Embedding research within advanced radiotherapy practice: A qualitative multi-centre study of UK radiotherapy departments with international implications

INTRODUCTION: Research is recognised as one of the four pillars of advanced practice, yet its integration within radiotherapy roles remains uneven. This study explored how research was embedded within Advanced Practice Research Radiographer (APRR) roles across UK radiotherapy services and identified organisational conditions associated with more formalised implementation. METHODS: An interpretivist qualitative multi-centre study was undertaken in five UK radiotherapy departments from January to December 2025. Purposive sampling recruited 28 participants from radiography, oncology, nursing and physics roles. Data were generated through non-participant observations, contemporaneous field notes and semi-structured interviews; interviews were documented in field notes rather than audio-recorded. Data were analysed using reflexive thematic analysis, supported by iterative team triangulation, and reported in line with Consolidated Criteria for Reporting Qualitative Research guidance. RESULTS: Four themes were identified: strategic integration of research; governance and professional identity; protected research capacity; and clinical-academic integration. Research was most effectively embedded where organisations aligned role expectations with service strategy, provided clearer governance and role definitions, protected research time, and supported collaboration across clinical and academic settings. Conversely, variable titles, inconsistent job planning and limited backfill reduced role clarity, sustainability and influence. A key limitation is that interviews were not audio-recorded, and the analysis therefore relied on contemporaneous field notes. CONCLUSIONS: Embedding research within advanced radiotherapy practice depends on transferable organisational conditions: strategic leadership, governance, protected capacity and clinical-academic connectivity. Although derived solely from UK data, these findings may inform workforce and policy development in other settings; Singapore is one illustrative example of a system seeking to adapt such principles without contributing empirical data to this study. PLAIN LANGUAGE SUMMARY: Research helps healthcare professionals improve care, but it is not always easy to include in everyday clinical roles. This study examined how research was built into advanced radiographer roles in radiotherapy departments in the United Kingdom. This study found that research was more successful when staff had protected time, clear responsibilities, supportive leadership, and strong links with academic partners. This matters because these conditions may help healthcare teams produce and use research that improves patient care and professional practice.