- Email: [email protected]
Men’s Experience of Virtual Simulation to Aid Patient Education for Radiation Treatment to the Prostate
Gerald Devinsc, Nora Emada, Alexandra Koch-Fitsialosa, Bethany Pitcherd, Tony Panzarellad and Anne Kochab a - Radiation Medicine Program, Princess Margaret Cancer Centre b - Department of Radiation Oncology, University of Toronto c - Department of Supportive Care, Princess Margaret Cancer Centre d - Department of Biostatistics, Princess Margaret Cancer Centre Purpose/Aim: Adjuvant breast radiotherapy (RT) is a standard treatment option in women with early-stage breast cancer following lumpectomy. Timeliness of RT treatment can impact patient satisfaction. The objectives of this study are to assess 1) patient satisfaction of their whole breast RT, 2) patient preference for timing of RT start after CT simulation (CTSim), and 3) factors that influence patient stress and quality of life. Method/Process: Women undergoing whole breast RT were given a survey before RT treatment and at treatment completion. Patients were offered treatment either through the conventional process (ConvProcess), where RT starts typically within 1-2 weeks of CTSim, or the QuickStart (QS) process, where RT starts 1 day after CTSim. The pre-treatment (PRE-Tx) survey included questions to understand the social impact of RT, and the post-treatment (POST-Tx) survey included questions relating to social climate and patient satisfaction. Questions relating to RT start preference, stress (Perceived Stress Scale [PSS]) and quality of life (Illness Intrusiveness Ratings Scale [IIRS]), were assessed both at PRE-Tx and POST-Tx. An analysis of covariance was used to determine if the RT process impacted PSS and IIRS, and t-tests were used as a secondary analysis. Fisher’s Exact test was used where appropriate. Results/Benefits/Challenges: 96 patients completed the PRE-Tx survey and 88 completed both surveys (QS process n¼28; ConvProcess n¼60). All patients indicated they had a positive experience with the RT team (strongly agree-64%; agree-36%) and would recommend their care (strongly agree75%; agree-25%). At PRE-Tx, 94% of the QS patients preferred to start RT within a day of CTSim compared to 16% of ConvProcess patients. The preference of ConvProcess patients changed significantly compared to QS patients at POST-TX (p<0.0001); 63% of ConvProcess and 96% of QS patients strongly agreed/agreed that given a choice they would prefer to start RT the next day after CTSim. The overall PSS for all patients were not different PRE and POST-Tx (p¼ .8) and stress levels did not differ significantly between QS and ConvProcess patients (p¼.76). For both groups, health was the most common stress. The IIRS for ConvProcess patients was 37.6 (PRE-TX) and 39 (POST-TX), and for QS patients was 32 (PRE-TX) and 31.8 (POST-TX); there was no difference in IIRS of ConvProcess and QS patients (p¼.2). However, subscales of IIRS showed an increase in illness interference with aspects of Physical Recreation and Social relationships for ConvProcess patients compared to QS patients (p¼ .03). Conclusion/Impact/Outcomes: Women undergoing whole breast RT were satisfied with their care and preferred to start RT quickly following their CTSim. Their strongest stressor was health and their stress levels were unchanged at RT completion. Patient involvement and selection of RT timing may impact on their views of how treatment interferes with their lifestyle and social relationships. The Perceptions of Health Care Providers and Cancer Patients on Educational Needs at the End of Radical Radiation Therapy Treatment in a Community Based Cancer Centre Christie Wilcox, Vanessa Barisic, Carrie Lavergne and Manon Lemonde R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health Purpose/Aim: This study aimed to identify educational topics deemed important by health care providers (HCPs) and their cancer patients at the end of radical radiation therapy treatment at a community-based cancer centre (CBCC). The purpose was to see if HCPs’ perceptions of patients’ educational needs match the topics of importance identified by the patients themselves and determine if the educational needs match between the HCPs. Method/Process: A questionnaire covering four domains on educational needs at the end of radical radiation therapy treatment was first piloted and then presented to cancer patients (n¼ 73) on their last day of radiation
