Perceived barriers and facilitators affecting utilisation of radiation therapy services: Scoping review findings - Patient and department level influences.

Existing evidence supports the benefits of radiation therapy (RT) for cancer patients however, it is underutilised. This scoping review aims to synthesise the current literature investigating patient and department level barriers and facilitators influencing the utilisation trends of RT. A systematic search strategy was developed to identify articles dated from 1993 to 2023. Four online databases (Medline, Embase, Scopus and CINAHL) were searched using key words. Eligible studies needed to report outcomes related to barriers and facilitators influencing utilisation of RT. Data was extracted and categorised into health professional, patient, and department level influences. The review resulted in 340 included studies with 298 (88 %) studies reporting on patient influences. More than half of these studies (n = 164; 55 %) reported accessibility concerns including distance and travel burden. Patient acceptability was reported in 88 (30 %) studies, patient affordability in 138 (46 %) studies, patient knowledge, and education in 92 (31 %) studies and patient health and demographics in 235 (79 %) studies. Of the department level influence papers (n = 242, 71 %), department availability such as infrastructure, staffing and waitlists were reported in 167 (69 %) papers. Department adequacy, including the quality, reputation and technology suitability of departments was reported in 60 (25 %) papers. Clinical pathway use was reported in 107 (44 %) papers. This scoping review identifies the broad range of patient and department level influences and facilitators affecting the global utilisation of RT. Recognition of such influences reducing access to RT will inform proposed interventions or educational strategies to overcome and address such barriers.