More than just a pamphlet: development of an innovative computer-based education program for cancer patients

Evaluation of centers for information and support combining formal and informal care for patients with cancer: a systematic review of the literature

PURPOSE

Clear information and supportive care are necessary for patients with cancer to effectively manage their condition. Traditionally, healthcare professionals offer information and support via the so-called formal care route. In addition, research has found favorable effects of informal care provided by volunteer programs and informal "walk-in support centers." Less research has been done on initiatives that combine formal and complementary informal supportive care for patients with cancer. This systematic literature study aimed to discover (1) which types of initiatives are described in the literature, (2) what type of care they offer, and (3). how they are evaluated in terms of outcome measures.

METHODS

We performed a systematic literature search of MEDLINE, Embase, PsycINFO, and CINAHL. Studies were included if the collaboration between one type of formal care together with one type of informal care was explicitly mentioned in the article. The search was not restricted to a specific cancer type.

RESULTS

A total of 4869 records were retrieved and 18 studies were included. In most studies, the care provided consisted of emotional support for, and/or providing information to, patients and their families. Initiatives were evaluated with interviews and questionnaires. Patients with cancer reported that they were satisfied with the care offered, including information, social and emotional support, help with activities of daily living, and family-related issues. Volunteers reported that visits they made were experienced positive and rewarding and the volunteers were confident about their contribution to general healthcare. Some negative experiences were reported by volunteers, e.g., interference of their own cancer diagnosis with volunteer work. The importance of proper training was stressed.

CONCLUSIONS

Initiatives combining formal and informal supportive care hold the potential of added value in terms of providing emotional support for, and providing information to, patients with cancer. Support and specific training for volunteers can be viewed as success factors in the involvement of volunteers in formal care practices.

The Cost of Patient Education Materials Development: Opportunities to Identify Value and Priorities

The study aim was to evaluate the costs associated with developing and reviewing patient education materials (pamphlets) across Ontario cancer centers. While patient education often produces a positive return on investment, limited efforts have been dedicated to optimizing the personnel, time, and capital dedicated to this feat across healthcare systems. Patient education leaders at 14 cancer centers completed a survey measure, estimating the number of hours spent developing and reviewing pamphlets and identifying the personnel involved in each procedural step. The time expended per center in each step was then combined with average salary data for the identified personnel to derive total cost estimates. Cancer centers spend on average $5672 (SD = $3180) developing (M = $4560, SD = $2620) and reviewing (M = $1112, SD = $654) one pamphlet. This cumulates to an average per annum spending of $65,401 (SD = $75,494) for pamphlet development and $19,819 (SD = $28,524) for annual pamphlet review at each cancer center. The cost and number of hours spent developing and reviewing pamphlets varied substantially between cancer centers. While the security of budgets for patient education varies across cancer centers, opportunities to optimize human capital and monetary resources should be considered. Results of the study can be used to advocate for sustainable investment into cancer education programs, improve the coordination of educational materials production and review, and ensure that resource quality and access are consistent across the province.

Cystic Fibrosis: A Pocket Guide

In 2010, an iPad app titled 'A Patient's Guide to Cystic Fibrosis' was developed for use by Cystic Fibrosis (CF) clinical nurse specialists during a patient's annual review. Feedback from pseudo-CF patients and NHS staff including CF clinical nurse specialists and respiratory consultants about the appearance, usability and content of the app and iPad interface, and the appropriateness of the app for CF patients was positive. The visual images, animations and interactive elements of the app were sufficient in providing an engaging experience for the user. The app was deemed suitable for patients and set a foundation for the development of comprehensive and interactive CF patient information learning tools. Since 2010, the prevalence and popularity of iPad apps in healthcare have soared and apps now have the capability to include more interactive touch-based experiences with digital content such as 3D models. The original iPad app was re-developed as an Apple iBook and an Android app titled 'Cystic Fibrosis: A Pocket Guide'. This paper describes the design, development and feedback on the original iPad app and its subsequent variants, and concludes with reflections from the specialist CF nurses, who have continued to use pocket guide over 10 years.

Impact of Virtual Learning Environment on Students' Satisfaction, Engagement, Recall, and Retention

BACKGROUND

Virtual learning environments (VLEs) were introduced to progress students from passive to active learners. Active learning promotes the critical thinking skills essential for the transfer/use of classroom-acquired knowledge into the clinical setting. A VLE forms an increasingly vital component of clinical skills development in a range of disciplines.