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treatment, and to HCPs during a four week span . The four domains consisted of physical and emotional side effects, follow-up care and a wellness plan. Frequencies using a Likert scale were tabulated and differences in proportions between groups were calculated with chi-squared analysis and Fisher’s Exact test. Results/Benefits/Challenges: Twenty-eight HCPs (radiation oncologists n¼4, oncology nurses n¼4, radiation therapists n¼20) and twenty-eight cancer patients (38.4%) participated in the study. Cancer patients found 18 out of 21 topics to be deemed important. Oncology nurses and radiation therapists (MRTs) found all topics important and RO’s found 14 out of 21 topics to be important. Significant differences (p values < 0.05) were found between cancer patients and HCPs on four topics. Further analysis showed significant differences on 9 topics between cancer patients versus oncology nurses and MRTs and two topics between cancer patients versus radiation oncologists (ROs). Differences between HCPs were seen between ROs and MRTs on five topics. Conclusion/Impact/Outcomes: Results emphasized the difference between patients and HCP’s on educational topics deemed important at the end of radical radiation therapy treatment and showed differences between the HCPs themselves. A more collaborative approach by HCPs at the CBCC can be achieved through group education sessions providing consistent education and information sharing. Further training in this area is needed. How Can a Seamless Transition to Community Care Be Achieved in Oncology? Gathering a Better Understanding of the Jurisdictional Practise Across Canada Danielle Wittal Sheffield Hallam University; BC Cancer Agency (CSI) Purpose/Aim: Due to the growing number of cancer survivors there needs to be a shift in our current health care system to continue to provide high quality cancer care. An environmental scan was conducted to gather an understanding of what is happening provincially and nationally, to highlight any trends and report disparities in the transition from cancer care to the community setting. Method/Process: An environmental scan was conducted across the Canada. Telephone interviews took place which aimed to identify activity, events, trends, issues and expectations of the transition of care processes. Results/Benefits/Challenges: Nine out of ten provinces were successfully contacted and the appropriate documents were obtained (included transfer of care/discharge letters, discharge packages, survivorship care plans (SCPs), patient/primary care physician checklists for follow-up recommendations). The transfer of care process is highly variable within a province and across the country. The research acknowledged some examples of good practice which led to some logical suggestions for future care to improve care for patients. Conclusion/Impact/Outcomes: Cancer survivorship is a complex topic which requires communication and coordination from the oncology setting to the community setting to ensure a seamless transition for cancer survivors. The study demonstrated the differences in transition of care practices across the province and yielded some plausible recommendations for high quality cancer care. Adopting the recommendations suggested in this study could lead to a number of increased benefits to patients including increased selfmanagement and self-advocacy (including a strong self-concept/self-confidence, improving patient empowerment, increasing self-esteem, fostering a sense of control and assisting adaptation to a life with cancer).
Men’s Experience of Virtual Simulation to Aid Patient Education for Radiation Treatment to the Prostate Alannah Flocktonab a - University of Otago, Wellington b - Wellington Blood and Cancer Centre Purpose/Aim: Prostate cancer affects more than 3000 New Zealand men each year and many of these men receive radiation treatment (Ministry of Health, 2011). This type of treatment is complex and requires patients to have a full bladder and empty rectum to aid in the treatment delivery and
Conference Proceedings from RTi3 2017/Journal of Medical Imaging and Radiation Sciences 48 (2017) S1-S22
minimise side effects. These concepts can be difficult to explain to patients and current education involves verbal and written materials. VERT (Virtual Environment Radiotherapy Training system) is a 3D immersive teaching tool that can visually simulate and demonstrate how radiation treatment is delivered to the prostate. There is sufficient evidence to support VERT as a useful teaching tool in the academic environment however; using VERT for one-on-one patient education is a novel approach (Boejen, Bloch-Larsen, Poulsen, & Seiersen, 2011). This qualitative, pilot study set out to explore the patient’s experience of VERT when it was incorporated into education sessions for prostate radiation treatment and how it shaped their (a) understanding of radiation therapy; (b) why a full bladder and empty rectum is required; (c) their initial treatment experience. Method/Process: Data collection involved semi-structured interviews with male patients one week after they had experienced the VERT education and received their first week of radiation treatment. Interpretative phenomenological analysis (IPA) was used to offer insight into the patients’ experience of VERT education session. Results/Benefits/Challenges: The men in this study attributed the VERT education to enhancing their understanding of radiation treatment and the technology involved. Visualisation of the process helped patients feel prepared for treatment and improved their understanding of why a full bladder and empty rectum is required. Prostate cancer can impact on masculinities such as autonomy, shame, embarrassment, guilt and sexuality. These can be difficult for men to talk about and a lack of information can add to their distress. VERT engages men with discussing radiation treatment and this may initiate further information sharing and encourage peer support. Conclusion/Impact/Outcomes: There is a role for visual tools such as VERT to be included in patient education for radiation treatment to the prostate. PROFFERED PAPER #3: MELANGE
