Transforming Multidisciplinary Palliative Radiotherapy Delivery Through Advanced Practice Radiographers: Opportunities, Evidence and Future Directions

Palliative radiotherapy (RT) is frequently delivered in time-sensitive clinical settings and requires rapid, patient-centred decision-making while balancing symptom burden, prognosis, comorbidities, treatment burden, and individual goals of care. Increasing demand for palliative RT and workforce pressures have stimulated the development of advanced practice models involving radiation therapy professionals. This review examines the evolving role of Advanced Practice Radiographers (APRs) in palliative RT, with particular attention to clinical practice, leadership, education, and research. APR-led models described internationally include patient assessment, treatment decision-making, treatment planning, treatment delivery, symptom and toxicity management, prescribing, follow-up, and coordination of supportive and palliative care. The available evidence indicates that appropriately trained APRs can undertake selected activities traditionally performed by medical staff within defined competency and governance frameworks, with reported benefits including increased service capacity, reduced waiting times, streamlined treatment pathways, continuity of care, and positive patient experience. However, the evidence base remains heterogeneous and is predominantly focused on feasibility, acceptability, workforce capacity, and service-level outcomes. Evidence regarding patient-centred outcomes, including symptom control, quality of life, treatment burden, safety, and concordance with patients’ goals of care, remains limited. Considerable international variation also exists in education, regulation, scope of practice, professional autonomy, and organisational support. Advanced practice radiography therefore represents a developing model for delivering palliative RT, but further prospective evaluation is needed to establish its impact on patient, clinical, service, workforce, and health-system outcomes, and to identify the organisational and governance conditions required for sustainable implementation.