Work empowerment among cancer care professionals: a cross-sectional study.

BACKGROUND: There is a growing understanding that empowerment of interprofessional personnel is linked to job satisfaction levels and quality of care, but little is known about empowerment in the context of cancer care. This study describes how interprofessional cancer care personnel perceive their performance and factors that promote work empowerment. METHODS: This cross-sectional study enrolled 475 (45.2%) of the 1050 employees who work at a regional cancer centre. The participants used two self-administered questionnaires - the Performance of an Empowered Personnel (PEN) questionnaire and Work Empowerment Promoting Factors (WEP) questionnaire - to report perceptions of work empowerment. Both questionnaires' categories comprise moral principles, personal integrity, expertise, future orientation, and sociality. The data were analyzed using IBM SPSS Statistics, Versions 24 and 25. RESULTS: Overall, the performance of work empowerment was evaluated as being rather high (overall sum score mean: 4.05; range: 3.51-4.41; scale: 1-5). The category that rated highest was moral principles (4.41), and the one rated lowest was the social category (3.51). The factors that promoted work empowerment also ranked high (3.93; range: 3.55-4.08; scale: 1-5), with personal integrity (4.08) the highest and future orientation (3.55) the lowest. Performance and factors that promoted work empowerment correlated positively, moderately, and highly statistically significantly (r = 0.531; p < 0.001). Statistically significant associations also were found between empowered performance of personnel and empowerment promoting factors (sex, education, leadership position, belonging to an interprofessional team, and time elapsed since training in interprofessional cooperation). CONCLUSION: The personnel rated their performance and the factors perceived to promote work empowerment rather highly. Personal empowerment can be promoted through teamwork training and supportive management in interprofessional cancer care.

Healthcare professionals' perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care.

OBJECTIVE: The purpose of this study is to describe the pre-requisites and realisation of interprofessional collaboration as perceived by healthcare professionals working in the cancer care setting and to produce knowledge to support the development of collaborative practices. METHODS: This study employed a descriptive survey design. The data were collected in one Finnish cancer centre between May and October 2018 from nurses, physicians and other healthcare professionals using an electronic survey (n = 350). The survey focused on the pre-requisites of interprofessional collaboration (appreciation and competence) and its realisation in cancer care. The data were analysed using descriptive and interferential statistics. RESULTS: The pre-requisites of interprofessional collaboration were perceived as good and the collaboration was well realised in the cancer centre. The perceptions of pre-requisites and realisation were associated with each other. Male respondents, physicians and professionals belonging to interprofessional teams had more positive perceptions of the pre-requisites and realisation of interprofessional collaboration than others. CONCLUSION: The findings indicate that the pre-requisites of interprofessional collaboration and its realisation seem to be well implemented in the cancer care setting. However, the ongoing evaluation of interprofessional collaboration requires further attention from healthcare administration and professionals to support the systematic development of collaborative practices.

Instruments measuring interprofessional collaboration in healthcare - a scoping review.

Worldwide there is growing understanding of the importance of interprofessional collaboration in providing well-functioning healthcare. However, little is known about how interprofessional collaboration can be measured between different health-care professionals. In this review, we aim to fill this gap, by identifying and analyzing the existing instruments measuring interprofessional collaboration in healthcare. A scoping review design was applied. A systematic literature search of two electronic databases, Medline (PubMed) and CINAHL, was conducted in 03/2018. The search yielded 1020 studies, of which 35 were selected for the review. The data were analyzed by content analysis. In total, 29 instruments measuring interprofessional collaboration were found. Interprofessional collaboration was measured predominantly between nurses and physicians with different instruments in various health-care settings. Psychometric testing was unsystematic, focusing predominantly on construct and content validity and internal consistency, thus further validation studies with comprehensive testing are suggested. The results of this review can be used to select instruments measuring interprofessional collaboration in practice or research. Future research is needed to strengthen the evidence of reliability and validity of these instruments.

