Joyce Nyhof-Young

Alleviating Emotional Exhaustion in Oncology Nurses: an Evaluation of Wellspring’s “Care for the Professional Caregiver Program”

A high level of burnout has been demonstrated in oncologists, nurses, and other health professionals. Interventions developed in response demonstrate mixed results. Wellspring, a community cancer support organization, has developed a 1-day session called Care for the Professional Caregiver Program (CPCP) and has delivered it to over 700 healthcare workers. The present study assessed the effects of the CPCP on three groups of oncology nurses (pediatric, surgical, and general oncology staff) and one group of nurse managers. Subjects completed the Maslach burnout inventory (MBI), the General health questionnaire (GHQ) and the short form of the Marlowe–Crowne social desirability scale (M–C) prior to receiving the intervention. They then completed the MBI and GHQ at 1-month and 7-month follow-ups. Six months after the original session, a small subset of subjects was randomly selected to participate in a 1-day CPCP booster session. At baseline, one third of the nurses showed high burnout on the MBI. The nurses demonstrated a significant decrease in emotional exhaustion and an improvement on the GHQ, at the 1-month follow-up testing (p = 0.003 and 0.001, respectively) and 7-month follow-up testing (p = 0.002 and 0.001). The booster session proved difficult to deliver because of institutional scheduling problems due to nurse shortages, so only a small percentage (22%) of the sample participated; however, it was well received. Thus, the CPCP is effective in ameliorating emotional exhaustion, an intrinsic aspect of burnout.

Look good feel better workshops: a "big lift" for women with cancer.

Background. Look Good Feel Better (LGFB) aims to help women manage appearance-related side effects of cancer and its treatment. In this pilot study, we assessed the impact of LGFB workshops on self-image, social interactions, perceived social support, and anxiety. Methods. We administered scales preworkshop and postworkshop participation. We conducted semistructured telephone interviews following attendance. Results. Statistically and qualitatively, subjects experienced significant improvement in self-image, social interaction, and anxiety. Participant anxiety decreased, but greater social support was anticipated than actually obtained. Conclusions. LGFB workshops increase self-image, improve social interactions, and reduce anxiety.Background. Look Good Feel Better (LGFB) aims to help women manage appearance-related side effects of cancer and its treatment. In this pilot study, we assessed the impact of LGFB workshops on self-image, social interactions, perceived social support, and anxiety. Methods. We administered scales preworkshop and postworkshop participation. We conducted semistructured telephone interviews following attendance. Results. Statistically and qualitatively, subjects experienced significant improvement in self-image, social interaction, and anxiety. Participant anxiety decreased, but greater social support was anticipated than actually obtained. Conclusions. LGFB workshops increase self-image, improve social interactions, and reduce anxiety.

Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases

Goals of workTo explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers.Patients and methodsTwo parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns.ResultsTwenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice.ConclusionsGiven the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.

The Role of a Clinician-Led Reflective Interview on Improving Self-Efficacy in Breast Cancer Survivors: A Pilot Study

Breast cancer survivors experience a wide range of survivorship issues that are not always adequately addressed. This study is an assessment of the Survivorship Consult (SC), a one-to-one clinician-led reflective interview used to capture a comprehensive summary of the survivor experience, to determine its impact on self-efficacy and the perceived likelihood that it initiates behavior change. Using a pre-test/post-test design, data were collected from participants (N = 40) using validated instruments and opened-ended questions to evaluate the SC. Participants found the SC to be a useful tool for planning and goal setting and improved self-efficacy as measured by the Cancer Behavior Inventory with an increase of 2.0 (p = 0.03). The SC demonstrates promise in improving the ability and confidence of breast cancer survivors to manage their care, but further research is required to understand the optimal implementation of this intervention and its impact on the delivery of survivorship services.

Mapping the Future: Towards Oncology Curriculum Reform in Undergraduate Medical Education at a Canadian Medical School

PURPOSE To evaluate (1) the quantity and quality of current undergraduate oncology teaching at a major Canadian medical school; and (2) curricular changes over the past decade, to enhance local oncology education and provide insight for other educators. METHODS AND MATERIALS Relevant 2011-2012 undergraduate curricular sessions were extracted from the University of Toronto curriculum mapping database using keywords and database identifiers. Educational sessions were analyzed according to Medical Council of Canada objectives, discussion topics, instructor qualifications, teaching format, program year, and course subject. Course-related oncology research projects performed by students during 2000 to 2012 were extracted from another internal database. Elective choices of clerks during 2008-2014 were retrieved from the institution. The 2011-2012 and 2000-2001 curricula were compared using common criteria. RESULTS The 2011-2012 curriculum covers 5 major themes (public health, cancer biology, diagnosis, principles of care, and therapy), which highlight 286 oncology teaching topics within 80 sessions. Genitourinary (10, 12.5%), gynecologic (8, 10.0%), and gastrointestinal cancers (7.9, 9.8%) were the most commonly taught cancers. A minority of sessions were taught by surgical oncologists (6.5, 8.1%), medical oncologists (2.5, 3.1%), and radiation oncologists (1, 1.2%). During 2000-2012, 9.0% of students (233 of 2578) opted to complete an oncology research project. During 2008-2014, oncology electives constituted 2.2% of all clerkship elective choices (209 of 9596). Compared with pre-2001 curricula, the 2012 oncology curriculum shows notable expansion in the coverage of epidemiology (6:1 increase), prevention (4:1), screening (3:1), and molecular biology (6:1). CONCLUSIONS The scope of the oncology curriculum has grown over the past decade. Nevertheless, further work is needed to improve medical student knowledge of cancers, particularly those relevant to public health needs. Defining minimum curricular content, emphasizing content based on population needs, and ensuring educational delivery with the support and expertise of oncologists and non-oncologists will be essential next steps.

