Theories of Loss and Grief Experienced by the Patient, Family, and Healthcare Professional: a Personal Account of a Critical Event.

When a patient is diagnosed with cancer, a number of losses and grief processes occur. Theories and models of loss, grief, and mourning are explored for the patient, her family member, and the medical treatment team, through a personal reflection when treating a patient undergoing a course of radiation treatment in a large cancer center. Reflection on this event can be used to guide health care facilities to assess and develop support systems for patients, caregivers, and health care professionals to cope with loss and grief processes in a healthy and meaningful way.

Video Material as an Effective Educational Tool to Address Informational and Educational Needs of Cancer Patients Undergoing Radiation Therapy.

With increasing rates of cancer patients undergoing radiation therapy, the treatment itself can cause patients significant amounts of anxiety and distress. This can be attributed to the diagnosis of the disease, lack of knowledge of what radiation therapy is, expectations and management of side effects, and the lack of knowledge of supportive care for patients and their families. Providing patients with effective educational tools to meet the informational needs of cancer patients undergoing radiation therapy can empower patients and allow them to participate in treatment decision-making and their own healthcare. This discussion paper will evaluate several studies on the psychological impact of cancer patients undergoing radiation therapy and how video material can effectively meet the informational and educational needs of this patient population group.

A Pilot Project to Investigate Radiation Therapist Referrals to an Ad Hoc Supportive Care Oncology Clinic.

PURPOSE/AIM: Approximately 400 patients are treated daily within the radiation therapy (XRT) department at the cancer centre where this project took place. As part of their clinical interactions during the treatment delivery process, radiation therapists (MRTs) may refer patients to a third party "RN Assessment Office" for non technical issues. These referrals can result in extended wait times for patients as well as disruptions to the scheduling of MRTs and other health care professionals. This review aimed to identify issues that resulted in third party referrals by MRTs. Data collected may enable insight into the issues that prompt third party referrals and help support MRTs in managing patient issues that are within their scope of practice. METHOD/PROCESS: A database of XRT patient referrals to the location "RN Assessment Office" in the electronic records (EMRs) was generated for this review. A 4-week period within the previous year was considered suitable by the investigators to produce a representative sample of referrals. Predetermined referral categories were compiled based on the experiences of the investigators. Data were extracted from two sources: (1) the progress note tab within each patient EMR and (2) the comments section of the registered nurses (RNs) Assessment workload location in the EMR systems. RESULTS/BENEFITS/CHALLENGES: Data demonstrated that 17% of the progress notes in the EMR contained MRT documentation before referral. The majority of referrals (29%) were related to patient skin reactions and wound/dressing care. CONCLUSIONS/IMPACT/OUTCOMES: Absence of documentation by MRTs in the EMR impaired the data collection. Anecdotal evidence suggests routine MRT patient assessment during the XRT process. Recommendations related to systematic assessments and documentation procedures may increase MRT documentation. Streamlining the referral processes may improve efficiencies and eliminate redundancies in the workflow of MRTs.

It Only Takes a Minute: The Development and Implementation of a Patient Experience Survey in Radiation Therapy.

INTRODUCTION: Health care services use surveys to assess patient satisfaction and identify areas for improvement. While it is important to assess patient satisfaction to ensure their needs are met, lengthy questionnaires with closed-ended questions often focus on areas that may be considered important by institutions rather than patients. Recently, focus has shifted toward patient and caregiver experience, which institutions address via appreciative inquiry. The aim of this initiative was the development of a patient experience survey (PES) for radiation therapy patients and caregivers which would allow them to express their opinions and priorities. This patient feedback would then be addressed through quality improvement (QI) projects geared toward improving the overall patient and caregiver experience in radiation therapy. METHODS: A three-question minute survey was developed for use as a PES in the radiation therapy department of an academic oncology program located in a large metropolitan area. Feedback was obtained from patient education and person-centred care experts, as well as 10 radiation therapy patients. All feedback was incorporated to create the final PES; respondents rated their agreement on a five-point Likert scale with the statement "My overall experience in Radiation Therapy was great" and two open-ended questions allowed them to highlight departmental strengths and areas for improvement. An initial 3-month pilot was conducted where PESs were available on a self-serve basis to patients and caregivers in waiting areas and at radiation therapy treatment units. All responses were anonymous and completed surveys were returned via drop boxes. Descriptive statistics and thematic analysis were used to analyse responses. RESULTS: A total of 86 surveys were returned. Of those, 80 (93%) responded to the Likert scale question with 83% agreeing or strongly agreeing that their experience in radiation therapy was great. Several strengths were identified by respondents including teamwork, professionalism, and knowledge. Areas identified for improvement included management of appointment delays and communication of delays to patients, as well as environmental improvements. CONCLUSIONS: Although most respondents reported a favourable experience, this pilot demonstrated the minute survey can identify areas for improvement that can be addressed through QI. Including the patient perspective in QI is evidenced to enhance its outcome and aligns with institutional, provincial, and national strategic goals of improving the quality of cancer care through patient engagement.

