Positioning in RT - Supine vs. Upright

Overview

This is a single-center, non-therapeutic prospective pilot cohort study evaluating patient-reported comfort levels between upright and supine positioning in patients receiving radiation therapy across all age groups using a concurrent mixed-methods design. Following standard-of-care RT planning or delivery in the conventional supine position, patients and caregivers will complete a questionnaire evaluating the current treatment position. Patients will then be positioned upright in a chair, using similar immobilization to their supine setup when feasible. This position will be maintained for up to 15 minutes, as tolerated by the patient. During the upright positioning session, patients and caregivers will be asked open-ended questions exploring their perceptions of comfort, stability, and overall experience with the upright chair. No radiation or therapeutic intervention will be delivered during the upright session; the upright positioning procedure is non-therapeutic and conducted solely for assessment purposes. Patients and their caregivers will again be asked to complete a questionnaire evaluating the upright position. Key stakeholders involved in RT (including Radiation Therapists, Registered Nurses, Radiation Oncologists, or Medical Physicists), will participate in one semi-structured interview to explore perspectives on supine versus upright positioning for RT. Each interview will take up to 60 minutes and will be conducted in-person or virtual using UHN's Microsoft Teams. All sessions will be audio recorded and transcribed on the UHN Microsoft cloud, which is encrypted and stored securely.

This is a mixed methods concurrent study design. Feedback will be collected from multiple participant groups as part of both the quantitative and qualitative components of the study. Quantitative Component Patients: Participants will provide feedback, rank preferences, and compare their experiences between supine and upright positioning, focusing on comfort, anxiety, overall acceptability, and demographic information. Caregivers: Caregivers will report their observations and preferences regarding both positioning approaches, including perceived comfort and distress levels. Qualitative Component Patients: During the upright positioning session (the study intervention), patients will be asked open-ended questions exploring their perceptions of comfort, stability, and overall experience. Key Stakeholders: Radiation Therapists, Registered Nurses, Radiation Oncologists, and Medical Physicists will participate in semi-structured interviews to share their perspectives on the feasibility and implementation of upright versus supine positioning. A description of the measures taken to minimize/avoid bias. To minimize bias in the study, the following measures will be implemented: 1. Study participants and caregivers (if applicable) will complete standardized feedback tools for consistency. 2. During the upright positioning session (study intervention), investigators will follow a scripted set of open-ended questions to explore patient perceptions. 3. For semi-structured interviews, investigators will use neutral language and encourage equal participation among all interviewees. A description of the trial treatment(s)/ intervention Patient participants will undergo the study intervention following a regularly scheduled radiation treatment. This involves being positioned upright in a chair using immobilization similar to their treatment setup, where feasible. No radiation or therapeutic procedures will be administered during the upright positioning session, which involves sitting in a chair for up to 15 minutes, as tolerated. There is no further study-related follow-up visit. Data collection from patients and caregivers will be completed on the same day as the positioning sessions. Key stakeholders including Radiation Therapists, Registered Nurses, Radiation Oncologists, or Medical Physicists will participate in a semi-structured interview to explore perspectives on supine versus upright positioning for RT.