MATERIAL AND METHODS

A randomized control trial was conducted with students randomly attending one of two teaching sessions about radiation therapy. Both sessions were identical except a VLE was used in the second talk with the first being solely didactic. Anonymous questionnaires were distributed. Two weeks after the talks, participants were required to complete the same knowledge questionnaire to determine retention. Mann-Whitney, means, standard deviations, and chi-squared tests were used according to data characteristics. Qualitative data (open-ended questions) were analysed thematically.

RESULTS

Virtual learning seemed to significantly improve students' satisfaction/engagement and recall. A total of 40 students attended the teaching sessions. The student group taught using the VLE had higher mean scores for retention than the didactic group; however, this was not statistically significant. Use of VLEs was associated with greater satisfaction/engagement than didactic information (P = .003). Students' learning styles seemed to have no effect on their satisfaction/engagement and ease of learning. Three key themes emerged from the qualitative data: (1) the visuals were good/helpful, (2) the talk was informative, and (3) more details/visuals were required.

DISCUSSION AND CONCLUSION

The key findings from this study suggest that there is a role for VLEs in the teaching of students. There is a need for the introduction of advanced technology into health care education as virtual reality, such as Virtual Environment of Radiotherapy, has shown improvement in students' satisfaction, engagement, and recall. Whether VLEs qualify students better than conventional didactic teaching is still undetermined, but these first results are encouraging.

Efficacy of three-dimensional visualization in mobile apps for patient education regarding orthognathic surgery

'Sur-face' is an interactive mobile app illustrating different orthognathic surgeries and their potential complications. This study aimed to evaluate the efficacy of Sur-face by comparing two methods of delivering patient information on orthognathic surgeries and their related potential complications: a mobile app with interactive three-dimensional (3D) animations and a voice recording containing verbal instructions only. For each method, the participants' acquired knowledge was assessed using a custom-designed questionnaire. Participants in the 'app' group performed significantly better (P<0.0034) than those in the 'voice' group and retained more knowledge, suggesting that interactive visualizations play a key role in improving understanding of the orthognathic surgical procedure and its associated complications. This study emphasizes the impact of 3D visualizations in delivering information regarding orthognathic surgery and highlights the advantage of delivering validated patient information through mobile apps.

Celebrating 10 Years of Undergraduate Medical Education: A Student-Centered Evaluation of the Princess Margaret Cancer Centre--Determinants of Community Health Year 2 Program

Between 2000 and 2011, over 170 second-year medical students participated in a Determinants of Community Health (DOCH 2) project at Princess Margaret Hospital (PMH). Students undertook community-based research projects at the hospital or with PMH community partners involving activities such as producing a literature review, writing a research proposal, obtaining ethics approval, carrying out data collection and analysis, presenting their data to classmates and supervisors, and production of a final report. An electronic survey consisting of both quantitative and qualitative questions was developed to evaluate the PMH-DOCH 2 program and was distributed to 144 past students with known email addresses. Fifty-eight students responded, a response rate of 40.3%. Data analysis indicates that an increase in oncology knowledge, awareness of the impact of determinants of health on patients, and knowledge of research procedures increased participants' satisfaction and ability to conduct research following DOCH 2. Furthermore, the PMH-DOCH 2 program enhanced the development of CanMEDS competencies through career exploration and patient interaction as well as through shadowing physicians and other allied health professionals. In addition, some students felt their PMH-DOCH 2 projects played a beneficial role during their residency matching process. The PMH-DOCH 2 research program appeared to provide a positive experience for most participants and opportunities for medical students' professional growth and development outside the confines of traditional lecture-based courses.

Development of a complex intervention to improve health literacy skills

BACKGROUND

Providing insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public.

METHODS

The web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention.

RESULTS

The web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations.

CONCLUSIONS

The web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals.

Evaluation of a hospital-based cancer information and support centre

BACKGROUND

Although information seeking is encouraged by health care professionals as a positive coping strategy evidence suggests information needs of those affected by cancer are not always fully met. In response to the need for novel models of information provision and educational support for people affected by cancer, a hospital-based cancer information and support centre (CISC) was introduced into a tertiary cancer hospital. Professional support is provided by a cancer support nurse (CSN) with the clinical experience of working with cancer patients, whilst peer support is provided by volunteers.

MATERIALS AND METHODS

A survey was developed to ascertain the perceptions and experiences of consumers (users) of a hospital-based CISC. The aim was to understand what information and support patients and families consider important and helpful in order to develop the service to reflect the needs of its users. During a 12-month period 111 surveys were distributed to users of the centre.

