Effects of information supply on satisfaction with information and quality of life in cancer patients receiving curative radiation therapy

Impact on patient satisfaction with a structured counselling approach on natural health products

Purpose. Natural health products (NHP) are commonly used by cancer patients. The provision of better information on NHP may improve the patient satisfaction and quality of life. We report the impact on patient satisfaction by routine counselling on NHP.

Methods. Patients visiting the pharmacy of a comprehensive cancer centre for the first time were recruited before (control) and after (intervention) the introduction of routine structured counselling on NHP by pharmacists. The primary endpoint was patient satisfaction. Overall cost and cost per improvement in satisfaction were estimated.

Results. 265 patients completed the questionnaires. The average age was about 60 years old, with roughly equal number of men and women. Breast and genitor-urinary cancers made up about 80% of the patients. Nearly 45% of patients had some college or university education. The scores for overall satisfaction and each subscale were all increased in the intervention group. This was statistically significant regarding information on NHP. Counselling was associated with an increase of about 9 minutes of counselling time and a mean additional cost of CDN$7.49 per patient.

Conclusion. We found increased patient satisfaction with routine counselling on NHP. There was only minimal increase in workload and cost for each counselling section. J oncol pharm practice (2008) 14: 37—43.

Patients' perspectives on the role of radiation therapists

OBJECTIVE

To examine patients' perspectives on the role of radiation therapists and to develop substantive theory about the relationships patients form with their radiation therapists.

METHODS

Semi-structured interviews were conducted with 34 breast cancer patients in Western Australia. Interviews were tape-recorded and transcribed verbatim. Grounded theory and the constant comparative method were used to analyse the data.

RESULTS

The major finding from this study was the importance that patients placed on achieving a sense of emotional comfort during their radiation therapy. Two ways in which patients achieved this comfort were by forming relationships with radiation therapists and gaining information related to their treatment and care.

CONCLUSION

Radiation therapists played a central role in enabling patients to achieve a sense of emotional comfort. Although radiation therapists have a technical job they need to remain aware of their role in providing patient care and take appropriate steps to ensure that they can assist patients in feeling comfortable during their radiation therapy.

PRACTICE IMPLICATIONS

The role of the radiation therapist in assisting patients to achieve a sense of emotional comfort needs to be formalised to ensure that all patients in radiation therapy are aware of the radiation therapist's role and receive a similar level of care during treatment.

Validity and reliability testing of two instruments to measure breast cancer patients' concerns and information needs relating to radiation therapy

Background

It is difficult to determine the most effective approach to patient education or tailor education interventions for patients in radiotherapy without tools that assess patients' specific radiation therapy information needs and concerns. Therefore, the aim of this study was to develop psychometrically sound tools to adequately determine the concerns and information needs of cancer patients during radiation therapy.

Patients and Methods

Two tools were developed to (1) determine patients concerns about radiation therapy (RT Concerns Scale) and (2) ascertain patient's information needs at different time point during their radiation therapy (RT Information Needs Scale). Tools were based on previous research by the authors, published literature on breast cancer and radiation therapy and information behaviour research. Thirty-one breast cancer patients completed the questionnaire on one occasion and thirty participants completed the questionnaire on a second occasion to facilitate test-retest reliability. One participant's responses were removed from the analysis. Results were analysed for content validity, internal consistency and stability over time.

Results

Both tools demonstrated high internal consistency and adequate stability over time. The nine items in the RT Concerns Scale were retained because they met all pre-set psychometric criteria. Two items were deleted from the RT Information Needs Scale because they did not meet content validity criteria and did not achieve pre-specified criteria for internal consistency. This tool now contains 22 items.

Conclusion

This paper provides preliminary data suggesting that the two tools presented are reliable and valid and would be suitable for use in trials or in the clinical setting.

Vitality, mental health, and satisfaction with information after breast cancer

OBJECTIVE

The purpose of this study was to investigate the relationship between satisfaction with information about treatment-related and survivorship issues and mental health outcomes, including vitality, in long-term breast cancer survivors.

METHODS

Participants who had finished treatment for breast cancer at least 3 months before enrollment completed a survey instrument designed to evaluate satisfaction with diagnostic and treatment information and satisfaction with survivorship information. Mental health and vitality were measured using the Medical Outcomes Study SF-36, and distress was measured using the impact of events scale. Bivariate analyses and linear regression analyses were performed to investigate the relationships between satisfaction with information, mental health, vitality, and distress controlling for clinical and treatment variables.

