Surveying the landscape: First Nations, Métis, and Inuit cancer resources in radiation therapy.

INTRODUCTION/BACKGROUND: Alberta Health Services (AHS) is Canada's largest provincial integrated health care authority. AHS services over four million people with over 100,000 employees. In 2018, AHS introduced Indigenous training modules which were mandatory for all staff. These eight modules included topics detailing residential schools, Indian hospitals, The Indian Act, The 60's Scoop, Alberta's Indigenous populations, present day realities, including customs, practices and traditional medicines. Limited research exists in general in the field of radiation therapy with Canadian Indigenous populations. No formal research exists on the effectiveness of these AHS training modules. METHODS: A mixed methods survey was developed and distributed by the radiation therapy managers to practicing radiation therapists in the four cancer centers in Alberta. The survey contained both drop down and open text boxes. RESULTS: Survey respondents indicated that 90 % of radiation therapists completed the AHS Indigeneous training modules. However, 50 % of the respondents did not know what resources are available for their Indigenous patients. Furthermore, only 67 % felt that the information provided in the modules created enough comfort for them to have a conversation with Indigenous patients with cancer and their families. DISCUSSION: Respondents indicated that although they felt knowledgeable and educated from the training modules, this did not necessarily translate into daily clinical practice. This included a lack of confidence to lead a conversation, knowing what resources are available and how to document if patient education material was given. CONCLUSION: Creation of an Indigenous specific oncology module highlighting both resource availability and cultural customs that may be part of a person's cancer journey, may be of benefit to health care providers providing radiation treatment. Having Elders and Knowledge Keepers be part of the development of an oncology module may help create mutual understanding for both the cancer patient and their families and health care providers. This research suggests that the current cultural competency training for radiation therapists at AHS may not be enough for radiation therapists to feel comfortable with translating learnings from Indigenous online modules into their practice.

A survey of Canadian radiation therapists' perspectives on caring for LGBTQ2SPIA+ cancer patients.

PURPOSE: The lesbian, gay, bisexual, trans, queer, two-spirit, pansexual, intersex, asexual, plus (LGBTQ2SPIA+) population faces unique cancer health risks and barriers to competent healthcare. This study aimed to identify current knowledge, attitudes, and practice behaviours amongst radiation therapists regarding the LGBTQ2SPIA+ community to ultimately improve care given to this population. METHODS: A 22-item online survey was sent out to Canadian radiation therapy department managers and forwarded to radiation therapists. The survey collected demographics and addressed knowledge, attitudes, and practice behaviours regarding the LGBTQ2SPIA+ population. Results were analyzed using descriptive statistics, inferential statistics and thematic analysis. RESULTS: 214 radiation therapists completed the survey. Over 70% were unfamiliar with all terms associated with "LGBTQ2SPIA+". 91.6% believed that being conscious of the LGBTQ2SPIA+ community is important to their role as a therapist; however, 34.5% reported "rarely" or "never" adapting practice behaviours when caring for this community. Only 17.3% felt they had received adequate information to comfortably care for the LGBTQ2SPIA+ population, with 86.9% interested in receiving more education on specific patient needs. The open-ended questions revealed four themes: uncertainty regarding knowledge of the LGBTQ2SPIA+ community; willingness and/or desire to improve practice behaviours; therapists are already aware of some unique needs of the LGBTQ2SPIA+ community; and some therapists believe that all patients should be treated equally. National generalizability is limited due to insufficient data collected from all geographical regions. CONCLUSION: Overall, this study was unable to provide national generalizability, however the results suggest that amongst the respondents there are knowledge gaps and inconsistencies in practice when caring for LGBTQ2SPIA+ cancer patients. Given the limited literature available, and the results from this study, more education and research is warranted to bridge knowledge gaps and aid in providing inclusive patient care.

The Oncology and Sexuality, Intimacy, and Survivorship Program Model: An Integrated, Multi-disciplinary Model of Sexual Health Care within Oncology.

Cancer-related sexual dysfunction is documented as one of the most distressing and long-lasting survivorship concerns of cancer patients. Canadian cancer patients routinely report sexuality concerns and difficulty getting help. In response to this gap in care, clinical practice guidelines were recently published in the Journal of Clinical Oncology. A sweeping trend is the creation of specialized clinics for patients' sexual health concerns. However, this much-needed attempt to address this service gap can be difficult to sustain without addressing the cancer care system from a broader perspective. Herein, we describe the implementation of a tiered systemic model of cancer-related sexual health programming in a tertiary cancer center. This program follows the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, used previously for guiding individual practitioners. Visually, the model resembles a pyramid. The top 2 levels, corresponding to Intensive Therapy and Specific Suggestions, are comprised of group-based interventions for common cancer-related sexual concerns and a multi-disciplinary clinic for patients with complex concerns. The bottom 2 levels, corresponding to Permission and Limited Information, consist of patient education and provider education and consultation services. We describe lessons learned during the development and implementation of this program, including the necessity for group-based services to prevent inundation of referrals to the specialized clinic, and the observation that creating specialized resources also increased the likelihood that providers would inquire about patients' sexual concerns. Such lessons suggest that successful sexual health programming requires services from a systemic approach to increase sustainability.

Quality improvement in sexual health care for oncology patients: a Canadian multidisciplinary clinic experience.

PURPOSE: With the goal of improving the quality of sexual health care provision at our tertiary cancer centre, we developed, implemented, and assessed a multidisciplinary sexuality in an oncology program, to identify patient needs and apply interventions that could be effective in a broader oncology care context. METHODS: The establishment of our institution's first oncology-focused sexual health program is described within a quality improvement framework. A complementary retrospective chart review was performed to evaluate clinicodemographic data, including responses to validated sexual health questionnaires, from a 2-year clinical pilot. RESULTS: A sexual health program was introduced for cancer patients identified by health care providers or self-referred, receiving 130 referrals and conducting 64 consultation and 75 follow-up visits within a 2-year pilot period. Patients attending the program were 75% female, of mean age 52 years, and had most often breast (33%) or hematologic (30%) malignancies. Most (84%) had completed curative-intent treatment, with no evidence of disease, with 34% on ongoing endocrine therapy. The most frequent reasons for referral were sexual pain (38%), decreased libido (35%), and vaginal dryness (35% of females). All female patients demonstrated sexual dysfunction on the Female Sexual Function Index, and 80% of male patients demonstrated moderate to severe erectile dysfunction on the Sexual Health Inventory for Men. Patients waited a median of 63 days (SD 107, range 3-516) from referral to consultation, suggesting that demand for multidisciplinary sexual health care overwhelmed existing resources. CONCLUSIONS: We have demonstrated unmet sexual health needs across a diverse oncology patient population and have presented a framework for addressing these issues, highlighting the challenges encountered and proposing improvements. Insights emerging from a quality improvement perspective included the role of group-based sexual health support to improve accessibility and the need for staff education to encourage proactive intervention before referral for specialized care is needed.