Palliative radiotherapy knowledge among community family physicians and nurses

Palliative radiotherapy: what do nurses know?

BACKGROUND

palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit.

AIM

the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis.

METHODS

a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses.

FINDINGS

the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education.

CONCLUSION

nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted.

Palliative Radiotherapy Education for Hospice and Palliative Medicine Fellows: A National Needs Assessment

Background: Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care. Objective: To assess the need for PRT education in HPM fellowship. Design: A cross-sectional survey of HPM fellows was conducted in June 2018. Setting/Subjects: The survey was distributed to accredited HPM fellowship programs in the United States for distribution to enrolled fellows; 114 fellows responded to the survey. Results: Nearly all respondents agreed that the principles of PRT should be taught in HPM fellowship, yet 51% had received no PRT education and 35% had received only one or two hours. Only 25% of respondents rated their working knowledge of PRT as sufficient, 40% felt confident in identifying radiation oncology emergencies or managing radiotherapy side effects, and 52% felt confident in assessing which patients to refer for radiotherapy. More than 75% agreed that were they more knowledgeable about PRT, they would be more likely to consider referral to radiation oncology, to collaborate with radiation oncologists, and to advocate for a short course of treatment based on a patient's prognosis or goals or care. Fellows who received PRT education in fellowship had significantly greater knowledge of and more favorable attitudes toward the use of radiotherapy. This difference was the greatest among fellows who had received at least five hours of PRT education. Conclusion: There is a need for PRT education in HPM fellowship. Efforts to address this need may lead to more appropriate utilization of PRT for patients with advanced cancer.

The Impact of a Radiation Oncologist led Oncology Curriculum on Medical Student Knowledge

Medical students at our institution all take a pre-clinical oncology course as well as a clinical radiation oncology didactic session during their clinical curriculum. The objective of this analysis is to demonstrate the impact of the radiation oncology didactic on medical student knowledge of core oncology concepts. All students received a standardized didactic lecture introducing students to core concepts of general oncology and radiation. We administered an 18-question pretest and a posttest examining student knowledge between 2012 and 2015. Changes in student responses between pre-test and post-tests were analyzed to evaluate the effectiveness of the didactic session. Over the course of three years, 319 (64.4%) of 495 students who completed the Radiology block completed both the pre-test and post-test. The average student test grade improved from 62.0% on the pretest to 69.6% on the posttest (p < 0.001). By category, students increased their score from 81.4% to 89.8% (p < 0.001) in general oncology, from 59.9% to 69.9% (p < 0.001) in breast oncology, from 43.0% to 51.0% (p < 0.001) in prostate oncology, and from 71.3% to 75.7% (p = 0.003) in radiation oncology. Students showed increases in knowledge across general oncology, prostate oncology, breast oncology, and radiation oncology.

Targeting general practitioners: Prospective outcomes of a national education program in radiation oncology

INTRODUCTION

We report on learning outcomes of a standardized national education program aimed at improving general practitioner (GP) knowledge about radiation therapy (RT) and referral pathways to radiation oncologists (ROs).

METHODS

In 2014, a GP education program was developed through the Targeting Cancer public awareness campaign of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology. The sessions were held in RT departments and comprised of RO-led case-based group learning and a department tour. Pre- and immediate post-session surveys assessed four domains: Objective knowledge about RT, understanding of referral pathways to ROs, self-reported referral behaviours, feedback on the session. A 6-month follow up survey assessed ongoing knowledge retention.

RESULTS

Eighteen sessions were held nationwide between October 2014 and March 2016. One hundred and seventy-four were surveyed. Pre-session, 96% of GPs reported their knowledge of RT required improvement. Post-session, 95% rated their knowledge as 'excellent', 'above average' or 'competent'. 32.5% of GPs were not aware of the location of their local RT department. 81% reported patients would benefit from having clearer referral pathways to ROs. 96% agreed the GP's role is to refer cancer patients to relevant specialists to discuss treatment options. However, only 49% were comfortable referring directly to an RO. Post-session rose to 92%. All respondents felt the session improved their understanding of RT. In the follow up survey, 17 respondents (94%) reported the session had improved their ability to care for cancer patients.

CONCLUSION

A national GP education program improves GP knowledge about RT and may influence patient referrals for RT.

Patients' perspectives on the role of their general practitioner after receiving an advanced cancer diagnosis

The aim of this study was to explore patients' perspectives on the role of their general practitioner (GP) after an advanced cancer diagnosis. A qualitative research approach was used. Semi-structured interviews were conducted and data were analysed using a constant comparative methodology. Participants were eligible if they were diagnosed with advanced cancer and referred for palliative radiotherapy. Data saturation was achieved after 21 interviews. Key themes included (1) obtaining diagnosis and referral for advanced cancer treatment; (2) preference for specialist oncology care; (3) a preference for GP to act as an advocate; and (4) obtaining ongoing routine care from their GP. GP involvement in the patients' management was dependent on: time since diagnosis, GP's involvement in diagnosis and referral, doctor/patient relationship, additional chronic conditions requiring management, frequency of seeing oncologist and specialist recommendation to involve GP. Patients want GPs to have varying levels of involvement following an advanced cancer diagnosis. Not all communication between GPs and patients was positive suggesting communication skills training may be a priority. Patients wished to maintain continunity of care for their non-cancer related issues and healthcare of their family members. Future research needs to focus on working with GPs to increase their role in the management of advanced cancer.

Referring advanced cancer patients for palliative treatment: a national structured vignette survey of Australian GPs

BACKGROUND

Although (general practitioners) GPs have a role in managing patients with advanced cancer, little is known about their referral decisions.

AIM

The aim of this study was to explore, using structured vignettes, how GPs might manage patients presenting with advanced cancer.

DESIGN

A self-administered survey consisting of structured vignettes was administered to GPs in Australia. Fifty-six vignettes describing patients who may benefit from palliative care and/or treatment were constructed encompassing seven advanced cancer diagnoses (cerebral metastasis, lung metastases, renal cancer, bone metastases, ulcerating skin metastases, spinal metastases and stridor) and three clinical variables (age, prognosis and mobility). Seven vignettes were presented to each respondent. Respondents were asked if they would refer the patient and the benefits of different treatment modalities. Participant responses were compared with responses provided by an expert panel. Logistic regression and parametric tests were used to estimate odds of referral.

SETTING/PARTICIPANTS

The respondents were GPs, currently registered and practicing in Australia. Participants were selected randomly from a national list of practitioners.

RESULTS

Four hundred and seven questionnaires were received. There was wide variation (31%-97%) in the proportion of respondents who agreed with the expert panel. The odds of referral for radiotherapy varied the most. Significant predictive variables included patient age, mobility and prognosis and respondent demographics.

CONCLUSION

GPs' referral decisions for patients with advanced cancer appear to deviate from expert opinion and can be predicted using respondent and patient characteristics. If these data were reflected in clinical practice some patients may not be offered helpful palliative treatment options.

Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey

CONTEXT

Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care.

AIMS

The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT).

SETTINGS AND DESIGN

Cross-sectional survey of 363 nurses in a multispecialty hospital.

MATERIALS AND METHODS

The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate 'correct', 'incorrect', or 'unsure.' The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items).

STATISTICAL ANALYSIS USED

Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson's co-efficient using SPSS version 16.0 for Windows.

RESULTS

The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05).

CONCLUSIONS

Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.