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.

More than just dancing: experiences of people with Parkinson’s disease in a therapeutic dance program

Abstract Purpose: To understand why individuals with Parkinson’s disease (PD) participate in a community-based therapeutic dance program and to explore its influence on perceived physical, social and emotional well-being of participants. Methods: A qualitative descriptive design was employed using one-on-one semi-structured interviews. Individuals with PD who participated in the Dancing with Parkinson’s program were recruited from two locations. Interviews were audio-recorded, transcribed, de-identified and then placed into NVivo 10 software for analysis. A content analysis approach was used with an inductive analysis method to generate a coding scheme. Group discussion facilitated development of overarching themes. Results: Ten participants’ responses revealed that the dance program allows for self-improvement and regaining identity through disease self-management. Positive influences of socialization arose through the class, decreasing isolation and improving quality of life. Participants communicate through music and dance to enhance connection with others. Conclusions: Dancing with Parkinson’s classes allow for re-development of the social self, which can increase sense of enjoyment in life. Dance programs provide opportunities for social interaction, non-verbal communication and self-improvement, reestablishing self-identity and a sense of usefulness. This study provides unique insight into the experience of participating in a dance program from the perspective of individuals with PD. Implications for rehabilitation Dance is emerging as a strategy to address the physical and psychosocial effects of Parkinson’s disease (PD), but little is known regarding participants’ perceptions of community-based therapeutic dance programs for PD. This study found that Dancing with Parkinson’s (DWP) facilitated an improvement in social participation, resulting in decreased isolation and improved quality of life. Participation in the DWP program can facilitate a positive change in perspective and attitude toward a PD diagnosis, thereby increasing feelings of self-efficacy and improving self-management of the disease. Participants of this study emphasized the multifaceted benefits of DWP, suggesting that it has great potential for addressing not only the physical challenges, but also the cognitive and emotional challenges associated with PD.

Information Needs of Hepato-Pancreato-Biliary Surgical Oncology Patients

A marked knowledge gap exists concerning the information needs of hepato-pancreato-biliary (HPB) surgical oncology patients. We investigated the comprehensive information needs of this patient population, including the type and amount of information desired, as well as the preferred method of receiving information. A questionnaire was administered to patients being treated surgically for cancers of the liver, pancreas, gallbladder, or bile ducts at Toronto General Hospital, part of the University Health Network, in Toronto, Canada. The questionnaire examined patients’ information needs across six domains of information: medical, practical, physical, emotional, social, and spiritual. Among 36 respondents, the importance of information and amount of information desired differed significantly by domain (both p < 0.001). This group of patients rated information in the medical and physical domains as most important, though they also desired specific items of information from the emotional, practical, and social domains. Patients’ overwhelming preference was to receive information via a one-on-one consultation with a healthcare provider. It is important for healthcare providers working with HPB surgical oncology patients to be comprehensive when providing information related to patients’ cancer diagnosis, prognosis, associated symptoms, and side effects of treatment. Certain emotional, practical, and social issues (e.g., fears of cancer recurrence, drug coverage options, relationship changes) should be addressed as well. Face-to-face interactions should be the primary mode of delivering information to patients. Our findings are being used to guide the training of healthcare providers and the development of educational resources specific to HPB surgical oncology patients.

Improving Access to Radiotherapy Services in the Simcoe-Muskoka Region of Ontario: Needs Assessment Study

Abstract Introduction The Simcoe-Muskoka region of Ontario, Canada, is underserviced with respect to radiotherapy utilization. A group from the Toronto Sunnybrook Regional Cancer Centre and the Royal Victoria Hospital (RVH) of Barrie, Ontario, conducted a study investigating health-care needs and access to radiotherapy services in the region. Methods A questionnaire evaluating access to and knowledge about palliative radiotherapy was distributed to health-care providers from the region, and two radiation therapy education focus groups were organized at RVH to investigate regional knowledge and utilization of radiotherapy. Results Of 400 distributed, 167 questionnaires were returned (41 percent). The major barrier to radiotherapy access was distance to regional radiation cancer centres. Only 37 percent of respondents felt very comfortable with treatment of pain and palliative care symptoms, and only 8.4 percent felt very knowledgeable about palliative radiotherapy. Most participants wanted to learn more about radiotherapy through smallgroup teaching, and different topics were suggested for such presentations. Two focus groups proposed five potential educational strategies. Conclusion Many respondents were unaware of the effectiveness of palliative radiotherapy for cancer patients; however, most would like to learn more about radiotherapy. The focus groups identified several ways to offer health-care providers in Simcoe-Muskoka up-to-date information about palliative radiotherapy.

Investigating student perceptions at an interprofessional student-run free clinic serving marginalised populations

ABSTRACT Many health profession schools have student-run free clinics (SRFCs), but their educational relevance has not been well studied. The aim of this study was to evaluate the learning experiences and skills developed among interprofessional healthcare students at an SRFC serving marginalised populations, in order to provide data for ongoing programme improvement and recommendations for other SRFCs based on lessons learned. Under 1:1 supervision with a preceptor, interprofessional students completed three clinical shifts at an SRFC and attended a reflection session. A total of 101 out of 105 participants answered semi-structured pre- and post-programme surveys (response rate: 96%). Descriptive statistics and descriptive thematic analyses were used for quantitative and qualitative data, respectively. Numerous skills derived from learning objectives common to many healthcare professions were addressed while participating at the SRFC. Valued programme elements included working with and learning about inner city populations in an interprofessional care model. Interprofessional SRFCs encourage student learning about resources for inner city populations and interprofessional collaboration while providing an opportunity to develop skills related to the formal curriculum. This may provide a workable strategy to address an interprofessional education gap in the healthcare professional curriculum.