RESULTS

Sixty-nine surveys were returned (62.1%). Nearly all visits were motivated by the need to access (58/84.0%) information, indicating an unmet or changing need. The CSN initiated referrals to support services, both internal and community based, for 21 (53.9%) participants with whom there was contact. Contact with the CISC volunteers also resulted in internal or community-based referrals for 15 (32.6%) of participants. Of note, half of the participants (35/50.7%) reported seeking additional information from the internet as a consequence of having visited the CISC and/or having contact with the CSN or volunteer, in contrast to the six (8.7%) who had reported internet use for information prior to their first visit. Participants indicated a desire for the service to provide additional support to enhance self-care capacity and to do so alongside other people affected by cancer.

CONCLUSIONS

Our study results support the capacity of a hospital-based CISC to provide a highly valued service that can broaden information options and meet changing information and support needs of people affected by cancer in an ongoing capacity. An experienced, qualified CSN in this setting is ideally positioned to screen for unmet information and support needs and deliver tailored education to support both inpatient and ambulatory care services. Information prescriptions have the potential to provide a 'directed information seeking approach' to those who visit a CISC. Through the use of information technology there is scope to develop information and support that expands beyond pamphlets and booklets.

The impact of a multimedia informational intervention on psychosocial adjustment among individuals with newly diagnosed breast or prostate cancer: a feasibility study

OBJECTIVE

To examine the impact of an 8-week cancer multimedia informational intervention on health-related outcomes among individuals newly diagnosed with cancer.

METHODS

Using a pre-/post-quasi-experimental design, participants with breast or prostate cancer (n=250) were conveniently recruited from four oncology ambulatory clinics and completed questionnaires at three points (enrolment, 1-2 weeks post-intervention, and 3 months later).

RESULTS

Repeated-measure analyses showed that, when compared to controls, the intervention significantly improved satisfaction with cancer information over time for women (p<.001), prevented deterioration in functional quality of life (p=.030) and marginally improved perceived oncologist informational support (p=.051). There were no significant differences in psychosocial adjustment among men. Unlike previously suggested, the intervention did not have a differential impact according to levels of personal resources (self-esteem, mastery, and optimism). However, for all outcomes and regardless of group, participants high in personal resources reported better adjustment across time.

CONCLUSION

Even though the hypotheses were only partially supported, the findings provide preliminary evidence that multimedia interventions can be supportive.

PRACTICE IMPLICATIONS

With increasing numbers of new cancer diagnoses, cancer survivors and more limited health care resources, further research is needed to evaluate potential benefits of health information technology in providing support to individuals facing cancer.

Computerized patient education in kidney transplantation: testing the content validity and usability of the Organ Transplant Information System (OTIS)

OBJECTIVE

To test content validity and usability of the Organ Transplant Information System (OTIS).

METHODS

This study used qualitative methods. The purposive sample consisted of 8 clinicians and 14 patients. Clinicians rated the content's congruence with current medical practice. We used the clinicians' evaluations to revise the OTIS content; then each patient evaluated the revised OTIS modules using the thinking-aloud method and via structured interviews. Descriptive statistics were applied for demographic and clinical data, and for the clinicians' ratings. Content data usability and validity were analyzed using Content Analysis.

RESULTS

Clinicians identified deviations from current medical practice regarding content, language, and information structure of OTIS. Seven rated OTIS as non-relevant for implementation into clinical practice. Five rated the program's content--with the stipulated adaptations--as important for patients. All patients encountered usability problems, mostly regarding the program's interface. Emerging categories from the patients' perspectives vis à vis content were knowledge acquisition, illness management, and partnership forming.

CONCLUSION

Problems arose regarding OTIS's initial content validity and usability, demonstrating the need to establish the presented material's content validity and usability by involving clinicians and patients before its clinical implementation.

PRACTICE IMPLICATIONS

High quality computer-learning-software is needed to enhance patient self-management.

Interactive, culturally sensitive education on colorectal cancer screening

BACKGROUND

Increasing colorectal cancer screening (CRCS) can have a substantial positive impact on morbidity and mortality.

OBJECTIVES

The purpose of this report is to describe the development and feasibility testing of a computer-based, theory-guided educational program designed to increase CRCS.

RESEARCH DESIGN

This mixed-methods study used focus groups and subsequent randomized controlled trial design.

SUBJECTS

Participants (N = 199) were randomized to an intervention or control group; 75% were African American; mean age was 57.36 (SD = 6.8); 71% were male.

MEASURES

Previously validated measures on knowledge, beliefs, and screening test adherence were used to establish pre- and post-intervention perceptions. Feasibility was measured by response and completion rates, and participants' perceptions of the program.

