Informational stories: a complementary strategy for patients and caregivers with brain metastases

What Are the Key Elements of Educational Interventions for Lay Carers of Patients With Advanced Disease? A Systematic Literature Search and Narrative Review of Structural Components, Processes and Modes of Delivery

CONTEXT

Educating carers about symptom management may help meet patient and carer needs in relation to distressing symptoms in advanced disease. Reviews of the effectiveness of carer interventions exist, but few have focused on educational interventions and none on the key elements that comprise them but which could inform evidence-based design.

OBJECTIVES

To identify the key elements (structural components, processes, and delivery modes) of educational interventions for carers of patients with advanced disease.

METHODS

We systematically searched seven databases, applied inclusion and exclusion criteria, conducted quality appraisal, extracted data, and performed a narrative analysis.

RESULTS

We included 62 articles related to 49 interventions. Two main delivery modes were identified: personnel-delivered interventions and stand-alone resources. Personnel-delivered interventions targeted individuals or groups, the former conducted at single or multiple time points, and the latter delivered as series. Just more than half targeted carers rather than patient-carer dyads. Most were developed for cancer; few focused purely on symptom management. Stand-alone resources were rare. Methods to evaluate interventions ranged from postintervention evaluations to fully powered randomized controlled trials but of variable quality.

CONCLUSION

Published evaluations of educational interventions for carers in advanced disease are limited, particularly for non-cancer conditions. Key elements for consideration in developing such interventions were identified; however, lack of reporting of reasons for nonparticipation or dropout from interventions limits understanding of the contribution of these elements to interventions' effectiveness. When developing personnel-delivered interventions for carers in advanced disease, consideration of the disease (and, therefore, caring) trajectory, intervention accessibility (timing, location, and transport), and respite provision may be helpful.

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.

A randomized controlled trial of storytelling as a communication tool

INTRODUCTION

Stories may be an effective tool to communicate with patients because of their ability to engage the reader. Our objective was to evaluate the effectiveness of story booklets compared to standard information sheets for parents of children attending the emergency department (ED) with a child with croup.

METHODS

Parents were randomized to receive story booklets (n=208) or standard information sheets (n=205) during their ED visit. The primary outcome was change in anxiety between triage to ED discharge as measured by the State-Trait Anxiety Inventory. Follow-up telephone interviews were conducted at 1 and 3 days after discharge, then every other day until 9 days (or until resolution of symptoms), and at 1 year. Secondary outcomes included: expected future anxiety, event impact, parental knowledge, satisfaction, decision regret, healthcare utilization, time to symptom resolution.

RESULTS

There was no significant difference in the primary outcome of change in parental anxiety between recruitment and ED discharge (change of 5 points for the story group vs. 6 points for the comparison group, p=0.78). The story group showed significantly greater decision regret regarding their decision to go to the ED (p<0.001): 6.7% of the story group vs. 1.5% of the comparison group strongly disagreed with the statement "I would go for the same choice if I had to do it over again". The story group reported shorter time to resolution of symptoms (mean 3.7 days story group vs. 4.0 days comparison group, median 3 days both groups; log rank test, p=0.04). No other outcomes were different between study groups.

CONCLUSIONS

Stories about parent experiences managing a child with croup did not reduce parental anxiety. The story group showed significantly greater decision regret and quicker time to resolution of symptoms. Further research is needed to better understand whether stories can be effective in improving patient-important outcomes.

TRIAL REGISTRATION

Current Controlled Trials, ISRCTN39642997 (http://www.controlled-trials.com/ISRCTN39642997).

Development and evaluation of a combined story and fact-based educational booklet for patients with multiple brain metastases and their caregivers

The aim of our study was to design and evaluate the impact on informational satisfaction of a combined story and fact-based educational booklet designed for patients with multiple brain metastases. Phase A evaluated the preference of participants for combined, fact, or story-based writing style. Based on these results, a resource was developed using a combined story and fact-based approach. Patients with newly diagnosed brain metastases and their caregivers read the booklet. Satisfaction was evaluated using the Information Satisfaction Questionnaire and Client Satisfaction Questionnaire. Anxiety was evaluated before and after reading using the State Trait Anxiety Inventory. Ninety-one patients participated in this study. In Phase A, 51% of patients expressed a preference for the combined story and fact-based approach. In phase B, participants expressed high satisfaction for both the informational content and the overall satisfaction towards the pamphlet. The level of anxiety before reading the booklet was lower for caregivers than patients. Anxiety score was increased in the caregiver group after reading the booklet. This was unchanged in the patient group. Both patients and caregivers endorsed the resource. The increase in anxiety in caregivers suggests the tool has been effective in conveying serious prognostic implications.