Could knowledge of patient demographics facilitate a personalized approach to radiation therapy patient education?

INTRODUCTION: Using patient demographics to tailor cancer patient education processes results in improved patient outcomes. However, there is little information on how to successfully tailor radiation therapy (RT) educational content and delivery. The aim of this quality improvement project was to describe the information preferences of a diverse group of patients undergoing RT and determine if different RT education processes were associated with certain patient demographics. MATERIALS AND METHODS: An educational needs assessment questionnaire, based on a validated tool, was offered to all patients undergoing RT on a single day. Questionnaire sections included demographics and questions regarding the importance of topics related to RT treatments, desired mode of information delivery, quantity of information, desired timing of information, and satisfaction with information received. Patients were also asked to answer qualitative questions focused on what was working well and what could be improved. Participants' responses were cohorted based on demographic groupings (age, gender, education level) and were tested for statistically significant differences and associations. RESULTS: 130 patients completed the questionnaire. Compared to those over 60 years, more participants who were 50 - 59 years old thought the topics were 'very important' (96% vs 77%, p<0.001) and wanted a higher quantity of information about the topics (80% vs 66%, p<0.001). More participants over 70 years old preferred pamphlets compared to those less than 70 years (48% vs 30%, p<0.047) while more participants under 50 years old preferred one-on-one sessions compared to those older than 50 years (40% vs 25%, p<0.038). Fewer participants <50 years wanted information at their first meeting with the Radiation Oncologist compared to those older than 50 years (57% vs 73%, p<0.001). Compared to the male cohort, more female participants felt the information topics were more important (83% vs 74%, p<0.0001) and had more unmet education needs (29% vs 17%, p<0.001). Compared to those with post-secondary education, more participants with primary or high school education desired a higher quantity of information (76% vs 65%, p<0.001), preferred to receive that information using pamphlets (43% vs 32%, p=0.006) and wanted all the information at the first opportunity (81% vs 67%, p<0.001). CONCLUSIONS: This quality improvement project found that age, gender and education level influenced patient preferences for information quantity, delivery mode and timing of RT education. These findings are promising and support further evaluations to determine a more precise definition of the personal factors that could help to individualize our approach to educating patients receiving RT.

Implementation and evaluation of an online anatomy, radiology and contouring bootcamp for radiation therapists.

BACKGROUND: As new treatments and technologies have been introduced in radiation oncology, the clinical roles of radiation therapists (RTs) have expanded. However, there are few formal learning opportunities for RTs. An online, anatomy, radiology and contouring bootcamp (ARC Bootcamp) originally designed for medical residents was identified as a prospective educational tool for RTs. The purpose of this study was to evaluate an RT edition of the ARC Bootcamp on knowledge, contouring, and confidence, as well as to identify areas for future modification. METHODS: Fifty licensed RTs were enrolled in an eight-week, multidisciplinary, online RT ARC Bootcamp. Contouring practice was available throughout the course using an online contouring platform. Outcomes were evaluated using a pre-course and post-course multiple-choice quiz (MCQ), contouring evaluation and qualitative self-efficacy and satisfaction survey. RESULTS: Of the fifty enrolled RTs, 30 completed the course, and 26 completed at least one of the post-tests. Nineteen contouring dice similarity coefficient (DSC) scores were available for paired pre- and post-course analysis. RTs demonstrated a statistically significant increase in mean DSC scoring pooled across all contouring structures (mean ± SD improvement: 0.09 ± 0.18 on a scale from 0 to 1, p=0.020). For individual contouring structures, 3/15 reached significance in contouring improvement. MCQ scores were available for 26 participants and increased after RT ARC Bootcamp participation with a mean ± SD pre-test score of 18.6 ± 4.2 (46.5%); on a 40-point scale vs. post-test score of 24.5 ± 4.3 (61.4%) (p < 0.001). RT confidence in contouring, anatomy knowledge and radiographic identification improved after course completion (p < 0.001). Feedback from RTs recommended more contouring instruction, less in-depth anatomy review and more time to complete the course. CONCLUSIONS: The RT ARC Bootcamp was an effective tool for improving anatomy and radiographic knowledge among RTs. The course demonstrated improvements in contouring and overall confidence. However, only approximately half of the enrolled RTs completed the course, limiting statistical power. Future modifications will aim to increase relevance to RTs and improve completion rates.

