i need a sort essay on current knowledge about radiation therapy and patient perception.
Literature Review
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Mixed messages? A comparison between the perceptions of radiation therapy
patients and radiation therapists regarding patients’ educational needs
Article in Radiography · May 2008
DOI: 10.1016/j.radi.2006.09.001
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1 author:
Amanda Bolderston
University of Alberta
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Radiography (2008) 14, 111e119
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
Mixed messages? A comparison between the
perceptions of radiation therapy patients and
radiation therapists regarding patients’
educational needs*
Amanda Bolderston*
Princess Margaret Hospital, UHN, Radiation Medicine Program, 610 University Avenue, Toronto, ON,
Canada M5G 2M9
Received 2 March 2006; accepted 1 September 2006
Available online 2 November 2006
KEYWORDS
Radiotherapy;
Patient education;
Professional’s
opinions;
Patients’opinions;
Educational topics;
Educational delivery
Abstract Objectives: The purpose of this study was to discover and compare radiation
therapy patients’ and radiation therapists’ perceptions of patients’ educational topics of interest and methods of information delivery during a course of radiation therapy.
Methods: Using Likert-type 4-point rating scales, 42 therapists and 183 radiation therapy patients were surveyed to rate the degree of importance of 15 informational items (for example,
‘‘What it feels like to have treatment’’). In addition, therapists and patients ranked 11 methods
of informational delivery (for example, ‘‘Watching video tapes’’) in order of preference.
Results: Results indicated several differences in therapists’ and patients’ perceptions of both
the educational topics of interest and methods of information delivery. Among other things,
patients assigned high importance to after treatment issues (‘‘What happens after radiation
therapy is finished’’) and how radiation therapy works, these areas were not seen as important
by the studied therapists. Patients expressed a strong preference for receiving information
about radiation therapy from their family doctor (ranked third), therapists ranked this source
of information as the least important.
Conclusion: It is vital to tailor educational interventions according to the patient’s preference
to optimize both understanding and compliance. This study demonstrated noteworthy differences in several areas between therapists’ and patients’ perceptions. Recommendations therefore include raising therapist’s awareness of topics that are important to patients and
meaningful informational delivery methods.
ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
*
This article builds on work previously published in the Canadian Journal of Medical Radiation Technologists,27 which is reproduced with
permission. Part of the original research was carried out for a Master of Science degree at Anglia Ruskin University.
* Tel.: þ1 416 946 4501×4857; fax: þ1 416 946 2019.
E-mail address: amanda.bolderston@rmp.uhn.on.ca
1078-8174/$ – see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.radi.2006.09.001
112
Introduction
Patient education (information provision) is an effective
strategy for alleviating psychosocial problems (such as
stress and anxiety) in cancer patients.1,2 Many patients actively seek information, and studies show consistently high
informational needs amongst radiation therapy patients,3e6
although patients vary in both how much they want to know
and the types of information they want.7 In addition, patients’ desire for information may change during the course
of their illness.8 Radiation therapy can cause additional
anxiety and stress for cancer patients9 and patient education, therefore, is typically focused on increasing knowledge of the treatment process7,10 as well as expected
side effects and their management.11
In general, an effective patient education program must
be culturally sensitive and incorporate different teaching
strategies, methods and media (such as one-to-one teaching, written material, group sessions and electronic media)
to accommodate a variety of learning styles and improve
access and information recall.12e16 However, despite the
knowledge that providing patients with information has
many benefits, there is evidence that patients are often
dissatisfied with the amount of information they receive
and the format(s) available.17,7 In addition, studies have
shown that patients’ retention of information is often less
than optimal.18,19
Radiation therapists educate and counsel patients on
a daily basis. The settings may vary from individual interactions with patients and family to group teaching
sessions. In addition, therapists are often involved in the
development of teaching materials such as booklets,
pamphlets and, increasingly, multimedia resources.
