Communicating with Emotional Patients: Thoughts, Skills, and Influencing Factors for Ontario Radiation Therapists

The empathy project: Staff confidence and training needs in psychosocial patient care

INTRODUCTION

Radiation Therapists (RT) must balance highly technical procedures and psychosocial patient care during their daily work practices. While RTs are in a unique position to form rapport with patients and provide support and information, many RTs lack confidence in the psychosocial care of patients, and struggle to identify and address emotional cues. This study aimed to assess the confidence, competence, and training needs of RTs regarding psychosocial patient care.

METHODS

All RTs at the Radiation Oncology Princess Alexandra Hospital Deparmtents were invited to participate in an electronic survey in May 2021, and May 2023 via email. The survey was distributed using SurveyMonkey and utilised a series of Likert-scale and open-ended questions.

RESULTS

Staff reported high confidence in addressing technical treatment issues (98 % of respondents) and communicating with anxious (78 %) and distressed (78 %) patients. However, lower confidence was indicated with managing patient conflict (58 %) and communicating with patients who were depressed (53 %) or suffering mental health conditions (74 %). Staff were concerned about saying the wrong thing and experienced stress when they couldn't adequately communicate with patients requiring psychosocial support. The most significant barriers to providing adequate psychosocial care included time, staff numbers, and workload. Staff requested training in emotional cues, communication, anxiety and depression, and understanding psychosocial and mental health conditions.

CONCLUSION

While staff perceptions and motivations of psychosocial care were overwhelmingly positive, further training is required to improve patient psychosocial care. Future steps include implementing psychosocial training resources in the departments, and reassessing staff confidence post training.

Addressing the communication needs of cancer patients for Magnetic Resonance Imaging (MRI) investigations-A phenomenological study on the experiences of MRI radiographers

INTRODUCTION

A higher demand in MRI services could increase the pressure on MRI departments to increase scanning efficiency. This presents the risk of downplaying person-centred care especially for cancer patients with increased communication needs that result from anxiety associated with the nature of their disease. This study explored the experiences of MRI radiographers in addressing the communication needs of cancer patients attending for MRI examinations.

METHODS

The study adopted a descriptive phenomenological methodology. Single contact interviews were conducted on eight MRI specialist radiographers, and these were recorded and transcribed using Microsoft Teams conferencing platform. Thematic analysis of the transcribed data was done through an inductive approach, breaking down the data into meaningful codes and thereafter, into themes and sub-themes.

RESULTS

Common themes generated from the interview data included: identified communication needs, approach to communication needs, support for radiographers and factors affecting communication. Experiences of MRI radiographers indicated increased communication needs in anxious cancer patients and approaches adopted in addressing these were mainly through listening and use of empathetic gestures. Some radiographers admitted to using "blocking" strategies to avoid being drawn into emotionally exhausting conversations. Both intrinsic factors such as radiographers' personality and experience; and extrinsic factors such as time constraints, demanding workload, inadequate staffing, and skill mix were noted to influenced MRI radiographers in addressing these communication needs.

CONCLUSION

Cancer patients can present with communication needs due to anxieties related to their disease. For the radiographer to deal with these needs, adequate support is needed, and necessary steps taken to address the identified influencing factors.

IMPLICATIONS FOR PRACTICE

MRI departments should encourage enabling environment and services that address communication needs of patients with cancer.

How do radiation therapists detect and manage patients experiencing anxiety in the radiation oncology setting? A vignette study

PURPOSE

Anxiety is commonly observed in oncology patients but infrequently screened, assessed or addressed. According to psychosocial guidelines, all healthcare professionals, including radiation therapists, are responsible for the psychosocial care of patients. Radiation therapists (RTs) interact with patients daily throughout treatment; however, little research exists to evaluate RTs' ability to identify and manage patients' psychosocial needs. This study aimed to determine if RTs can detect and manage patient anxiety.

METHOD

A cross-sectional, mixed-methods survey containing two clinically relevant vignettes was developed. Two fictitious patients were presented to elicit responses reflective of RTs' experiences and judgements in the recognition and management of anxiety. Surveys were distributed via email in Australia, New Zealand and Canada. Ethical approval was obtained from the University of Sydney (2016/227) and informed consent was obtained from participants.

RESULTS

Eligible and complete surveys were received from 582 respondents (240 (41.2%) from Australia; 78 (13.4%) New Zealand; 264 (45.4%) Canada). Almost all respondents endorsed a relevant descriptor of anxiety (vignette 1, 577 (99.1%); vignette 2, 579 (99.5%)). For both vignettes, the most frequently endorsed management strategy was to acknowledge the patients' feelings and encourage them to express their concerns (vignette 1, 548 (94.2%); vignette 2, 455 (78.2%)).

