1. Paediatric radiotherapy is a complex process for the patient and their family. The radiotherapy department is an unfamiliar, mostly adult- orientated environment and this can be a daunting experience. Paediatric patients make up only 1% ¹ of the total workload of radiotherapy services. For this reason it is not a realistic vision to have a dedicated radiotherapy centre just for children. However, it is recommended that radiotherapy centres treating children in the UK appoint a lead paediatric radiographer². The Specialist Paediatric Radiotherapy Radiographer Meeting the needs of the patient, their carers and the radiotherapy service Through a review of current literature and personal reflections on the development of a specialist paediatric radiographer post, our aim was to identify the important aspects of such a role and discuss how these serve to address the needs of the patient, their family/carers and the radiotherapy service. The Role and responsibilities The national group Specialist paediatric Radiotherapy Radiographer Interest (SPRRIG) has contributed to the ‘Good practice guide to paediatric radiotherapy’³. They list the key duties of the paediatric radiographer to include: Liaise with multi disciplinary team (MDT) Be the key worker for the child and their family throughout planning and treatment Provide information for the child and their family Have overall responsibility for advising age appropriate facilities and ensuring working practices are developed and maintained Provide education and information to staff regarding radiotherapy for children. Lucy Hume BSc †, Catherine Holborn  †Senior Paediatric Radiographer, St James Institute of Oncology, Leeds  Senior Lecturer, Sheffield Hallam University. Play therapy Play therapy Patient support and continuity of care Education and development Education and development Communication and information giving Communication and information giving Key roles of the paediatric radiographer Key roles of the paediatric radiographer

2. The Specialist Paediatric Radiotherapy Radiographer Meeting the needs of the patient, their carers and the radiotherapy service Lucy Hume BSc †, Catherine Holborn  †Senior Paediatric Radiographer, St James Institute of Oncology, Leeds  Senior Lecturer, Sheffield Hallam University. Communication and information giving Improved communication between the MDT has shown an improvement in the experience for the child and their parents⁴. The paediatric radiographer should meet early in the discussion for the need of radiotherapy - for assessment of the need/level of support. Information should always be given in a clear, honest manner, it must be passed on in both verbal and written forms, using both medical and non medical information⁵. This then should be passed on to the child in an easy to understand, positive language using age appropriate information. Education and development Teaching within paediatric radiotherapy is crucial in order to: Work along side the MDT to help improve staff knowledge and understanding of up and coming cases. Train new staff and students within the department Pass on information from national meetings¹³. Ensure future goals are set to improve the service through long term follow up¹⁴. Play therapy Preparation for radiotherapy has proven to reduces the need for a GA ³̕⁸̕⁹. Play therapy aids in the understanding of procedures. Orientation of the department and playing with equipment reduces fear and anxiety of necessary procedures ⁵̕⁸̕¹⁰. Working with siblings can help them to understand what is happening within the family and to feel included¹¹. Reducing GA’s benefits the departments as costs decrease as do time needed on set ¹¹̒¹². Patient support and continuity of care Continuity of care has been highlighted as one area that children and their families greatly benefited from. By becoming the key worker the paediatric radiographer is the continuity in care and set up during treatment, providing support for both the families and the treatment staff ⁵ and providing a point of contact each day⁶. They can create an environment where the child feels safe by filling in the separation from parents during medical procedures⁷. By offering support the radiographer is creating better informed parents during what can be a very stressful time⁸. Support for a child can be through verbal and non verbal methods which are learnt through experience and developed over time.

3. The paediatric radiographers role and perspective The role of a paediatric radiographer plays a small but vital part of a big radiotherapy department. It encompasses many area however the main aim is to provide continuity of care for the whole treatment process. The role is constantly developing to create the optimum service for paediatric patients and their families. By meeting the family early in their journey I can work alongside the paediatric team to decide the best method of aiding and supporting the family during treatment. Being involved with the national group SPRRIG provides me with a link to other paediatric radiographers around the country. The group has set out the key roles of the paediatric radiographer and can provide advice and support for any difficult cases to individual members. The Specialist Paediatric Radiotherapy Radiographer Meeting the needs of the patient, their carers and the radiotherapy service References 1.NRAG, National Radiotherapy Advisory Group; Radiotherapy. Developing a world class service for England: Report to Ministers. 2007; www.dh.gov.ukwww.dh.gov.uk 2.Specialist paediatric radiotherapy radiographer’s interest group (2009) Role of the paediatric Radiographer. Draft copy, Unpublished to date. 3.National Institute for Health and Clinical Excellence Guidance on cancer services; improving outcomes in Children and Young people with Cancer: The manual. Radiotherapy 2005; 47-51 www.nice.org.uk.www.nice.org.uk 4.Scott L, Langton F, O’Donoghue J. Minimising the use of sedation/anaesthesia in young children receiving radiotherapy through an effective play preparation programme. European Journal of Oncology Nursing 2002; 6: 15-22. 5.Pimm P, Fitzgerald E, Taylor L. Caring for children undergoing radiotherapy. The College of Radiographers 1997; 3: 27-30. 6.Mercer M, Ritchie J. Tag team parenting of children with cancer. Journal of Paediatric Nursing. 1997; 12: 331-341. 7.O’Connor G, Drennan C. Optimising patient care: meeting the needs of the paediatric oncology patient. Journal of Diagnostic Radiography and Imaging 2003; 5: 33-38. 8.Last B, Grootenhuis M. Emotions, coping and the need for support in families of children with cancer: a model for psychosocial care. Patient Education and Counseling.1998; 33: 169-179. 9.Jun-Tai N. Play in hospital. Paediatrics and Child Health; 2008; 233-237. 10.Fortney J, Halperin E, Hertz C, Schulman S. Anaesthesia for paediatric external beam radiation therapy. International Journal Radiation Oncology, Biology and Physics 1999; 44: 537-591. 11.Björk M, Wiebe T, Hallström I; An everyday struggle – Swedish families’ lived experiences during a child’s cancer treatment. International Peadiatric Nursing. 2009; 24: 12.Goddard M, Hutton J. What is the cost of radiotherapy? European Journal of Radiology. 1991; 13: 76-79. 13.Specialist paediatric radiotherapy radiographer’s interest group (2009) Rationale, aims and objectives. Draft copy, Unpublished to date. 14.Skinner R, Hamish W, Wallace B, Levitt G. Long-term follow-up of people who have survived cancer during childhood. The Lance. 2006 7: 489-497. Lucy Hume BSc †, Catherine Holborn  †Senior Paediatric Radiographer, St James Institute of Oncology, Leeds  Senior Lecturer, Sheffield Hallam University.