Deborah L McLeod

What do Canadian uro-oncologists believe patients should know about androgen deprivation therapy?

Introduction Patients prescribed luteinizing hormone-releasing hormone agonists for androgen deprivation therapy (ADT) have significant misconceptions about treatment side effects and how to manage them. We surveyed a subset of Canadian physicians about what they think is important information to tell patients starting on ADT to determine the degree to which there is consensus of opinion. Method A questionnaire about ADT side effects and management strategies was distributed to physicians–urologists, radiation oncologists, and medical oncologists – actively practicing within cancer and urology centers in the Canadian provinces of British Columbia, Alberta, Ontario, and the Maritime Provinces. Result A total of 75 physicians filled out the survey. Physicians agreed that osteoporosis, erectile dysfunction, hot flashes, loss of libido, and loss of muscle mass were drug responses that were essential or important to warn patients about. However, for six commonly reported side effects (i.e. depression, diabetes, elevated cholesterol, anemia, delayed or absent orgasm, and genital shrinkage), physicians showed great variance, with less than 60% agreeing on whether to discuss these topics or not. Conclusion There is little consensus among physicians regarding what to tell patients when prescribing this treatment. The lack of agreement among physicians may partially explain the lack of awareness of ADT side effects by patients and partners. The current findings may help guide strategies for the design, evaluation, and implementation of educational interventions for both physicians and patients that will better prepare patients to recognize, adapt to, and overcome ADT side effects.

A pan-Canadian web-based education program to support screening for distress: evaluation of outcomes.

OBJECTIVE Cancer-related distress has been endorsed as the sixth vital sign by many international cancer organizations, and some countries such as Canada have implemented national screening for distress programs. The completion of a screening tool is an important first step in improving responsiveness to cancer-related distress, but screening must be followed with skilled supportive care to make a difference in patient-reported outcomes. Our objective was to create a web-based education program to support nurses and other frontline staff in providing an initial response to screening results. METHOD To address screening and supportive care learning needs, the Canadian Association of Psychosocial Oncology (CAPO), with support from the Canadian Partnership Against Cancer, created a web-based education program as one component of the national screening for distress agenda. The program provides clinically grounded and interactive learning through the use of PowerPoint presentations, video clips of clinical interactions with patients and family members, and test questions. Presentation topics include, for example, strategies for dealing with screening results, managing referrals, and supportive counseling. We employed a matched pairs, pre-post survey design to assess the effect of the education program on confidence in screening and in providing initial supportive care. RESULTS Our analysis of the first 147 matched pairs to complete the course suggests that satisfaction with the course was high. Statistically significant increases in confidence in relation to screening for distress and assessing distress, and in providing initial supportive care, were evident. SIGNIFICANCE OF RESULTS Our ongoing experience with CAPOs Interprofessional Psychosocial Oncology Distance Education (IPODE) project (www.ipode.ca) project suggests that healthcare professionals value web-based learning for its accessibility and convenience. Such programs appear to offer excellent opportunities for cost-effective education that supports practice change.

Metaphor and meaning in an online creative expression exercise to promote dyadic coping in young couples affected by breast cancer

Abstract Background: Establishing a sense of shared meaning is related to optimal adjustment for couples faced with cancer. The present study examined couple response to a creative expression exercise designed to facilitate shared meaning construction in young couples affected by breast cancer. Method: Thirteen women diagnosed with breast cancer and their male partners were guided through an original online exercise designed to help facilitate the creative processing of the couples experience with cancer. All couples’ creative expressions were later subjected to a qualitative content analysis. Results: This analysis yielded two main themes, Existential Hardship and Mutual Resilience. The majority of participants indicated that they found the exercise to be beneficial and/or enjoyable. Conclusions: Creating a shared meaning of cancer through an online artistic expression exercise is feasible, and offers a novel approach to supporting the dyadic coping processes of young couples affected by breast cancer.