Factors that influence the type and amount of information patients receive include the preferences and perceptions of the healthcare professionals who are responsible
for teaching them. Although there is limited information
available from the medical radiation sciences, the nursing
literature demonstrates that nurses are not always correct
when asked to anticipate their patients’ needs and preferences. Studies have been conducted to examine nursee
patient congruence in areas such as patients’ emotional
distress, primary areas of current concern, physical and
emotional needs, and quality of life.20e24 Results clearly
show that nurses’ perceptions may not align with those of
their patients in these important areas. These studies also
demonstrate that nurses may teach/care based on their
own professional interests (which may be primarily technological, highly empathetic, etc.) and not based on the
needs of their patients. Research that examines patient
teaching also reveals significant differences in perception
between nurses and cancer patients’ of patients’ educational needs.25,26,10
The hypothesis of this study is, therefore, that radiation
therapists might also be incorrect in their assessments of
their patients’ educational needs. This research builds on
results presented in a previous study27 where the primary
objective was to identify any gaps in service in a department’s radiation therapy education program by gathering
information on what patients want to know and how they
prefer to receive this information. This paper compares
A. Bolderston
the previous results from radiation therapy patients with
data gathered concurrently from radiation therapists using
the same survey instrument.
Study population and methods
The two-study populations consisted of patients undergoing
treatment and radiation therapists at a large urban Canadian cancer centre treating about 4000 patients per year.
After appropriate institutional ethics approval was granted
for this study, the survey instruments (which consisted of
two similar versions of a self-administered questionnaire)
were distributed to both groups.
For both groups the nature of the survey was explained
in the cover letter, along with the fact that the completion
of the survey was voluntary and responses would be
anonymous. Patients were also assured that non-completion would not affect their treatment. Consent was implied
with the return of the survey.
Group one: patients
The first subject population for this study were patients
receiving radiation therapy. Exclusion criteria were as
follows:
Patients who were too sick to complete the study (this
included inpatients from the centre’s host hospital).
Non-English speaking patients.
Patients who had previously completed the pilot study.
The survey instrument was given to each patient on
arrival by reception staff during one treatment day (10 h).
Group two: radiation therapists
Two weeks after the survey was administered to the patient
population, the second survey (a self-administered questionnaire) was sent to all of the radiation therapists working
in the centre. Demographic information collected included
years qualified, gender and professional education.
Survey instrument
The survey instruments were two versions of the same selfadministered questionnaire.
Version 1: patient survey
The original format for this questionnaire was based on
a modified version of the Toronto Informational Needs
Questionnaire6 developed for use with breast cancer patients. The redesigned survey was tested using several
semi-structured face-to-face interviews with a group of volunteers from a peer-support cancer group who had received radiation therapy in the past. Content validity of
the questionnaire was assessed using the collective professional experience of several oncology nurses, radiation
therapists and radiation oncologists. The survey was piloted
with a group of patients and radiation therapists; several
revisions were subsequently made to correct ambiguity.
Comparison between the perceptions of radiation therapy patients and radiation therapists
The first section (Section A) consisted of 15 questions
with a stem of ‘‘During my radiation therapy it is important
for me to know.’’ followed by 15 items such as ‘‘What it
feels like to have treatment’’. The respondent rated these
with a 4-point Likert scale from ‘‘Not Important at All’’ to
‘‘Extremely Important’’. The second section (Section B)
asked patients to choose their top 3 preferred methods of
receiving information based on a list of 11 methods (‘‘I
would like information on my treatment by.’’). There was
also a section inviting patients to comment in both of these
areas. Finally, there was a request for demographic
information.
Version 2: therapist survey
The second (therapist) version of the survey was identical
except for 2 things. Firstly the words ‘‘me’’ and ‘‘I’’ in the
following stems ‘‘During my radiation therapy it is important for me to know.’’ and ‘‘I would like information on
my treatment by.’’ were replaced by the words ‘‘patients’’ and ‘‘the patient,’’ respectively, thus asking therapists what they feel patients want. Secondly, the
demographic section was different as discussed above.
113
Table 1 Patient demographic variables for age, sex and
educationa (N Z 174)
Variable
Category
Result (percent)
Age
16e30
31e40
41e50
51e60
61e70
71e80
81e90
Over 90
2
7
6
25
33
23
4
1
Gender
Female
Male
53
47
Education
No school
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