Distress Among Locally Advanced Breast Cancer Patients from Diagnosis to Follow-Up: A Critical Review of Literature.

OBJECTIVE: This critical review used a systematic approach to explore the prevalence of distress among locally advanced breast cancer (LABC) patients along their treatment journey. This review explored the domains of distress (psychosocial, physical and/or practical) that are significant to this patient population and determined indications for psychosocial support throughout the patients' treatment. METHODS: Electronic databases including CINAHL, EmBase, Medline PsycInfo, and gray literature were searched from the year 2000 to 2016, to produce relevant literature. A critical review was conducted on 73 articles meeting the inclusion and exclusion criteria. A narrative synopsis was used to summarize the findings under key themes. RESULTS: The results indicate that 16/73 studies assessed for distress in all three domains of distress throughout the treatment course. A meta-analysis was not possible due to the methodological heterogeneity of the articles, the variation of assessment tools used, timing in which the assessments were done, and the different treatment modalities. Distress was prevalent from the time of diagnosis, through treatment, and into survivorship. Sexuality, body image, age, financial difficulty, family/social support, and informational needs were common themes that emerged among the LABC population in these studies. CONCLUSIONS: Comprehensive assessments incorporating all three domains of distress with the appropriate tools will assist health care professionals throughout the complicated treatment trajectory of LABC patients in taking a more proactive approach in assisting patients' concerns and preventing undue or increase in psychological distress during or after active treatment. This will encourage effective patient-centered communication and supportive care referrals for a better patient experience.

A Feasibility Study on the Role of Ultrasound Imaging of Bladder Volume as a Method to Improve Concordance of Bladder Filling Status on Treatment with Simulation.

PURPOSE: Accurate positioning of the prostate is of paramount importance to ensure optimal target coverage and normal tissue sparing in stereotactic ablative body radiation when large doses per fraction are delivered with tight margins around the prostate. Bladder and rectal filling play an important part in controlling the accuracy of a patient's setup and therefore the overall toxicities and outcomes. The aim of this study was to establish the value of characterizing patients' bladder filling kinetics at the time of simulation with ultrasound scans so that a predictive model can be used to ensure that a bladder volume at treatment would match at simulation. METHODS: A prospective trial was conducted in unfavorable risk prostate cancer patients to evaluate the utility of ultrasound bladder monitoring. Thirty patients (n = 30) were enrolled in this study. Patients were required to void before simulation and then were given 500 mL of fluids to drink. Ultrasound measurements of the bladder were documented at 15-minute intervals for up to four measurements before simulation. On treatment, bladder volumes were measured at a single time point; typically, half an hour after the patient voided and consumed 500 mL of fluids. The kinetic model was then used to predict the optimal time to set up the patient for treatment such that the bladder volume at treatment would match the volume at simulation. Every patient had a cone beam computed tomography scan before each fraction to ensure accurate patient positioning before dose delivery. Bladder volumes at treatment were measured and compared with those at simulation on the cone beam computed tomography data sets using MIMVISTA software. RESULTS: Of 30 patients, 26 were analyzed. The comparison of the bladder contours at treatment compared to simulation yielded a DICE coefficient (similarity) of 0.76 ± 0.11. The largest variation in bladder size was seen in the anterior-posterior direction. CONCLUSIONS: This study demonstrated that ultrasound monitoring of the bladder status was a valuable tool in ensuring reproducible bladder filling on treatment. The bladder kinetic model indicated the general time required to achieve optimal bladder filling was 60 minutes after voiding and drinking 500 mL of water.