APSHO membership, radiation oncology APP listservs, and word of mouth. Surveys were completed by a national cohort of oncology APPs across diverse practice settings. Survey items were adapted from established online education tools and refined through expert review by 10 radiation oncology APPs to establish face and content validity. Measures included self-reported knowledge, disease-site familiarity, confidence in toxicity management, and satisfaction using Likert-type scales. This project received a quality improvement determination from the UT Tyler IRB. Pre/post differences were analyzed using Wilcoxon rank sum tests, with significance set at p < 0.05.

Results: A total of 140 (100%) participants completed the pre-survey, and 72 (51%) completed the post-survey. Statistically significant improvements were observed across all domains (p < 0.05). Self-reported knowledge increased; strongly agree responses for understanding radiation oncology concepts rose from 8.6% to 54.2%, and sufficient training in radiation biology rose from 1.4% to 36.1%. Disease-site familiarity improved across all seven sites, with the largest gains in gastrointestinal (+25.0%), breast (25%), and lung (+22.2%) cancers. Mean confidence in managing radiation side effects increased from 3.01 to 5.28 on a 7-point scale. Not familiar responses for pediatric considerations fell from 81.3% to 19.4%. Overall satisfaction with training rose from 62.2% to 88.9%, with extremely satisfied responses increasing by 27.5%.

Conclusions: The APRO curriculum effectively addresses gaps in standardized APP radiation oncology training and reduces variability in onboarding experiences. This scalable, asynchronous model improved knowledge, disease-site familiarity, confidence, and satisfaction across diverse practice settings, supporting APP role development and workforce sustainability. Limitations include a 51% post-survey completion rate and reliance on self-reported rather than objective outcomes. Adopting APRO as a national onboarding standard for APPs entering radiation oncology would advance training consistency, clinical readiness, and equitable access to specialty education.

Date of publication

Summer 6-29-2026

Document Type

DNP Scholarly Project

Language

english

Persistent identifier

http://hdl.handle.net/10950/5083

Committee members

Angie (Mary) McInnis, Heather Koniarczyk; Emily Fox; Jeni Chilton

Degree

Doctor of Nursing Practice

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