Lisa Di Prospero

Educating our patients collaboratively: a novel interprofessional approach.

Providing cancer patients with more information regarding their treatments allows them to feel more in control, increases self efficacy, and can decrease anxiety. The aims of the present study were to develop an interprofessional group education session and to evaluate the usefulness and acceptability of this session. In addition, informational distress levels pre- and post-education were evaluated. A prostate radiation therapy (RT) education session was developed and facilitated by an interprofessional team. Topics discussed included how RT works, side effects and management, and support services available. Prior to the education session, participants reported their informational RT distress levels using the validated Distress Thermometer (DT). Post-education session, the DT was readministered. In addition, participants completed an acceptability survey to assess format, structure, and usefulness of the education session. Participants agreed that the session contained valuable and useful information helping them understand expectations during treatment, including resource availability, side effects and management, as well as procedural expectation during treatment. All stated they would recommend the session to other patients. The interprofessional nature of the sessions was deemed useful. Suggested areas for improvement included addition of a dietitian, information on long-term side effects, statistics of radiotherapy side effects, impact of radiotherapy on sexual function, and overall quality of life. The group education session significantly improved informational distress levels (p = 0.04). Educating prostate cancer patients utilizing an interprofessional group format can decrease anxiety and stress related to their RT treatment. Future development of group education sessions for other disease site groups may be valuable.

Opinions from the Experts: Exploring What Prostate Cancer Patients Should Know About Post-Operative Radiotherapy

The present study investigated health professionals’ opinions about important questions that should be discussed with patients who may require post-prostatectomy radiotherapy. A 74-question survey was conducted among radiation oncologists, urologists, nurses, and radiation therapists involved in the care of prostate cancer patients. Survey questions covered six domains: understanding my situation and prostate cancer diagnosis, making a decision, radiotherapy: procedures involved, potential benefits, side effects, and my support network during radiation treatment. Respondents rated the importance of addressing these questions as either essential, important, no opinion, or avoid with a hypothetical post-prostatectomy case. The majority of questions were rated as either essential or important. There was disagreement between professions on essential questions, mostly between nurses and urologists in the side-effects domain. There was agreement between all professions regarding which questions should be avoided.

To prep or not to prep - that is the question: A randomized trial on the use of antiflatulent medication as part of bowel preparation for patients having image guided external beam radiation therapy to the prostate

INTRODUCTION Radiation therapy is a standard treatment option for prostate cancer. With growing use of escalated doses and tighter margins, procedures to limit rectal size variation are needed to reduce prostate motion, increase treatment accuracy, and minimize rectal toxicity. This prospective study was done to determine whether the introduction of an antiflatulent medication would decrease rectal distention at computed tomography (CT) simulation and throughout a course of radiation therapy. METHODS AND MATERIALS Patients undergoing a radical course of radiation therapy to the prostate/prostate bed were eligible to participate. Participants were randomly assigned to the intervention arm (antiflatulent medication) or the control arm (no medication). For each participant, the number of CT simulation rescans was recorded. Rectal diameters were measured on CT simulation and treatment cone beam CT scans. Acute rectal toxicities were assessed at baseline and weekly using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0. A χ2 analysis was used to compare the number of participants requiring a rescan in each study arm. Change in rectal diameter over time was assessed using repeated measures analysis of variance. RESULTS A total of 78 patients participated, with equal numbers assigned to each study arm. There was no significant difference between arms in the number of participants requiring a CT simulation rescan (P = .5551). There was no significant variation in rectal diameter between arms (P = .8999); however, there was a significant effect of time (P = .0017) and a significant interaction effect between study arm and time on rectal diameter (P = .0141). No acute rectal toxicities above grade 2 were reported. CONCLUSIONS The addition of antiflatulent medication did not affect the frequency of CT simulation rescans. Both time and the interaction between study arm and time had a statistically significant effect on rectal diameter, although neither finding was clinically significant. Instead, standardized bowel preparation education developed for this study may have been sufficient to limit rectal size variation.

The National Landscape: A Pain Needs Assessment Survey of Radiation Therapists

Background: Pain is considered a serious symptom of cancer and can significantly affect a patient’s quality of life. The inadequate ability to identify and manage a patient’s pain can lead to patients suffering needlessly. The purpose of this study was to gain insight into the current knowledge of pain concepts and pain management among Radiation Therapists (RTs) spanning all provinces of Canada. Methods: A needs assessment survey comprising an eight topic questionnaire pertaining to pain management was distributed to RTs across Canada. A total of 273 RTs across 10 provinces, responded. Survey topics were ranked using a four-point Likert scale based on preference for further education, familiarity, and relevance to practice. Results: RTs rated topics pertaining to screening for addiction/misuse, prescription drug diversion and opioids and the College (regulations) as the most preferred topics requiring further education and subsequently also indicating they were most unfamiliar with those topics. The assessment and diagnosis (acute, chronic and cancer pain), treatment (acute, chronic and cancer pain) and the under treatment of pain were identified as the most relevant to practice yet the least preferred for further education. Breakthrough cancer pain was indicated as the most preferred for further education. Holding in-services or completing on-line courses were identified as the preferred format preferences for acquiring knowledge of the identified deficiencies. Conclusion: Implementation of an educational intervention for RTs to address gaps in supporting pain management for cancer patients is beneficial to improve patient care. Topics pertaining to pain as it relates to scope of practice as well as topics most relevant to ‘their’ patients should remain a priority when addressing a provincial education strategy for RTs.