Evaluating Canadian Radiation Therapists and UK Therapeutic Radiographers' Experiences and Opinions of a Safety Strap to Secure Patients during Radiotherapy.

INTRODUCTION: A serious patient safety incident at a cancer centre in Ontario, Canada, saw a patient fall from an elevated treatment couch. A regional investigation recommended the use of a securing safety strap. The authors evaluate the value of the strap through the experiences of the radiation therapists' who use it. A secondary aim is to explore the potential for using a securing safety strap with UK therapeutic radiographers. METHODS: A two-stage design was guided by an evidence-based practice framework. Stage one used a questionnaire to capture treating radiation therapists' experiences and opinions of the strap at a single cancer centre. Quantitative data were analysed descriptively and free-text data via a content analysis. Stage two used semistructured interviews with thematic analysis to explore views of three UK therapeutic radiographers. RESULTS: Twenty-five of approximately 130 eligible staff responded to the Canadian questionnaire. Of the respondents, 24% (n = 6) 'strongly disagreed', 28% (n = 7) 'agreed' and 48% (n = 12) 'neither agreed nor disagreed' that they would recommend the strap to other departments. Most of the respondents think strap use should be at the staffs' discretion, with patients with dementia/cognitive impairment ranked as the group benefiting most. Ninety-two percent (n = 23) of respondents confirmed that patients sometimes refuse the strap. Themes arising from stage two interviews are as follows: patient benefit (use for select patients only); patient safety versus control (restraint); and practical implementation issues. CONCLUSION: The policy of universal use of the strap should be reviewed. Those who use it are equivocal about its value and feel it should be reserved for select patients at the treating professional's discretion. Full evaluation of the effectiveness and acceptability of the device for different patients may promote both staff enthusiasm towards the device and evidence-based practice. Adequate resources are required to evaluate implementation of such safety initiatives.

Cannabis and Radiation Therapy: A Scoping Review of Human Clinical Trials.

INTRODUCTION: It is estimated that at least 20% of Canadian patients with cancer use cannabis to alleviate symptoms of their disease and/or cope with the side effects of their treatment. Most patients want to learn more about cannabis from their healthcare team, but most oncology professionals feel too uninformed to make recommendations. The purpose of this scoping review was to address this oncology professionals' knowledge gap, by summarizing the literature on evaluations of the benefits and harms of cannabis use before, during, or after radiation therapy (RT). METHODS AND MATERIALS: A literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, using multiple electronic databases and combinations of key terms. To be included, studies must address the use of cannabis in patients undergoing RT. In vitro and in vivo evaluations, reviews, and editorials were excluded. Eligible full text manuscripts were then subjected to a formal risk of bias assessment using the Cochrane RoB 2.0 or ROBINS-I frameworks. RESULTS: A total of 48 records were identified, and 8 articles were included after vetting. These 8 studies suggest that the use of cannabinoids may calm anxious patients about to start RT, reduce nausea and vomiting consistent with the contemporary standard of care, reduce the symptoms of relapse for patients with glioma, and provide symptom relief >3 years after head and neck RT but not during or immediately. Six of these studies contained a high risk of bias (eg lack of randomization, poor blinding, and subjective outcome assessments). Most studies reported mild episodes of drowsiness and dry mouth with Δ9tetrahydrocannabinol, but substantial rates of dizziness, fatigue, and disorientation were also seen. It is important to note that these studies did not measure the impact of long-term cannabis consumption. CONCLUSIONS: The existing body of literature evaluating the use of cannabinoids by patients undergoing RT is very limited. Well-designed randomized controlled trials are urgently needed, which address the significant design flaws of previous studies and evaluate the impact of phytocannabinoids in patients undergoing RT.

