• Janet E Squires, Sarah Asad, Melissa Demery Varin, Kristin Dorrance, Edward Chow, Alysa Fairchild, Rebecca Wong, Ian D Graham, Jeremy M Grimshaw, and Kristopher Dennis.
• School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
• Int. J. Radiat. Oncol. Biol. Phys. 2021 Feb 1; 109 (2): 374-386.

BackgroundA mainstay therapy for pain relief from uncomplicated bone metastases is external beam radiation therapy. Single fraction radiation therapy (SFRT) is more convenient and cost-effective, causes fewer acute side effects, and is equivalent to multiple fraction radiation therapy for pain relief. Despite these advantages, radiation oncologists seldom prescribe SFRT.PurposeTo identify the behavioral determinants to Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases.Methods And MaterialsSemistructured interviews were conducted with 38 radiation oncologists from all 10 Canadian provinces. The interview guide and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were analyzed using a 5-phase thematic content analysis process: coding, generation of belief statements, generation of themes within TDF domains, generation of overarching themes, and classification of themes as barriers or facilitators to SFRT use, or as divergent (a barrier or facilitator depending on the participant).ResultsThirteen overarching themes were identified of which 2 were barriers, 7 were facilitators, and 4 were divergent. The most commonly identified theme was the facilitator "most radiation oncologists are aware of evidence and guidelines on the use SFRT" (n = 38, 100%). The 3 next most reported themes (n = 37, 97.4% ) were (1) "radiation oncologists' use of SFRT can influence their colleagues" use of it (divergent), (2) experience with SFRT can increase its use (facilitator), and (3) SFRT is convenient for patients (facilitator). The most commonly identified barrier (n = 31, 81.6%) was "SFRT is associated with a higher risk of retreatment."ConclusionsOur use of the TDF to explore the behavioral determinants of Canadian radiation oncologists' use of SFRT for uncomplicated bone metastases identified a range of factors that are perceived to encourage and discourage its use. Our results will inform the design of future interventions to increase the use of SFRT.Copyright © 2020 Elsevier Inc. All rights reserved.

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