RESULTS

Before feasibility testing, the program was presented to 2 focus groups. Changes were made to the program based on discussion, leading to a visually appealing, easy to understand and navigate, self-paced program. In the RCT pilot test that followed, of the participants in the intervention group, 80% said the education helped them decide to get CRCS; 49% agreed it helped them overcome barriers; 91% agreed it was useful, 68% thought it raised new concerns about cancer, but only 30% said it made them worry about CRC; 95% agreed their doctor's office should continue giving such education, and 99% said they would inform family about the program.

CONCLUSIONS

The response rate of 83% demonstrated feasibility of conducting colorectal cancer education in the primary care setting; overall the program was well received; participants averaged 23 minutes to complete it. Participants sought no help from attending data collectors and navigated the revised touch screen program with ease. Computer-based education is feasible in primary care clinics.

Psychosocial impact of the lack of information given at referral about familial risk for cancer

We aimed to identify patient' information and communication needs irrespective of their risk level, when they are referred for genetic risk assessment and genetic counselling for a predisposition to cancer. Semi-structured telephone interviews were conducted with a purposive sample of individuals referred to a clinical genetics unit for a risk assessment of their genetic predisposition to either breast, ovarian or colorectal cancer and stratified by their level of risk. Triangulation was achieved by focus groups conducted with specialist genetic health professionals. Twenty-three participants were interviewed pre- and post-genetic counselling or risk assessment. A further 11 completed a single interview, five pre-assessment and six post-assessment. Three focus groups were conducted with the genetic health professionals. The results showed that many participants were unaware they had been referred for genetic counselling and as a consequence they felt this caused difficulties in coping with the genetic risk information received. Health professionals corroborated these findings of people's lack of awareness about their referral. This work raises important questions about the psychosocial consequences of inadequate information provision at the point of referral by clinicians in primary and hospital-based healthcare that are responsible for referring the majority of people to clinical genetics units.

Tay Sachs disease carrier screening in schools: educational alternatives and cheekbrush sampling

PURPOSE

Tay Sachs disease carrier screening programs have been offered successfully worldwide since 1970. The programs typically offer education, testing, and counseling to provide reproductive choices. One such program has been offered to Jewish school students in Melbourne since 1998. In a time of increasing public awareness of genetics, programs require continuous evaluation and updating.

METHODS

Over 2 successive years, a longitudinal evaluation involved students attending Jewish schools in Melbourne. Both qualitative and quantitative techniques were used to analyze alternative methods for education and sampling procedures. Comparisons involved (1) a computer-based resource versus an oral educational presentation and (2) blood sampling for enzyme and genetic testing versus cheekbrush testing for genetic sampling alone.

RESULTS

The education session was effective in significantly increasing students' knowledge (10.5% +/- 1.2%, P < .0001) and decreasing their anxiety about being a carrier (-12.2% +/- 1.6%, P < .0001). For the students, no significant differences were found between the computer-based resource and oral presentation. There were significantly more students accepting a carrier test and anxiety was lower when a cheekbrush test was offered compared with when a blood test was offered.

CONCLUSIONS

Computer-based instruction is equally effective, in addition to offering advantages of self-paced learning and minimization of human resources as an oral presentation within a genetic carrier screening program. Cheekbrush sampling is preferred to blood sampling and should be implemented into current practices for offering genetic screening programs. These results present alternatives to practices for genetic screening reflecting the current developing technology.

Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases

GOALS OF WORK

To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers.

PATIENTS AND METHODS

Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns.

RESULTS

Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice.

CONCLUSIONS

Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.

Patients' need for information about cancer therapy

PURPOSE/OBJECTIVES

To obtain detailed information about the preferences of patients with cancer and their need for information about side effects of cancer treatment to design an interactive multimedia educational program.

DESIGN

Qualitative.

SETTING

Regional rural academic medical center.

SAMPLE

51 patients and 14 spouses of patients who either currently were undergoing or recently had completed chemotherapy or radiation therapy for cancer.

METHODS

Focus groups.

MAIN RESEARCH VARIABLES

Information needs and common and distressing symptoms.

FINDINGS

Patients wanted information about the process of getting treatment, specific side effects that might occur, and the impact of treatment on their lives. Patients sought information from a variety of sources, but many found that other patients were the most helpful source. Although most patients wanted as much information as possible so they would be prepared for whatever happened, some patients preferred to avoid information about possible side effects. Several obstacles related to information were reported, including access to providers, communication difficulties with providers, informational overload, and problems with retention.

CONCLUSIONS

Several aspects regarding information needs confirmed previous findings, and new aspects were illuminated. This led to a conclusion that multimedia technology offered many advantages to meet these informational needs.

IMPLICATIONS FOR NURSING

New approaches to patient education that will meet the needs of patients as well as clinicians and educators need to be developed.