Implementing Workshops to Improve Radiation Therapists' Knowledge and Attitudes about Sexual Health Issues in Cancer Patients.

OBJECTIVES: Although it is widely acknowledged that radiotherapy treatments can have a negative impact on a patient's sexual health, this aspect of side effect management is not commonly addressed by radiation therapists or by other cancer specialists. It is important for radiation therapists to recognize and address possible sexual health issues to provide a holistic approach to care. This quality-improvement project was designed to help radiation therapists discuss the sexual health needs of patients undergoing radiotherapy by improving their clinical knowledge, skills, and comfort level about the topic. METHODS: This study used a cross-sectional descriptive prequestionnaire/postquestionnaire design, in which data were collected from a nonrandom sample of radiation therapists at a single urban radiation therapy center. Participants attended two 90-minute sexual health education workshops specifically designed for radiation therapists and completed online preworkshop/postworkshop questionnaires. All questions were quantitative in nature. The survey consisted of multiple-choice, multiple-select, and five-point Likert-scale questions. Descriptive analysis was used for data analysis. RESULTS: The results of this improvement project indicated that participants had introductory-level knowledge about how cancer treatments can impact patients' sexual health. Although there is potential for some changes in the general knowledge levels of the participants after the initiative, two general workshops about the topic are not enough to have radiation therapists feel comfortable enough with the topic to change their clinical practice. CONCLUSION: This project identified that although radiation therapists acknowledge the importance of discussing sexual health concerns as part of delivering holistic health care, lack of knowledge and expertise with the topic is a main barrier to initiating conversations. To help prepare radiation therapists, education and training initiatives, which build on knowledge and offer opportunities to develop and apply practical skills in both simulated and real-life situations, should be created. This can help to increase confidence in the sexual health counseling provided, which may result in more radiation therapists frequently engaging in these important sexual health conversations.

Examining the Prevalence of Compassion Fatigue and Burnout in Radiation Therapists Caring for Palliative Cancer Patients.

OBJECTIVE: Radiation therapists (RTs) play an important role in caring for patients undergoing radiotherapy for palliative intent. RTs are in a primary position to provide emotional support to their patients and, as a result, compassion fatigue (CF) and burnout can develop. The purpose of this study was to investigate the prevalence of CF and burnout in RTs providing care to palliative cancer patients, the various intrinsic and extrinsic factors that influence how RTs provide care to this specific patient population, and to determine if RTs feel supported through education and resources. METHODS: RTs at a single radiation therapy centre who have direct patient contact comprising greater than 50% of their clinical practice were invited to complete a self-administered electronic questionnaire. The questionnaire consisted of demographic questions; the Professional Quality of Life Compassion Satisfaction and Fatigue Questionnaire to assess for CF and burnout; and additional questions to assess possible factors affecting CF and burnout among subgroups. Descriptive statistics were used for data analysis. RESULTS: A total of 42 survey responses were received resulting in a 32% response rate. Responses indicated RTs have a high level of compassion satisfaction and low burnout and secondary traumatic stress. However, it was observed that lack of resources to assist dying patients and their family members as well as a fast-paced work environment and the need for education to support staff in coping with CF and burnout were potential stressors. CONCLUSION: This study found that RTs do not experience above average levels of CF and burnout. However, intrinsic factors such as high patient load, a fast-paced clinical environment, and patients' age had the most impact emotionally on staff providing care to this specific patient population.

An Investigation into Body Image Concerns in the Head and Neck Cancer Population Receiving Radiation or Chemoradiation Using the Body Image Scale: A Pilot Study.