The Role of the Clinical Specialist Radiation Therapist in Delivering Person Centred Care Across the Cancer Continuum L. D’Alimonteab, D. Erlerab, L. Holdenab, A. Turnerab, E. Sinclairab and L. Di Prosperoab a - Odette Cancer Centre, Sunnybrook Health Sciences Centre b - University of Toronto Purpose/Aim: Patient navigation roles were developed to help reduce gaps in care by improving access to cancer services. A primary activity of the Clinical Specialist Radiation Therapist (CSRT) at the Odette Cancer Centre (OCC) is to serve as a navigator for ‘complex’ patients. Complexity is defined not only by the treatment but also the anticipated needs of the patient. The spectrum of navigation includes support through care coordination, patient education and meeting the psychosocial needs of the patient. The aim of this work was to quantify the impact of the CSRT navigator on the patient population. Method/Process: As part of the systematic approach to implementation, current processes were reviewed to identify gaps in service delivery including support for patients. Within each position, the review identified the need for navigational roles for each CSRT that would, upon integration, not only drive greater efficiency within the system but moreover improve the patient experience. Coupled with this was an internal organizational review of the staff and patient experience that identified the ‘want’ and ‘need’ for more navigational roles within the system. CSRT navigational workload codes were developed and piloted for six months. In addition, CSRT captured qualitative data received from patients, family and/or caregivers. An audit of workload codes was performed to quantify the navigational role for each CSRT. Results/Benefits/Challenges: The CSRT as navigator has helped streamline the patient journey through the cancer treatment trajectory by providing coordinated, evidence-based, person-centred care. Early data shows that navigation accounts for upwards of 45% of clinical workload. Navigation tasks included but are not limited to; coordinating/scheduling appointments, tests and procedures, connecting patients to supportive care services, symptom assessment and management, and education.
Conclusion/Impact/Outcomes: The role of CSRT navigator has shown to positively impact on the patient’s cancer care journey. A formal evaluation of the impact of these roles on the patient population is planned for the future. A costing analysis to understand impact of these from both the patient and program perspective is warranted. Quantifying the Impact of CSRTs: The Creation and Evaluation of Workload Codes Darby Erlerab, Laura D’Alimonteab, Lori Holdenab, Emily Sinclairab, Angela Turnerab and Lisa Di Prosperoab a - Sunnybrook Odette Cancer Centre b - University of Toronto Department of Radiation Oncology Purpose/Aim: Two key drivers for the development of the Clinical Specialist Radiation Therapist (CSRT) position in Ontario were to increase the quality of cancer care and improve system efficiency. Quantifying the impact of each role is integral to role sustainability especially in a time of fiscal constraints faced by the provincial health care system. Our organization endeavoured to measure impact by creating CSRT specific workload codes in Mosaiq to quantify workload related to clinical service for each CSRT position. Method/Process: The development of the CSRT specific workload codes has been an iterative process guided by the Deming’s Cycle. In the planning phase, all CSRTs participated in a brainstorming exercise to establish a list of codes essential to their practice with an accompanying definitions. Upon consensus, the codes were created in Mosaiq under a specific CSRT group and each CSRT was assigned their own location to capture codes for recording clinical service. The code capture was trialed over a 9-month period; after which an audit was performed to assess utilization. The information garnered from the audit resulted in the amalgamation of codes, clarification of the definition of codes and the creation of new codes, which will maximize data capture in the future. Results/Benefits/Challenges: The use of Mosaiq has been shown to be a valuable method to capture data related to the patient activities completed by CSRTs. Inherent in Mosaiq is the ability to run reports on the frequency that a specific code is captured or the quantity of codes captured by each CSRT, which simplifies reporting. The interpretation of this data, however, poses quite a challenge given the vastly different clinical practices of each CSRT. The audit yielded optimistic results but did uncover some inconsistent use of codes between CSRTs and identified gaps in practice that were not captured. In addition, the data captured in Mosaiq reflects only the patient related activities of the CSRTs, which