Psychosocial outcomes of e-feedback of radiotherapy for breast cancer patients: a randomized controlled trial.

OBJECTIVE: This study aims to test the effectiveness on psychosocial outcomes of electronic feedback knowledge of radiotherapy intervention (e-Re-Know) for breast cancer patients. METHOD: Randomized controlled trial in one university hospital in Finland was carried out. Breast cancer patients (n = 126) in the radiotherapy (RT) department were randomly assigned into two groups: intervention (the e-Re-Know and standard education) and control group (standard education). The e-Re-Know intervention consisted of e-feedback after response to the knowledge test delivered by e-mail. Instruments were completed before commencing first RT (M1), after concluding last RT (M2) and 3 months after last RT (M3). The main outcomes were anxiety and QOL. RESULTS: Compared with the control group, the patients in the intervention group reported a marginally significant improvement in anxiety and significant improvement in QOL over time. CONCLUSION: The e-Re-Know seems to have positive effects on psychosocial outcomes for breast cancer patients. They might gain additional value from the e-Re-Know over a longer time period. Further research needs to focus more on development of e-feedback in patient education.

Randomized, controlled trial of the effect of e-feedback on knowledge about radiotherapy of breast cancer patients in Finland.

The growing number of women with breast cancer and their unmet knowledge expectations of radiotherapy pose a challenge to develop effective electronic patient education. Development efforts should be focused on e-feedback on knowledge because of its positive effects. In this study, we evaluated how an e-feedback knowledge intervention (e-Re-Know) before first radiotherapy improves breast cancer patients' knowledge of radiotherapy and identified the associations with patients' characteristics. Women with breast cancer (n = 128) were randomized prior to the radiotherapy period either to the intervention group or control group. The outcome measured three months after the radiotherapy period was knowledge level of radiotherapy. The increase in knowledge level was higher in the intervention group after adjustment for baseline knowledge level, and a significantly higher increase in knowledge level was seen in one subdomain, side-effect self-care, compared to the control group. The results of this study indicate that the e-Re-Know can be used in patient education to support empowerment. Future research should target new applications of e-Re-Know available on the Internet for those interested in the subject.

Knowledge tests in patient education: a systematic review.

This study describes knowledge tests in patient education through a systematic review of the Medline, Cinahl, PsycINFO, and ERIC databases with the guidance of the PRISMA Statement. Forty-nine knowledge tests were identified. The contents were health-problem related, focusing on biophysiological and functional knowledge. The mean number of items was 20, with true-false or multiple-choice scales. Most of the tests were purposely designed for the studies included in the review. The most frequently reported quality assessments of knowledge tests were content validity and internal consistency. The outcome measurements for patient-education needs were comprehensive, validating knowledge tests that cover multidimensional aspects of knowledge. Besides the measurement of the outcomes of patient education, knowledge tests could be used for several purposes in patient education: to guide the content of education as checklists, to monitor the learning process, and as educational tools. There is a need for more efficient content and health problem-specific knowledge-test assessments.

Perspective of radiography science - a document analysis of dissertations.

INTRODUCTION: The aim of this study was to clarify the perspective of radiography science as an academic discipline. A discipline can be studied by discovering the collective use of concepts, especially core concepts. We have previously identified the core concepts as clinical practices in radiography, radiographers' profession, safe and high-quality radiation use, and technology in radiography. The relationships between these concepts have not been studied previously. In order to clarify the perspective of radiography science we have investigated further the core concepts, their interrelationships and interdependencies. METHODS: Altogether, 53 dissertations meeting the inclusion criteria were selected for a qualitative document analysis. The data were first analysed deductively using an extraction matrix comprising four core concepts developed from previous studies, then relational statements were synthesised, and the statements were analysed semantically. RESULTS: Analysis revealed the bilateral interrelationships between the concepts and their dependencies. All the concepts were used within healthcare. The rationale for radiography science research was the clinical practice of radiography and the improvement of services in a complex environment as a part of patients' pathways. Safe and high-quality radiation use was investigated as a means to deliver optimal services. Technology was studied as being functional or a means to deliver services. The perspective of the discipline was seen as the combination of humanistic interaction with advanced technology, where safety and quality were a necessity. CONCLUSIONS: Defining core concepts and their interrelations clarifies the perspective of the discipline and gives radiography researchers a way to argue their viewpoint.

