A review of results from patient experience surveys during the introduction of group pre-radiotherapy patient information sessions

Impact of patient information format on the experience of cancer patients treated with radiotherapy

Introduction

Radiotherapy (RT) stands as one of the main cancer treatments. The impact of RT and cancer treatment can have a physical and psychological impact on patients and their carers. To gain patient's trust, and ensure they feel valued, information should be provided before, during, and after RT. Patient and public involvement (PPI) has been lacking, and increased engagement with PPI groups could improve this. This rapid review aims to analyse the literature, and describe and report patient perception, experience, and satisfaction regarding the information received concerning their course of RT.

Methods

To allow the synthesis of results, a pragmatic decision was made to use a rapid review approach to analyse the literature, providing more timely information to inform future work. This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42023415916).Electronic databases CINAHL, AMED, Pubmed/MEDLINE, EMBASE, and PsycINFO were searched using a comprehensive search for published studies from January 2012 to November 2023. Two independent reviewers applied the eligibility criteria. Evidence from literature was extracted and transcribed into qualitative data and Braun and Clarke's six-step thematic analysis (TA) was employed to determine themes by one reviewer and checked by a second [26]. Due to the heterogeneity of the included literature, the analysis of this review is presented primarily through narrative synthesis.

Results

Sixty eight articles met the inclusion criteria for this review. Emerging themes included; a desire for information based on patient characteristics, information format, patient preparedness, timing e.g. timing of information and changing priorities over time, health care professional (HCP) involvement, barriers to information, and motivators for better information delivery.

Conclusions

Several factors can influence a patient's desire for information, from whom and when they receive it, to what format they would prefer to receive it. There is benefit to be gained in employing PPI and patient advocacy to inform future studies that aim to further understand the themes that emerged from this review. Such studies can therefore inform HCPs in providing patient-specific information and support by utilising multiple teaching strategies available to them.

First day of radiotherapy for women with breast cancer: predictors of anxiety

PURPOSE

Radiotherapy treatment may generate anxiety, especially on the first day of treatment. This study aimed to identify potential predictors of radiotherapy-related anxiety in women  with breast cancer before treatment initiation, in terms of treatment concerns and trait anxiety.

METHODS

This transversal study included 94 patients from one Radiation Oncology Department, who had been diagnosed with primary breast cancer and who had been prescribed external radiotherapy for the first time. Patients completed a Treatment Concerns Questionnaire and the State-Trait Anxiety Inventory (STAI) before the  first treatment session.

RESULTS

Women identified radiation involved in the procedure and treatment efficacy as major concerns surrounding radiotherapy. No significant differences were found between patients with higher and lower state anxiety scores, or by age, level of education, cancer treatment protocol used, prior information given about treatment, or report of doubts before treatment initiation. In the final model, the combination of trait anxiety (49.1% of the total variance) with two treatment-related concerns, regarding radiation and the duration of treatment (plus 10.8% of the total variance), significantly predicted treatment-related anxiety experienced on the first day of treatment.

CONCLUSION

Our findings highlight the need to identify women with moderate or higher levels of trait anxiety before radiotherapy initiation and to provide them with a more approach to personalized care, adjusted to their specific concerns and susceptibility to anxious reactions. Effective education sessions involving the discussion of specific treatment concerns, and anxiety coping strategies training should be developed and applied in initial interactions with breast cancer patients.

The development of patient information leaflets incorporating patient diversity considerations: Varicocele embolisation and fluoroscopy guided joint injection examinations

PURPOSE

The production of patient information leaflets (PILs) for diverse patient cohorts is challenging. This study developed varicocele and fluoroscopy guided joint injection (FLGJI) procedural PILs.

METHODOLOGY

Evidence-based PILs were developed, providing radiological procedural information - preparation, explanation of interventional procedures and aftercare. PIL readability was tested via validated readability programs: Flesch Kincaid and Flesch ease reading score methods. Radiology approval of PIL(s) content was confirmed. PILs were distributed with appointment information. Patient interviews were conducted just prior to examination and by telephone, 7 days post procedure.

RESULTS

Participants were purposely sampled (6 months): varicocele embolisation (n = 17) and FLGJI (n = 47). Overall 78.1% of all participants preferred Maltese leaflets. Varicocele embolisation patients were generally younger and a greater percentage educated to tertiary level compared to FLGJI patients. Education and age were found to be recurrent significant variables in the patient demographics and responses for both patient cohorts. Age versus education for the FLGJI cohort proved to be significant for several responses. Readability statistics identified the FLGJI leaflet as a plain English rating, the varicocele embolisation leaflet was more difficult. Patient feedback identified 'what is a varicocele?' as important to varicocele embolisation patients whereas FLGJI patients chose, 'advice about aftercare' and 'advice about pain management', highlighting differences in patients' priorities between procedures.

CONCLUSION

PILs provided tangible, accurate information pre and post examination. Patient involvement in achieving appropriate information informed the PILs development, which were adopted clinically. The development of tailored PILs to meet the diversity of other interventional radiology procedures is recommended.

International audit of Virtual Environment for Radiotherapy Training usage

Introduction

The Virtual Environment for Radiotherapy Training (VERT) is a high-fidelity simulation hardware and software resource that replicates the expensive and high-pressure clinical environment of a radiotherapy treatment machine. The simulation allows students to gain confidence with clinical techniques in a safe and unpressured academic environment before clinical placement. The aim of this study was to establish the current and future role of VERT and explore the potential for collaborative resource development and research.

Methods

An anonymous online survey was made available to all users of the software internationally (n=52). A mixture of fixed and open response questions gathered usage data and user feedback.

Results

The study had a 90% response rate (n=47). Most participants (78·5%) used the resource 1 day/week or less; around 8,000 hours worldwide. It was clear that most participants used the simulation resource to help student to either gain understanding of concepts and techniques or to gain practice with techniques and practical skills. There was good support for collaborative resource development, deployment and evaluation to help VERT users to fully exploit its range of pedagogical uses.

Conclusions

This audit demonstrated high levels of engagement and enthusiasm for collaborative resource development and ongoing research among the radiotherapy simulation community. Adoption of an international Academic Community of Practice for collaborative simulation resource deployment and support may be of significant value and is worthy of further discussion and consideration.