INTRODUCTION: Body image (BI) can have a major impact on quality of life, sense of self, and self-confidence. BI concerns are underrepresented within the literature among patients treated with radiation therapy. This pilot study aimed to determine the prevalence of BI concerns among head and neck cancer patients receiving radiation alone or chemoradiation. METHODS: Using a cross-sectional descriptive study design, the Body Image Scale was completed by two cohorts of patients recruited consecutively in their last week of treatment (N = 15) or their follow-up appointment 8-24 weeks postradiation treatment (N = 15). RESULTS: The results revealed a minority of patients had moderate BI concerns in both cohorts. CONCLUSION: The data suggest BI concerns dissipate over time as those in the follow-up cohort reported lower Body Image Scores. Further research into BI within this population would allow a deeper understanding into the global impact of radiation therapy.

Communicating with Emotional Patients: Thoughts, Skills, and Influencing Factors for Ontario Radiation Therapists.

PURPOSE: Patients receiving radiation therapy are subject to high anxiety levels. Radiation Therapists (RTs) are uniquely positioned to support patients as they progress through treatment, but little is known about therapists' ability to perform this important task. This research was designed to describe RTs' ability to communicate with cancer patients during emotional interactions and to determine what intrinsic and extrinsic factors influence that ability. METHODS: Single-centre focus groups were used to develop themes for a questionnaire. That questionnaire was then distributed throughout 13 Ontario cancer centres. Themes evaluated included intrinsic factors (demographics, value, and so forth) and extrinsic factors (work environment, resources, and so forth). A validated clinical vignette was used to evaluate actual respondent communication skill and a validated scale reported various aspects of emotional intelligence. RESULTS: One hundred ninety-nine responses were received from 13 cancer centres distributed across Ontario. Response rate was low (31%), but wave analysis indicated a lack of nonresponse bias. Based on the clinical vignette, RTs showed a high degree of skill when communicating with emotional patients, reporting minimal use of blocking or controlling behaviours. Factors shown to significantly influence the ability to communicate with emotional patients included personal sociability and years of experience, organizational provision of time, private space, and support (P < .05). CONCLUSIONS: RT respondents were particularly skilled at communicating with emotional patients. That skill level was significantly influenced by both personal and organizational factors. The most important of these were experience and time. These findings are consistent with the literature for other professions and are likely generalizable throughout Canada and similar international practice environments.

Radiation Therapy Students' Knowledge, Attitudes, and Beliefs about Palliative and End-of-Life Care for Cancer Patients.

BACKGROUND AND PURPOSE: Although radiation therapy students are highly interested in providing palliative and end-of-life care (PEOLC), students often lack understanding of what palliative care is and express a lack of confidence when interacting with palliative patients. This study examined radiation therapy students' existing knowledge, attitudes, and beliefs toward PEOLC for cancer patients and how professional and personal experiences influenced those factors. METHODS: This study used a cross-sectional online questionnaire. After informed consent, data were collected from a sample of students in an undergraduate radiation therapy program in Canada. Questions were both quantitative and qualitative in nature. Responses were comprised of Likert scales and true or false responses, a case study-based vignette and several short open-ended questions. RESULTS: Sixty-one students completed the questionnaire; the response rate was 42%. Responses indicate students had an incomplete understanding of PEOLC principles despite reporting positive views and interest in the topic. Professional and personal experiences improved students' knowledge regarding the role of PEOLC and attitudes and beliefs became more positive with increased real-life experiences. CONCLUSIONS: Experiential learning influences students' knowledge, attitudes, and beliefs about PEOLC. To better prepare students for their future professional roles, it is necessary for radiation therapy undergraduate programs to include PEOLC educational initiatives in its curricula. These initiatives should emphasize holistic care to prepare students to be competent radiation therapists who can address patients' complex PEOLC needs.

Are Current Care Models Meeting the Psychosocial Needs of Adolescent and Young Adult Cancer Survivors? A Literature Review.

