2 Evidence gaps
This section describes the evidence gaps, why they need to be addressed and their relative importance for future committee decision making.
The committee will not be able to make a positive recommendation without the essential evidence gaps (see section 2.1) being addressed. The company can strengthen the evidence base by also addressing as many other evidence gaps (see section 2.2) as possible. Addressing these other evidence gaps will help the committee to make a recommendation by ensuring it has a better understanding of the benefits of the technology for patients and the NHS.
2.1 Essential evidence for future committee decision making
Impact of ProKnow on quality assurance for radiotherapy treatment planning
There is a desire to increase standardisation of radiotherapy treatment planning protocols across radiotherapy centres in the NHS. ProKnow could help reduce variation between centres through:
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supporting national data collection
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scorecard use
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training
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peer review
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potentially linking to local or national clinical registries to test for associations and outcomes.
Treatment plan quality (dosimetry, variance and spread) could be monitored over time through scorecard outputs.
Evidence appraised in the assessment included 8 service evaluations or audits of plan quality variance between up to 227 individual treatment plans. But none of the evidence used a patient cohort or dataset for prospective treatment planning or quality assurance, and the largest sample patient dataset size uploaded was 2. Evidence for using the technology to evaluate large or prospective patient datasets is important for considering the benefits of the technology in the NHS.
Understanding whether ProKnow affects day-to-day clinical practice, and what changes healthcare professionals think its use has brought about, will support the committee in determining the usefulness of the technology.
Impact on staffing and treatment planning resources
It is important to understand the impact of the technology on resource use, including planning and auditing time, workflow, usability, and ease of retrieving and storing data. This will support the committee in assessing the real-world uptake and use of the technology in radiotherapy treatment planning.
2.2 Evidence that further supports committee decision making
Impact on staff training
ProKnow can support healthcare professional training through a contouring accuracy module. This could lead to an increase in standardisation and potentially improve patient outcomes over time (see section 2.1). Data collection of contouring accuracy scores and module uptake could show changes over time.
Changes in radiotherapy treatment accessibility
Access to some radiotherapy treatments, such as stereotactic ablative radiotherapy could be supported by ProKnow. This could make it easier to share treatment plans and specialist knowledge between NHS services. This is important for people who may be able to access specialist treatments in their local services after review by external healthcare professionals.