reflects only one pillar of their practice and not necessarily the full impact of the role as such caution to its’ full use by decision makers remains. Conclusion/Impact/Outcomes: The ability to generate consistent data on patient related activities undertaken by CSRTs will certainly facilitate quantifying each role’s impact. The next step is to affix either a dollar or time value to each task to further quantify the impact, essentially a formal cost-benefit analysis. Creative solutions like capturing codes in Mosaiq need to be utilized to provide solid data illustrating the impact of CSRTs on provincial cancer care. Although there are flaws, a workload measure will provide support to decision makers when constituting staffing models for each regional cancer program. How a Single Case-study Quality Review Changed Treatment Protocol for Prophylactic Whole Brain Radiotherapy Mike Holwella, Biu Chana, Tara Rosewellab and S.H. Huangab a - Princess Margaret Cancer Centre b - University of Toronto Purpose/Aim: To report a case that triggered a review and subsequent change of clinical treatment protocol for prophylactic cranial irradiation (PCI). Method/Process: A 63 year-old male was treated with parotid-sparing IMRT for a base of tongue tumor. Reasonable salivary function was retained postradiotherapy with only mild xerostomia (Grade 1). Six months later the patient was diagnosed with small cell lung cancer and received a standard course
Conference Proceedings from RTi3 2017/Journal of Medical Imaging and Radiation Sciences 48 (2017) S1-S22
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treatment, and to HCPs during a four week span . The four domains consisted of physical and emotional side effects, follow-up care and a wellness plan. Frequencies using a Likert scale were tabulated and differences in proportions between groups were calculated with chi-squared analysis and Fisher’s Exact test. Results/Benefits/Challenges: Twenty-eight HCPs (radiation oncologists n¼4, oncology nurses n¼4, radiation therapists n¼20) and twenty-eight cancer patients (38.4%) participated in the study. Cancer patients found 18 out of 21 topics to be deemed important. Oncology nurses and radiation therapists (MRTs) found all topics important and RO’s found 14 out of 21 topics to be important. Significant differences (p values < 0.05) were found between cancer patients and HCPs on four topics. Further analysis showed significant differences on 9 topics between cancer patients versus oncology nurses and MRTs and two topics between cancer patients versus radiation oncologists (ROs). Differences between HCPs were seen between ROs and MRTs on five topics. Conclusion/Impact/Outcomes: Results emphasized the difference between patients and HCP’s on educational topics deemed important at the end of radical radiation therapy treatment and showed differences between the HCPs themselves. A more collaborative approach by HCPs at the CBCC can be achieved through group education sessions providing consistent education and information sharing. Further training in this area is needed. How Can a Seamless Transition to Community Care Be Achieved in Oncology? Gathering a Better Understanding of the Jurisdictional Practise Across Canada Danielle Wittal Sheffield Hallam University; BC Cancer Agency (CSI) Purpose/Aim: Due to the growing number of cancer survivors there needs to be a shift in our current health care system to continue to provide high quality cancer care. An environmental scan was conducted to gather an understanding of what is happening provincially and nationally, to highlight any trends and report disparities in the transition from cancer care to the community setting. Method/Process: An environmental scan was conducted across the Canada. Telephone interviews took place which aimed to identify activity, events, trends, issues and expectations of the transition of care processes. Results/Benefits/Challenges: Nine out of ten provinces were successfully contacted and the appropriate documents were obtained (included transfer of care/discharge letters, discharge packages, survivorship care plans (SCPs), patient/primary care physician checklists for follow-up recommendations). The transfer of care process is highly variable within a province and across the country. The research acknowledged some examples of good practice which led to some logical suggestions for future care to improve care for patients. Conclusion/Impact/Outcomes: Cancer survivorship is a complex topic which requires communication and coordination from the oncology setting to the community setting to ensure a seamless transition for cancer survivors. The study demonstrated the differences in transition of care practices across the province and yielded some plausible recommendations for high quality cancer care. Adopting the recommendations suggested in this study could lead to a number of increased benefits to patients including increased selfmanagement and self-advocacy (including a strong self-concept/self-confidence, improving patient empowerment, increasing self-esteem, fostering a sense of control and assisting adaptation to a life with cancer).
