What information is communicated by radiation therapists to patients during education sessions on the first day of treatment?

Enhancing patient education in cancer care: Intelligent cancer patient education model for effective communication

BACKGROUND

The incidence of cancer is on the rise annually, whereas there exists a significant deficit of healthcare personnel. Inadequate communication between healthcare providers and patients may result in adverse emotional outcomes for the latter and interfere with their treatment progress. A viable solution to alleviate patient distress involves utilizing text generation models as an efficacious tool for delivering patient education.

MATERIALS AND METHODS

In this study, we proposed an intelligent cancer patient education model (ICPEM) based on the pre-trained T5 model. Meanwhile, we presented a new method for optimizing the model's comprehension of the patient's intent through simulating the inquiries that the patient may ask. The datasets used include a doctor and patient dialogue dataset and a cancer patient education scenario dataset. After prompt-tuning, the model is capable of educating patients through four major aspects including medical examination, health care, radiotherapy, chemotherapy.

RESULTS

We conducted a comprehensive evaluation of the model by employing both automated and manual metrics. Our findings indicate that the responses generated by the model effectively catered to the requirements of patient education. Furthermore, our visualization analysis demonstrated the model's proficiency in processing sentences that are prone to confusion while maintaining a robust comprehension of human intent. Finally, several shortcomings of the model are presented, such as the inadequate amount of knowledge and the limited range of responses.

CONCLUSION

We proposed a method for training and deploying medical language models in a low-resource environment. The proposed model facilitated the comprehension of cancer patients' intentions, resulting in suitable responses, which promotes effective patient-provider communication.

A Personalized Patient Teaching Session at the Time of Radiation Simulation May Improve Patient Satisfaction Scores

Purpose

Radiation therapy simulation is an excellent time for patient education. We implemented a comprehensive personalized patient experience-focused (PX) teaching session at the time of simulation and assessed its effect using patient satisfaction scores.

Methods and Materials

From February 2016 to June 2018, a single PX-trained radiation therapy therapist met patients at simulation to address and resolve all treatment-related questions. Results from a Centers for Medicare & Medicaid Services approved voluntary patient satisfaction tool were used to assess the effect of this intervention, using tools the patients received during the on-treatment period. Scores from patients contacted by the PX therapist were compared with those of noncontacted patients.

Results

For the survey, 1369 patients were contacted (median contact duration, 23 minutes; range, 0-117). Of 732 surveys submitted during this time, 98 were from on-treatment patients (69 contacted, 29 not contacted). The majority of contacted patients and survey responders were women (64% and 62%, respectively), patients with breast cancer (38%, 41%), and patients who had received curative therapy (82%, 69%). Scores from contacted patients were significantly higher for 10 of the 17 questions (registration helpfulness, P = .03; registration wait time, P = .048; facility way finding, P = .03; facility cleanliness, P = .01; treatment staff skill, P = .03; treatment staff concern for questions, P = .003; response to concerns, P = .01; staff worked together, P = .01; overall rating of care, P = .01; and likelihood of recommending care, P = .04) and 4 of the 5 domains (registration, P = .04; facility, P = .03; personal issues, P = .02; overall assessment, P = .002).

Conclusions

Contact by a PX therapist was associated with higher patient satisfaction scores, including areas specifically addressed by the PX teaching session (concerns for questions, response to concerns) as well as other areas (cleanliness, registration wait time).

Use of a Patient Information Leaflet on Oro-Dental Care During Radiotherapy

PURPOSE

A patient information leaflet (PIL) on oral and dental care during radiotherapy was tested whether and at which time during therapy it would be helpful to increase the knowledge about the therapy and the resulting side effects and the management of these. Additionally, the participants' subjective perception of being well informed about the topic was examined.

PARTICIPANTS AND METHODS

Surveys were conducted in August 2018-April 2019, at the University Hospitals Halle and Leipzig (Germany). The study population consisted of patients who were treated with radiotherapy in the head and neck region. Half of them received access to the PIL. The survey was conducted with three different versions of a printout questionnaire, which covered the relevant topics at three different times of therapy. The time the participants were surveyed depended on the time of their first therapy appointment. The items of the questionnaires tested their concrete knowledge and assessed the subjective perception of the level of information received.