RESULTS

The survey was completed by 231 participants (response rate 83%). More respondents were highly satisfied with treatment information (87%) than with survivorship information (30%, p=0.0001). There was a strong positive relationship between satisfaction with information (both treatment and survivorship issues) and vitality, mental health, and a strong negative relationship with distress. In multivariate analyses, satisfaction with treatment information was independently associated with mental health (p<0.01), and satisfaction with survivorship information was independently associated with vitality (p<0.05).

CONCLUSION

Among patients who have completed treatment for breast cancer, satisfaction with diagnosis and treatment information is greater than satisfaction with survivorship issues and satisfaction with information may play an important role in mental health outcomes.

PRACTICE IMPLICATIONS

Given the relationship between satisfaction with information and vitality, interventions to improve informational support regarding survivorship issues are warranted.

A purpose-based evaluation of information for patients: an approach to measuring effectiveness

OBJECTIVE

To assess the feasibility, internal reliability, and validity, of an assessment tool, purpose-based information assessment (PIA), that we had developed to evaluate how effectively information provided to patients addresses their individual purposes for the information. The study also demonstrated potential novel insight gained by the PIA assessment.

METHODS

One hundred and eighty-two patients and family members were provided with a booklet on early-stage prostate cancer and its treatment options, in the context of a clinical trial comparing two booklets. Using the PIA, participants rated the importance (4-point Likert scale) of each of six previously identified common purposes for such information: to organize their thoughts, to understand their situation, to decide on treatment, to plan their future, to provide emotional support to others, and to discuss issues. Participants then rated how much their booklet helped address each of their purposes (4-point Likert scale). Evaluations were returned by mail. This report assesses the PIA evaluation of one of the booklets.

RESULTS

One hundred and fifty-six (86%) participants returned evaluations. Participants wanted information for a mean of 5.8 purposes (range 2-7); 72.5% rated the booklet at different levels of helpfulness across their purposes. The assessment showed internal reliability on three constructs tested, and convergent validity on 10 of 11 tested. PIA's individualized purpose-based approach revealed how an overall assessment could be misleading: overall, the booklet was more effective at helping readers decide than at helping them plan (64.7% versus 55.8%, respectively, rated the booklet as "helpful" or better). However, among readers who rated the two purposes as "very important", the booklet had a mean helpfulness rating of 1.95 for deciding compared to a mean of 2.02 for planning. The result suggests that the booklet was not better at helping people decide than at helping them plan, for the readers who most needed the help.

CONCLUSION

The PIA seems reliable and valid and adequately sensitive. The individualized purpose-based approach to assessing information appears to provide more specific feedback and more insights into its effectiveness than a single, global evaluation.

PRACTICE IMPLICATIONS

Developers of information source or educational tools for patients can use an individualized purpose-based assessment, such as the PIA, to identify strengths and limitations of the tools more precisely than global assessments.

Patient satisfaction in radiation oncology

As part of a quality improvement exercise at the Perth Radiation Oncology Centre, a survey was undertaken to ascertain the current level of patient satisfaction with the information they were receiving from their treating radiation oncologist. In addition, the effect of radiation on patients' anxiety levels was investigated. Two questionnaires were given to patients having radical radiotherapy for malignancy. The first questionnaire consisted of the Information Satisfaction Questionnaire and the State Trait Anxiety Index. It was given to patients before the commencement of their course of radiotherapy. The second questionnaire consisted of the State Trait Anxiety Index and was given at the completion of their radiotherapy. A total of 120 patients completed both the questionnaires. The majority of patients were satisfied/very satisfied with the explanation of their illness and radiation toxicities. Fewer patients were satisfied with the explanation of lifestyle (e.g. diet, exercise, smoking) and practical issues such as parking and treatment costs. The patients showed a statistically significant reduction in both their State and Trait Anxiety scores following radiotherapy. Following this study, we have developed new information booklets addressing lifestyle and practical issues, which were not being adequately addressed as shown in this study. Our next study will assess the effect of these new information booklets.

Prospective trial of a video educational tool for radiation oncology patients

OBJECTIVES

Prospective assessment of the informational needs of radiation oncology patients and efficacy of an educational video in meeting them.

METHODS

Subjects completed baseline self-administered questionnaires and subsequently viewed the patient education video. Post-testing was performed after initiation of therapy and subjects rated their satisfaction with the video, its relevance, and their emotional response. Analyses were performed with respect to patient and disease characteristics.

