Positioning in RT - Supine vs. Upright

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:

• Study participants and caregivers (if applicable) will complete standardized feedback tools for consistency.
• During the upright positioning session (study intervention), investigators will follow a scripted set of open-ended questions to explore patient perceptions.
• 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.

Inclusion criteria

• Pediatric and adult patients aged 3 years and older, undergoing radiation therapy as part of standard clinical care.
• Lansky or Karnofsky score 40 or greater
• Ability to provide informed consent (or if appropriate, provided by parent or legal guardian).
• Ability to understand and speak English or with appropriate assistance