RESULTS

Of the 81 participants who received the PIL, 93.8% read it and 92.1% of them considered it helpful. The sample comprised 181 participants aged 32 to 85 years (M = 62.9), of which 135 were males, 42 were females, and 4 were unspecified. Evaluation showed a difference of 4.7%; 18.5%; and 13.6% in correct answers between subjects with and without access to the PIL before, during, and after the therapy, respectively. The assessment of the participants' personal information level was independent of their access to the PIL (chi-squared test, p = 0.89).

CONCLUSION

Having access to the PIL increased participants' ability to answer the questionnaires correctly. Access to the PIL had no influence on the subjective feeling of being well informed.

Cancer Patient Experience in a Nuclear Medicine Department: Comparison Between Bone Scintigraphy and 18F-FDG PET/CT

Our objective was to assess the anxiety level in cancer patients undergoing nuclear medicine exams and to identify how professionals can improve patient experience. Methods: In total, 94 patients undergoing ^99mTc-hydroxymethylene diphosphonate (^99mTc-HDP) bone scintigraphy (BS) or ¹⁸F-FDG PET/CT completed 2 scan-experience questionnaires and the Spielberger State Anxiety Inventory (STAI-S) before the scan and after image acquisition. Results: Before the exam, the mean anxiety levels were higher for the ^99mTc-HDP BS group than for the ¹⁸F-FDG PET/CT group. After the exam, the opposite was true. Both groups experienced a reduction in anxiety after the scan (prescan score, 51.75 for ^99mTc-HDP BS and 44.67 for ¹⁸F-FDG PET/CT; postscan score, 36.70 for ^99mTc-HDP BS and 38.82 for ¹⁸F-FDG PET/CT). The greatest anxiety factor for the ^99mTc-HDP BS group was the duration of the exam (mean ± SD, 5.34 ± 2.08), whereas for the ¹⁸F-FDG PET/CT group it was the result (5.40 ± 1.80). Conclusion: Patients undergoing nuclear medicine exams in an oncologic context had significant anxiety levels before and after their scans. However, ^99mTc-HDP BS and ¹⁸F-FDG PET/CT had different triggers. It is of extreme importance that health-care professionals be aware of these peculiarities and adjust their procedures accordingly.

Communicating the External Beam Radiation Experience (CEBRE): Perceived Benefits of a Graphic Narrative Patient Education Tool

PURPOSE

Current radiation oncology patient education materials exceed national readability recommendations. A graphic narrative educational tool, the Communicating the External Beam Radiation Experience (CEBRE) discussion guide, was developed to facilitate patient-provider communication. A pilot study evaluated perceived benefits of CEBRE for patients and physicians.

METHODS AND MATERIALS

CEBRE was designed through a collaboration between physicians and designers. Designers interviewed patients, family members, and the clinical team. Interviews were coded for themes, leading to the design principles that drove the design of CEBRE, including a graphic narrative component. CEBRE explains the radiation therapy care path. Readability was measured using the Flesch-Kincaid test. Patients receiving radiation therapy or in follow-up and practicing radiation oncologists reviewed CEBRE and completed independent surveys. Each survey included modified versions of the Systems Usability Score (SUS) and Spielberger State-Trait Anxiety Inventory (STAI) short form, along with questions unique to CEBRE. Likert-type scores are reported as median (interquartile range).

RESULTS

CEBRE scores at a 5.4 Flesch-Kincaid grade level. Thirty-four patients and 15 radiation oncologists completed surveys. Patients had completed a high school/general equivalency degree (18%), a 2-year degree or some college (50%), or at least 4 years of college (32%). Patient and physician responses were concordant. On a scale of 1 to 5 for modified SUS and 1 to 4 for modified STAI ("strongly disagree" to "strongly agree") the SUS scores were 4 (4-5) and 4 (4-5) and STAI scores were 3 (3-4) and 3 (3-3.5) for patients and providers, respectively. This indicates CEBRE is usable and would decrease anxiety. Compared with text, the graphic narrative component of CEBRE was rated as "quite helpful" (4 [4-5]).

CONCLUSIONS

CEBRE, a graphic narrative education tool developed through a novel collaboration between designers and radiation therapy stakeholders, is accessible for patients and practical to facilitate patient-provider discussion. Perceived benefits demonstrating high usability and the potential to decrease patient anxiety warrant further prospective investigation of CEBRE in the clinical setting.

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.