BACKGROUND: Adolescents and young adults diagnosed with cancer are expected to become long-term survivors. A cancer diagnosis during this critical life stage can have a profound impact on normal psychosocial development, increasing risk for adverse long-term and late effects and influencing quality of life. PURPOSE: The purpose of this article was to review the impact of cancer on some key psychosocial aspects of adolescent and young adult cancer survivors, including the impact of a cancer diagnosis on psychosocial development, the effectiveness of current models of care in relation to addressing the psychosocial needs of this patient population, and the evaluation of current Canadian models of care and implications for clinical practice. METHODS: A review of the English literature from 2002 to 2012 was performed using PubMed (National Center for Biotechnology Information), Ovid MEDLINE, and Google Scholar. RESULTS AND CONCLUSIONS: Various survivorship care models have been implemented to assist adolescent and young adult cancer survivors in addressing the psychosocial issues associated with a cancer diagnosis, although the type of model used varies based on institutional resources and survivors' needs. Preliminary survivorship research identifies the need for long-term follow-up care including ongoing assessment for psychosocial issues. The literature also identifies the need to educate adolescents and young adults regarding their disease, which will empower these patients to act as their own health care advocates, resulting in improved health-related outcomes and overall quality of life. However, despite the increasing focus on the benefits of good survivorship care and the availability of government-funded survivorship programs in Canada, programs are often underused by this patient population. Survivorship care is a new focus for research that requires more evaluation regarding the feasibility and effectiveness of the different care models in meeting the psychosocial needs of adolescent and young adult cancer survivors.

Hoping for the Best While Preparing for the Worst: A Literature Review of the Role of Hope in Palliative Cancer Patients.

Palliative care and hope have both been known to improve the quality of life (QoL) of palliative cancer patients. Hope is a complex, multidimensional concept that is influenced by a variety of factors and is considered to be an effective coping strategy when dealing with serious illness. Review of the literature identifies an abundance of hope-fostering strategies that healthcare professionals (HCPs) can use to assist patients to improve their QoL. Ethical issues can arise during HCPs' struggles to remain truthful while attempting to maintain patients' hopes. Increased communication regarding realistic treatment outcomes between the multidisciplinary team and the patient and family is essential for maintaining a patient's hope during the terminal stage of disease. Effective communication with patients demonstrates respect for autonomy and allows for informed decision-making regarding end-of-life interests. This results in the achievement of final end-of-life goals and will increase QoL, which is considered to be the goal of palliative care.

A Literature Review of Preceptorship: A Model for the Medical Radiation Sciences?

Preceptorship is a time-limited, education-focused model for teaching and learning within a clinical environment that uses clinical staff as role models. Its primary goal is to assist new staff and students to adapt to their roles, develop clinical skills and socialize the novice to a department or institution. It has been widely used within the allied health professions; however, very little is known of its practice within the medical radiation sciences. The purpose of this paper was to review the literature available regarding the practice of preceptorship within the medical radiation sciences as well as provide a general overview of the key components to consider in any application of preceptorship. Key findings have been categorized into the following components: evolving definitions of preceptorship, purpose of preceptorship, benefits, roles within preceptorship, qualities of a good preceptor, drawbacks, structured and self-directed preceptorship programs.

Supporting Clinical Teachers: Developing Radiation Therapists' Preceptorship Skills.

Preceptorship is a valuable component of undergraduate radiation therapy education and allows students to develop clinical skills and professional attitudes under the supervision of experienced practitioners. Preceptor preparation in the form of continuing professional development is an important factor for successful preceptorship to occur. This article describes the development and evaluation of a short, flexible blended learning course by a group of Ontario educators. The course was designed to support radiation therapists teaching students from the joint University of Toronto and Michener Institute Medical Radiation Sciences (MRS) program undergoing the clinical practicum component of their 3-year program. The course comprises two workshops and a web-based component. Topics include adult education theories, orienting a student to clinic, feedback, fostering clinical reasoning, conflict resolution, formal evaluation, the MRS program structure/processes and the needs of the student with English as a second language. To date, three cohorts have completed the course (52 learners) from four Ontario radiation therapy departments. Evaluations have been positive, with high participant satisfaction and a noteworthy difference in self-perceived knowledge using the original course objectives between pre- and post-knowledge levels. It is hoped that this course will contribute to the success of the role and provide an opportunity for staff recognition and support.