RESULTS

Fifty-three subjects were enrolled and completed both before and after video measures. The mean age of participants was 58 years (range, 33 to 83). Pretreatment, >90% of patients reported specific information needs. One hundred percent of patients watched the video and 77% rated it as highly relevant. High levels of satisfaction (>90%) were reported with video information describing radiation and simulation. Older subjects (58 years and older) found video information significantly more relevant than those younger (55% versus 27%, P = 0.04) and rated greater satisfaction with side effect information (78% versus 41%, P = 0.006). Subjects with breast cancer exhibited a trend towards feeling better informed by the video.

CONCLUSIONS

Radiation oncology patients reported informational needs unmet by standard educational measures. High levels of satisfaction were reported with video education. It promoted better understanding of radiotherapy. Older patients found the video to be significantly more relevant and informative.

Patient Education and Health-related Quality of Life

The purpose of this study was to analyze the connections between patient education and health-related quality of life as an outcome variable. Data were collected among surgical hospital patients (n = 237) in Finland. On the basis of the results, there seems to be a positive relationship between received knowledge and health-related quality of life, and as such, the study produced knowledge about one quality indicator in nursing care. More research is needed to explore this connection in greater details.

Psychometric assessment and application of a questionnaire measuring patient satisfaction with information on cancer treatment

OBJECTIVE

Pharmaceutical care follows a needs-based approach. Cancer patients form a group with particular needs. Information about cancer treatment plays an important role in terms of coping strategies, initiation of self-care behaviour, and quality of life. In order to develop pharmaceutical care strategies for cancer patients, it is important to assess patients' information needs. This survey aims at providing a suitable instrument to measure patient satisfaction with information on cancer treatment and to reveal the present situation in Germany.

METHODS

Since there was no suitable German measure available, the Canadian 'Patient Satisfaction with Cancer Treatment Education (PS-CaTE) questionnaire' was translated into German and its test quality criteria were examined. Selected socio-demographic variables were added to the original version of the questionnaire to facilitate subgroup analysis. A pre-test was performed to assess the reliability of the adapted instrument. The questionnaire was distributed among patients of cooperating hospitals, oncology practices, and self-aid groups over Germany.

RESULTS

The pre-test established a good reliability of the instrument. In the main survey, overall satisfaction, on a 5-point Likert scale, showed a median score of 3.5, where 5 represented the highest degree of satisfaction. A subscale analysis revealed that satisfaction with information provided on adverse events and complementary treatment options was lower compared to the information provided on cancer treatment. A stepwise multiple-regression analysis identified three significant predictors of satisfaction: a) diagnosis of a mammary carcinoma; b) recent diagnosis; and c) treatment by a primary-care oncologist. Patients with a mammary carcinoma and patients treated by a primary-care oncologist were less satisfied, and patients with a recent diagnosis were more satisfied compared to other patients. In comparison to other information sources, pharmacists still seem to play a minor role as a source of information for patients.

CONCLUSIONS

The version of the questionnaire with a total of 14 items seems to be suitable for measuring patient satisfaction with information. Additional research is needed to further verify the validity of the instrument. The questionnaire may help pharmaceutical-care providers to develop needs-based information strategies. The assessment of patient satisfaction can contribute to the outcome evaluation of pharmaceutical care. The fact that pharmacists are not yet being recognised by most patients as a source of information should support an intensified and more active offer of care by the pharmacist.

The content and amount of information given by medical oncologists when telling patients with advanced cancer what their treatment options are. palliative chemotherapy and watchful-waiting

This study aimed to determine the content and the amount of information given by medical oncologists when proposing palliative chemotherapy and whether this information given is influenced by patient or physician background characteristics. In a prospective study, 95 patients with incurable cancer were interviewed before they consulted their medical oncologist. Their first consultation was audiotaped, and their eventual decision scored. A coding scheme comprised six categories of information given during the consultation. Medical oncologists mentioned or explained the disease course (53%), symptoms (35%) and prognosis (39%). Most patients were told about the absence of cure (84%). Watchful-waiting was mentioned to only half of the patients, either in one sentence (23%) or explained more extensively (27%). Multilevel analysis revealed that the patients' age, patient's marital status, and consulting in an academic hospital explained 38% of the amount of information given. Most of the physicians' attention is spent on the 'active' treatment option. Older patients, married patients and patients in academic hospitals receive more information.