The impact of an empowering Internet-based Breast Cancer Patient Pathway program on breast cancer patients' clinical outcomes: a randomised controlled trial.

AIMS AND OBJECTIVES: To evaluate the effect of the Breast Cancer Patient Pathway program on breast cancer patient's empowerment process. BACKGROUND: The results of earlier studies indicate that the use of tailored Internet-based patient education programs increased patient's knowledge level; however, other outcome measures differed. DESIGN: This randomised control trial studied the effect of the Internet-based patient educational program on breast cancer patients' empowerment. In this study, we measured the quality of life, anxiety and managing with treatment-related side effects as the outcomes of breast cancer patients' empowering process. METHODS: Breast cancer patients who were Internet users in one Finnish university hospital during 2008-2010 were randomised to the control group (n=43) and the intervention group (n=47). Baseline data were collected first in the hospital and the following data seven times during the treatment process, the last time one year after breast cancer diagnosis. RESULTS: There were no statistically significant differences in the quality of life, anxiety or side effects of treatment between the groups. The amount of treatment-related side effects was connected to both physical and psychological well-being. CONCLUSIONS: In this study, the Breast Cancer Patient Pathway program did not decrease anxiety level or treatment-related side effects among breast cancer patients or improve subscales of quality of life when compared with controls. RELEVANCE TO CLINICAL PRACTICE: There is a need to relieve the side effects caused by patients' care with the help of patient education. Internet-based patient education programs need more focus when developing new patient education methods.

Developing a patient education method - the e-Knowledge Test with feedback.

Breast cancer and its treatment radiotherapy, have impact on woman's psychosocial and physical well-being causing disruption to quality of life. Because of the positive effects of knowledge on quality of life there is a challenge to develop effective education methods. Due to the growing use of internet among breast cancer patients the development should be focused on e-education. An e-education method, the e-Knowledge Test of radiotherapy with feedback for breast cancer patients (e-KTRT-BC) was planned and piloted. The content of it based on literature of breast cancer patients' knowledge needs of radiotherapy and structured through aspects of empowerment as a nursing intervention. The face validity study that was conducted via email revealed that the content of e-KTRC-BC was easy to use and understand. The e-KTRT-BC could be used as an e-education method to meet the breast cancer patients' knowledge needs. Evaluating the empowering effect of patient e-education with feedback is important for further development of e-education methods.

Leadership and administrative support for interprofessional collaboration in a cancer center.

PURPOSE: The interprofessional collaboration is a key practice for providing cancer care. However, the realization of collaboration requires effective leadership and administrative support. In this study, the aim was to analyze healthcare professionals' perceptions of leadership and administrative support (strategic and management) in interprofessional collaboration for developing practices in cancer care. DESIGN/METHODOLOGY/APPROACH: A descriptive survey design was used to collect data from healthcare professionals (n = 350, response rate 33.3%), including nurses, physicians and other professionals participating in patient care in one Finnish cancer center (out of five) in 05/2018-10/2018. The data were analyzed using descriptive and inferential statistics. The instrument focused on leadership in the work unit and administrative support including organization strategy and organizational management. FINDINGS: Healthcare professionals perceived leadership in the work unit, organization strategy and management for the support of interprofessional collaboration as weak. However, the ratings of male respondents and those in leading positions were more positive. The findings indicate that healthcare professionals in the cancer care setting are dissatisfied with the leadership and administrative support. RESEARCH LIMITATIONS/IMPLICATIONS: Interprofessional collaboration, including its leadership, requires systematic and constant evaluation and development. ORIGINALITY/VALUE: Healthcare leaders in the cancer care setting can use the results to identify factors that might be in need of attention and development in the field of interprofessional collaboration.