Men’s Experience of Virtual Simulation to Aid Patient Education for Radiation Treatment to the Prostate Alannah Flocktonab a - University of Otago, Wellington b - Wellington Blood and Cancer Centre Purpose/Aim: Prostate cancer affects more than 3000 New Zealand men each year and many of these men receive radiation treatment (Ministry of Health, 2011). This type of treatment is complex and requires patients to have a full bladder and empty rectum to aid in the treatment delivery and
Conference Proceedings from RTi3 2017/Journal of Medical Imaging and Radiation Sciences 48 (2017) S1-S22
minimise side effects. These concepts can be difficult to explain to patients and current education involves verbal and written materials. VERT (Virtual Environment Radiotherapy Training system) is a 3D immersive teaching tool that can visually simulate and demonstrate how radiation treatment is delivered to the prostate. There is sufficient evidence to support VERT as a useful teaching tool in the academic environment however; using VERT for one-on-one patient education is a novel approach (Boejen, Bloch-Larsen, Poulsen, & Seiersen, 2011). This qualitative, pilot study set out to explore the patient’s experience of VERT when it was incorporated into education sessions for prostate radiation treatment and how it shaped their (a) understanding of radiation therapy; (b) why a full bladder and empty rectum is required; (c) their initial treatment experience. Method/Process: Data collection involved semi-structured interviews with male patients one week after they had experienced the VERT education and received their first week of radiation treatment. Interpretative phenomenological analysis (IPA) was used to offer insight into the patients’ experience of VERT education session. Results/Benefits/Challenges: The men in this study attributed the VERT education to enhancing their understanding of radiation treatment and the technology involved. Visualisation of the process helped patients feel prepared for treatment and improved their understanding of why a full bladder and empty rectum is required. Prostate cancer can impact on masculinities such as autonomy, shame, embarrassment, guilt and sexuality. These can be difficult for men to talk about and a lack of information can add to their distress. VERT engages men with discussing radiation treatment and this may initiate further information sharing and encourage peer support. Conclusion/Impact/Outcomes: There is a role for visual tools such as VERT to be included in patient education for radiation treatment to the prostate. PROFFERED PAPER #3: MELANGE
The Role of the Clinical Specialist Radiation Therapist in Delivering Person Centred Care Across the Cancer Continuum L. D’Alimonteab, D. Erlerab, L. Holdenab, A. Turnerab, E. Sinclairab and L. Di Prosperoab a - Odette Cancer Centre, Sunnybrook Health Sciences Centre b - University of Toronto Purpose/Aim: Patient navigation roles were developed to help reduce gaps in care by improving access to cancer services. A primary activity of the Clinical Specialist Radiation Therapist (CSRT) at the Odette Cancer Centre (OCC) is to serve as a navigator for ‘complex’ patients. Complexity is defined not only by the treatment but also the anticipated needs of the patient. The spectrum of navigation includes support through care coordination, patient education and meeting the psychosocial needs of the patient. The aim of this work was to quantify the impact of the CSRT navigator on the patient population. Method/Process: As part of the systematic approach to implementation, current processes were reviewed to identify gaps in service delivery including support for patients. Within each position, the review identified the need for navigational roles for each CSRT that would, upon integration, not only drive greater efficiency within the system but moreover improve the patient experience. Coupled with this was an internal organizational review of the staff and patient experience that identified the ‘want’ and ‘need’ for more navigational roles within the system. CSRT navigational workload codes were developed and piloted for six months. In addition, CSRT captured qualitative data received from patients, family and/or caregivers. An audit of workload codes was performed to quantify the navigational role for each CSRT. Results/Benefits/Challenges: The CSRT as navigator has helped streamline the patient journey through the cancer treatment trajectory by providing coordinated, evidence-based, person-centred care. Early data shows that navigation accounts for upwards of 45% of clinical workload. Navigation tasks included but are not limited to; coordinating/scheduling appointments, tests and procedures, connecting patients to supportive care services, symptom assessment and management, and education.