CONCLUSION

RTs in Australia, New Zealand and Canada are able to detect anxiety and endorse a strategy to manage patients experiencing anxiety depicted in written vignettes. Exploring RTs' abilities to detect and manage patient anxiety whilst in the high-pressure clinical environment is an important next step.

Sexual Health Issues in Patients with Cancer-An Exploratory Mixed Methods Study of the Awareness Levels of Radiation Therapists

INTRODUCTION

Patients with cancer report dissatisfaction with care they receive in relation to changes affecting intimacy and relationships. Health care professionals describe barriers in providing support in these areas due to lack of time, training, education, and privacy. Radiation therapists (RTs) play a key role in cancer care, but there is little evidence in the literature of their role in sexual health care. This project investigated awareness levels of RTs in sexual health issues related to patients with cancer receiving radiation therapy.

METHODS

A prospective mixed methods approach was used for this investigation. Quantitative data was collected via an online questionnaire developed from the literature. Two hundred eighty-four RTs from two large cancer centers were eligible to participate; 84 responded (29%). Two focus groups were conducted with 15 volunteer RTs to validate questionnaire data and further explore the topic. Content analysis was used to identify key themes from the qualitative data.

RESULTS

RT respondents acknowledged the complexity of sexual health issues in patients with cancer. Eighty-five percent (n = 56) strongly agreed/agreed that all patients with cancer, regardless of cancer site, can experience issues which may affect sexual health. Ninety-two percent (n = 61) strongly agreed/agreed that sexual health is important for a persons' quality of life. As part of the radiation therapy treatment planning process, 54.5% of RTs (n = 31) strongly agreed/agreed that they consider the impact of physical side effects of radiation therapy on the sexual health of patients; during treatment delivery, 56% (n = 36) agreed/strongly agreed that they consider the physical side effects on their patients' sexual health.

CONCLUSIONS

Data indicated that RTs are aware that a cancer diagnosis and the subsequent treatments may lead to issues that affect sexual health. They are aware of the complex nature of sexual health and understand its importance in a persons' quality of life and that all patients with cancer regardless of site may experience issues which can impact their sexual health. Their responses suggest that they can relate their training and clinical practice to sexual health issues experienced by patients in their care. Current RT involvement in sexual health care is limited due to various process and environmental factors similar to those found in other health care professionals practice. By eliminating these barriers and supporting the inclusion of sexual health into the clinical practice of RTs, health care resources can be maximized to support the resolution of unmet needs of patients and their partners. In that way the quality of patient care services can be improved.

Implementing Workshops to Improve Radiation Therapists' Knowledge and Attitudes about Sexual Health Issues in Cancer Patients

OBJECTIVES

Although it is widely acknowledged that radiotherapy treatments can have a negative impact on a patient's sexual health, this aspect of side effect management is not commonly addressed by radiation therapists or by other cancer specialists. It is important for radiation therapists to recognize and address possible sexual health issues to provide a holistic approach to care. This quality-improvement project was designed to help radiation therapists discuss the sexual health needs of patients undergoing radiotherapy by improving their clinical knowledge, skills, and comfort level about the topic.

METHODS

This study used a cross-sectional descriptive prequestionnaire/postquestionnaire design, in which data were collected from a nonrandom sample of radiation therapists at a single urban radiation therapy center. Participants attended two 90-minute sexual health education workshops specifically designed for radiation therapists and completed online preworkshop/postworkshop questionnaires. All questions were quantitative in nature. The survey consisted of multiple-choice, multiple-select, and five-point Likert-scale questions. Descriptive analysis was used for data analysis.

RESULTS

The results of this improvement project indicated that participants had introductory-level knowledge about how cancer treatments can impact patients' sexual health. Although there is potential for some changes in the general knowledge levels of the participants after the initiative, two general workshops about the topic are not enough to have radiation therapists feel comfortable enough with the topic to change their clinical practice.

CONCLUSION

This project identified that although radiation therapists acknowledge the importance of discussing sexual health concerns as part of delivering holistic health care, lack of knowledge and expertise with the topic is a main barrier to initiating conversations. To help prepare radiation therapists, education and training initiatives, which build on knowledge and offer opportunities to develop and apply practical skills in both simulated and real-life situations, should be created. This can help to increase confidence in the sexual health counseling provided, which may result in more radiation therapists frequently engaging in these important sexual health conversations.