The impact of an empowering Internet-based Breast Cancer Patient Pathway programme on breast cancer patients' knowledge: a randomised control trial.

OBJECTIVE: The aim of this study was to analyse the effect of Breast Cancer Patient Pathway program. METHODS: In one Finnish university hospital during 2008-10 newly diagnosed breast cancer patients were randomised to the intervention (n = 50) and the control groups (n = 48). The breast cancer patient's knowledge expectations and perception of received knowledge, knowledge, the source of information and satisfaction in received patient education were measured. Baseline and one year follow up data collection was conducted. RESULTS: No differences were found in knowledge expectations between the groups at baseline. Patients in the control group evaluated their perception of received knowledge to be higher and they were more satisfied with the patient education they received from the hospital staff. However, the Intervention group's knowledge level was higher. The most important source of information was the healthcare professionals in both groups. CONCLUSION: The results of study indicate that when patient education increases, patients' knowledge expectations increase as well, while their perceptions of received knowledge decrease. Future research is needed to examine the relationship between patients' knowledge expectations and perception of received knowledge as patients' knowledge level increases. PRACTICE IMPLICATIONS: Patient education has to be individually adjusted, taking patients' expectations into account.

The effects of Internet or interactive computer-based patient education in the field of breast cancer: a systematic literature review.

OBJECTIVE: The aim of this systematic review was to analyze what kind of Internet or interactive computer-based patient education programs have been developed and to analyze the effectiveness of these programs in the field of breast cancer patient education. Patient education for breast cancer patients is an important intervention to empower the patient. However, we know very little about the effects and potential of Internet-based patient education in the empowerment of breast cancer patients. METHODS: Complete databases were searched covering the period from the beginning of each database to November 2008. Studies were included if they concerned patient education for breast cancer patients with Internet or interactive computer programs and were based on randomized controlled, on clinical trials or quasi-experimental studies. RESULTS: We identified 14 articles involving 2374 participants. The design was randomized controlled trial in nine papers, in two papers clinical trial and in three quasi-experimental. Seven of the studies were randomized to experimental and control groups, in two papers participants were grouped by ethnic and racial differences and by mode of Internet use and three studies measured the same group pre- and post-tests after using a computer program. The interventions used were described as interactive computer or multimedia programs and use of the Internet. The methodological solutions of the studies varied. The effects of the studies were diverse except for knowledge-related issues. Internet or interactive computer-based patient education programs in the care of breast cancer patients may have positive effect increasing breast cancer knowledge. CONCLUSION: The results suggest a positive relationship between the Internet or computer-based patient education program use and the knowledge level of patients with breast cancer but a diverse relationship between patient's participation and other outcome measures. PRACTICE IMPLICATIONS: There is need to develop and research more Internet-based patient education.

Internet knowledge expectations by radiotherapy patients.

The purpose of this study was to describe what kind of information radiotherapy patients expected to receive through Internet education. Questionnaire data for the longitudinal study were collected from patients at the beginning (stage 1), in the middle (stage 2), and at the end (stage 3) of their radiotherapy period. In stage 1, a total of 150 questionnaires were handed out, and 100 were returned, giving a response rate of 67%. Of the 100 patients, 75 and 73 completed the questionnaires in stages 2 and 3, respectively. Descriptive statistics and content analysis were used in data analysis. Knowledge expectations could be classified into four: "I have no expectations," "I don't know what I want," "I want all possible available knowledge," and "I want specific knowledge from different issues." "I want specific knowledge from different issues" were biophysiological, functional, social, experiential, ethical, and financial areas. Patients' information expectations were highest in the biophysiological, functional, and social areas and lowest in the experiential, ethical, and financial areas. Expectations varied during radiotherapy. Characteristics' variables of patients associated with expectations. This study can contribute toward the development of an Internet site based on the knowledge expectations of radiotherapy patients. The results can also be used in individual patient education.