Conclusion/Impact/Outcomes: The role of CSRT navigator has shown to positively impact on the patient’s cancer care journey. A formal evaluation of the impact of these roles on the patient population is planned for the future. A costing analysis to understand impact of these from both the patient and program perspective is warranted. Quantifying the Impact of CSRTs: The Creation and Evaluation of Workload Codes Darby Erlerab, Laura D’Alimonteab, Lori Holdenab, Emily Sinclairab, Angela Turnerab and Lisa Di Prosperoab a - Sunnybrook Odette Cancer Centre b - University of Toronto Department of Radiation Oncology Purpose/Aim: Two key drivers for the development of the Clinical Specialist Radiation Therapist (CSRT) position in Ontario were to increase the quality of cancer care and improve system efficiency. Quantifying the impact of each role is integral to role sustainability especially in a time of fiscal constraints faced by the provincial health care system. Our organization endeavoured to measure impact by creating CSRT specific workload codes in Mosaiq to quantify workload related to clinical service for each CSRT position. Method/Process: The development of the CSRT specific workload codes has been an iterative process guided by the Deming’s Cycle. In the planning phase, all CSRTs participated in a brainstorming exercise to establish a list of codes essential to their practice with an accompanying definitions. Upon consensus, the codes were created in Mosaiq under a specific CSRT group and each CSRT was assigned their own location to capture codes for recording clinical service. The code capture was trialed over a 9-month period; after which an audit was performed to assess utilization. The information garnered from the audit resulted in the amalgamation of codes, clarification of the definition of codes and the creation of new codes, which will maximize data capture in the future. Results/Benefits/Challenges: The use of Mosaiq has been shown to be a valuable method to capture data related to the patient activities completed by CSRTs. Inherent in Mosaiq is the ability to run reports on the frequency that a specific code is captured or the quantity of codes captured by each CSRT, which simplifies reporting. The interpretation of this data, however, poses quite a challenge given the vastly different clinical practices of each CSRT. The audit yielded optimistic results but did uncover some inconsistent use of codes between CSRTs and identified gaps in practice that were not captured. In addition, the data captured in Mosaiq reflects only the patient related activities of the CSRTs, which reflects only one pillar of their practice and not necessarily the full impact of the role as such caution to its’ full use by decision makers remains. Conclusion/Impact/Outcomes: The ability to generate consistent data on patient related activities undertaken by CSRTs will certainly facilitate quantifying each role’s impact. The next step is to affix either a dollar or time value to each task to further quantify the impact, essentially a formal cost-benefit analysis. Creative solutions like capturing codes in Mosaiq need to be utilized to provide solid data illustrating the impact of CSRTs on provincial cancer care. Although there are flaws, a workload measure will provide support to decision makers when constituting staffing models for each regional cancer program. How a Single Case-study Quality Review Changed Treatment Protocol for Prophylactic Whole Brain Radiotherapy Mike Holwella, Biu Chana, Tara Rosewellab and S.H. Huangab a - Princess Margaret Cancer Centre b - University of Toronto Purpose/Aim: To report a case that triggered a review and subsequent change of clinical treatment protocol for prophylactic cranial irradiation (PCI). Method/Process: A 63 year-old male was treated with parotid-sparing IMRT for a base of tongue tumor. Reasonable salivary function was retained postradiotherapy with only mild xerostomia (Grade 1). Six months later the patient was diagnosed with small cell lung cancer and received a standard course
Conference Proceedings from RTi3 2017/Journal of Medical Imaging and Radiation Sciences 48 (2017) S1-S22
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