D9.89 - Report on venues, challenges, opportunities and recommendations for stakeholder engagement in the medical field.


Report EJP-CONCERT- ENGAGE - European Joint Programme for the Integration of Radiological protection Research, September 2019.

CEPN-R-323, September 2019.

Summary ou Abstract

This document reports on case studies carried out in the ENGAGE project, on stakeholder engagement in relation to medical exposures to ionising radiation. It is centred on stakeholder engagement in justification and optimization practice, and in the aspects of informed consent, communication in radiation protection, and on the education and training on ionising radiation in the medical field. Case studies include procedures characterized by different inherent complexities, and pertaining to radiology, radiotherapy, interventional radiology. These cases refer to medical exposures of pregnant women, paediatric CT-scanning, interventional image-guided procedures, use of radiation for cancer treatment, and X-rays use in dental clinics.

The current continuous increase of medical exposure, a matter of concern from a radiological protection point of view, is often accompanied by lack of awareness, about risk, from the members of the public, and in some cases also from the medical professionals. Cooperation among the relevant stakeholders is deemed useful for giving due attention to the justification process, and for engaging the patients in the process of defining the prescriptions of radiological imaging by the family doctors. Awareness for the implementation of stakeholder engagement is, in the view of some professional figures, still poor. The more complex the procedure of medical exposure, the more important is the involvement and consultation of stakeholders, as they enable patient-centred approaches and informed decision making, both in radiotherapy and radiology.

Even if communication with patients is perceived by medical staff as beneficial, it is mainly seen as a one-way approach. The topic of communication is very rarely present as part of education and training courses, for health professionals and practitioners, while communication would help in the practice to introduce to patients both the expected benefits and potential risks of medical exposure. The intrinsic complexity of the nature of radiation risk estimate, and the differences between how the professionals evaluate and the patient perceives the related risk and benefits of the medical exposure, substantiate the significant role in communication. With an improved risk benefit dialogue with patient, the level of information on radiation risk-benefits would be tailored to the different medical exposures and to the attention and respect of patient.

Informed consent is a process, starting with communication, providing adequate information and answers to patient on the risks-benefits and options about the diagnostic, or therapeutic, or interventional procedures, and defining if there is an agreement by the patient about the proposed procedure. Depending on the medical situation and the preferences of patients, there are situations characterised by an increasing expectation by the patient to be involved in the decision process or, the opposite, there are situations where patients consider radiation as their last problem needing attention. In reality, in many instances, the informed consent remains a formality. The use of an adequate informed consent, with a procedure including a higher consideration for patient dignity in decision-making, is still considered a challenge. 


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