Survey of computer use for health topics by patients with head and neck cancer

BACKGROUND

Computers are potentially powerful tools for patient education. E-health, which refers to health services and information delivered through the Internet, is a growing phenomenon within the health-care field. We sought to describe computer use and interest in e-health resources among patients with head and neck cancer.

METHODS

A questionnaire was administered to 207 patients with head and neck cancer attending oncology follow-up clinics at a single comprehensive cancer center.

RESULTS

Forty-eight percent had never used a computer; 43% used one more than once a week. E-health information had been sought by 31%. Likelihood to access e-health information increased with education and income but decreased with age (p < or = .05).

CONCLUSIONS

Many patients with head and neck cancer welcome information technology, but most prefer more traditional sources of information. Interventions to improve computer access and/or skills are largely undesired. Individuals seem to either embrace technology or not. In this respect, patients with head and neck cancer are similar to, rather than unique from, other patients with cancer.

Using information technology for patient education: realizing surplus value?

Computer-based patient information systems are introduced to replace traditional forms of patient education like brochures, leaflets, videotapes and, to a certain extent, face-to-face communication. In this paper, we claim that though computer-based patient information systems potentially have many advantages compared to traditional means, the surplus value of these systems is much harder to realize than often expected. By reporting on two computer-based patient information systems, both found to be unsuccessful, we will show that building computer-based patient information systems for patient education requires a thorough analysis of the advantages and limitations of IT compared to traditional forms of patient education. When this condition is fulfilled, however, these systems have the potential to improve health status and to be a valuable supplement to (rather than a substitute for) traditional means of patient education.

Types of social support in African Americans with cancer

PURPOSE/OBJECTIVES

To determine the types of social support that African Americans use to cope with the experience of cancer.

RESEARCH APPROACH

Qualitative study using a grounded theory approach.

SETTING

Participants' homes in the southeastern United States.

PARTICIPANTS

A purposeful sample of 13 African American men (aged 61-79 years) treated for prostate cancer and 15 African American women (aged 42-87 years) treated for breast cancer. Participants were selected according to key variables known to influence social support: age, gender, marital status, education, geographic region, and proximity to family.

METHODOLOGIC APPROACH

Open-ended and semistructured interviews were conducted with each participant (N = 28). Participants were interviewed until informational redundancy was achieved. Constant comparison techniques were used to identify variations of social support within and across cases.

MAIN RESEARCH VARIABLES

The experience of social support during diagnosis or treatment for cancer as well as post-treatment.

FINDINGS

Participants used types of social support not currently emphasized in the literature. The emotional support of "presence" was reported most frequently. Instrumental support included not only current conceptualizations but also offers of prayers, assistance to continue religious practices, and assistance to maintain social roles. Informational support included what to expect and how to manage symptoms, interpret information, and validate information received.

CONCLUSIONS

Findings suggest the need to reconceptualize social support for African Americans with cancer and to refine instruments to include these different manifestations of social support.

IMPLICATIONS FOR NURSING

Researchers can use these findings in the design of culturally relevant questionnaires and interventions for this population. Clinicians can use knowledge of the types of social support valued among African American patients with cancer to develop more appropriate strategies to promote healthy outcomes for this population.

An internet-based intervention to improve psychosocial outcomes in heart transplant recipients and family caregivers: development and evaluation

BACKGROUND

Although quality of life (QOL) is generally improved by heart transplantation, medical noncompliance and mental health and QOL limitations often emerge and persist. Transplant teams' ability to address these issues is hampered because many patients reside long distances from the transplant program. We therefore conducted the first empirical evaluation of an internet-based psychosocial intervention for heart recipients and their families.

METHODS

Based on focus group work and previous research, a multifaceted web-based intervention was developed with stress and medical regimen management workshops; monitored discussion groups; access to electronic communication with the transplant team; and information on transplant-related health issues. Intervention effectiveness was evaluated with 20 patients and family caregivers who used the website for 4 months (plus usual clinical care). Pre- and post-intervention assessments of mental health, QOL and medical compliance were performed. Comparison groups of 40 patients and their caregivers who received only usual care were similarly assessed.

RESULTS

Relative to the comparison groups, intervention patients' depressive and anxiety symptoms, and caregivers' anxiety and hostility symptoms declined significantly (P < 0.05). QOL in social functioning significantly improved. Mental health and QOL benefits were greater among more frequent users of the website. Overall, intervention patients' medical compliance did not change. However, the sub-group using the website's medical regimen workshop showed significantly better compliance at follow-up than all other patients in attending clinic appointments, completing blood work and following diet.

CONCLUSIONS

These preliminary findings suggest that a web-based intervention could have a vital role in follow-up care and in patients' and families' adjustment to heart transplantation.