Radiography (2008) 14, 111e119

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Mixed messages? A comparison between theperceptions of radiation therapy patients andradiation 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 2006Available online 2 November 2006

KEYWORDSRadiotherapy;

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Patient education;Professional’sopinions;Patients’opinions;Educational topics;Educational delivery

This article builds on work previourmission. Part of the original researTel.: þ1 416 946 4501x4857; fax: þE-mail address: amanda.boldersto

78-8174/$ - see front matter ª 200i:10.1016/j.radi.2006.09.001

Abstract Objectives: The purpose of this study was to discover and compare radiationtherapy patients’ and radiation therapists’ perceptions of patients’ educational topics of inter-est 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 pa-tients 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 methodsof informational delivery (for example, ‘‘Watching video tapes’’) in order of preference.Results: Results indicated several differences in therapists’ and patients’ perceptions of boththe educational topics of interest and methods of information delivery. Among other things,patients assigned high importance to after treatment issues (‘‘What happens after radiationtherapy is finished’’) and how radiation therapy works, these areas were not seen as importantby the studied therapists. Patients expressed a strong preference for receiving informationabout radiation therapy from their family doctor (ranked third), therapists ranked this sourceof information as the least important.Conclusion: It is vital to tailor educational interventions according to the patient’s preferenceto optimize both understanding and compliance. This study demonstrated noteworthy differ-ences in several areas between therapists’ and patients’ perceptions. Recommendations there-fore include raising therapist’s awareness of topics that are important to patients andmeaningful informational delivery methods.ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

sly published in the Canadian Journal of Medical Radiation Technologists,27 which is reproduced withch was carried out for a Master of Science degree at Anglia Ruskin University.1 416 946 2019.

n@rmp.uhn.on.ca

6 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

112 A. Bolderston

Introduction the previous results from radiation therapy patients with

Patient education (information provision) is an effectivestrategy for alleviating psychosocial problems (such asstress and anxiety) in cancer patients.1,2 Many patients ac-tively seek information, and studies show consistently highinformational needs amongst radiation therapy patients,3e6

although patients vary in both how much they want to knowand the types of information they want.7 In addition, pa-tients’ desire for information may change during the courseof their illness.8 Radiation therapy can cause additionalanxiety and stress for cancer patients9 and patient educa-tion, therefore, is typically focused on increasing knowl-edge of the treatment process7,10 as well as expectedside effects and their management.11

In general, an effective patient education program mustbe culturally sensitive and incorporate different teachingstrategies, methods and media (such as one-to-one teach-ing, written material, group sessions and electronic media)to accommodate a variety of learning styles and improveaccess and information recall.12e16 However, despite theknowledge that providing patients with information hasmany benefits, there is evidence that patients are oftendissatisfied with the amount of information they receiveand the format(s) available.17,7 In addition, studies haveshown that patients’ retention of information is often lessthan optimal.18,19

Radiation therapists educate and counsel patients ona daily basis. The settings may vary from individual in-teractions with patients and family to group teachingsessions. In addition, therapists are often involved in thedevelopment of teaching materials such as booklets,pamphlets and, increasingly, multimedia resources.

Factors that influence the type and amount of informa-tion patients receive include the preferences and percep-tions of the healthcare professionals who are responsiblefor teaching them. Although there is limited informationavailable from the medical radiation sciences, the nursingliterature demonstrates that nurses are not always correctwhen asked to anticipate their patients’ needs and prefer-ences. Studies have been conducted to examine nurseepatient congruence in areas such as patients’ emotionaldistress, primary areas of current concern, physical andemotional needs, and quality of life.20e24 Results clearlyshow that nurses’ perceptions may not align with those oftheir patients in these important areas. These studies alsodemonstrate that nurses may teach/care based on theirown professional interests (which may be primarily techno-logical, highly empathetic, etc.) and not based on theneeds of their patients. Research that examines patientteaching also reveals significant differences in perceptionbetween nurses and cancer patients’ of patients’ educa-tional needs.25,26,10

The hypothesis of this study is, therefore, that radiationtherapists might also be incorrect in their assessments oftheir patients’ educational needs. This research builds onresults presented in a previous study27 where the primaryobjective was to identify any gaps in service in a depart-ment’s radiation therapy education program by gatheringinformation on what patients want to know and how theyprefer to receive this information. This paper compares

data gathered concurrently from radiation therapists usingthe same survey instrument.

Study population and methods

The two-study populations consisted of patients undergoingtreatment and radiation therapists at a large urban Cana-dian cancer centre treating about 4000 patients per year.After appropriate institutional ethics approval was grantedfor this study, the survey instruments (which consisted oftwo similar versions of a self-administered questionnaire)were distributed to both groups.

For both groups the nature of the survey was explainedin the cover letter, along with the fact that the completionof the survey was voluntary and responses would beanonymous. Patients were also assured that non-comple-tion would not affect their treatment. Consent was impliedwith the return of the survey.

Group one: patients

The first subject population for this study were patientsreceiving radiation therapy. Exclusion criteria were asfollows:

� Patients who were too sick to complete the study (thisincluded 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 onarrival by reception staff during one treatment day (10 h).

Group two: radiation therapists

Two weeks after the survey was administered to the patientpopulation, the second survey (a self-administered ques-tionnaire) was sent to all of the radiation therapists workingin the centre. Demographic information collected includedyears qualified, gender and professional education.

Survey instrument

The survey instruments were two versions of the same self-administered questionnaire.

Version 1: patient surveyThe original format for this questionnaire was based ona modified version of the Toronto Informational NeedsQuestionnaire6 developed for use with breast cancer pa-tients. The redesigned survey was tested using severalsemi-structured face-to-face interviews with a group of vol-unteers from a peer-support cancer group who had re-ceived radiation therapy in the past. Content validity ofthe questionnaire was assessed using the collective profes-sional experience of several oncology nurses, radiationtherapists and radiation oncologists. The survey was pilotedwith a group of patients and radiation therapists; severalrevisions were subsequently made to correct ambiguity.

Table 1 Patient demographic variables for age, sex andeducationa (N Z 174)

Variable Category Result (percent)

Age 16e30 231e40 741e50 651e60 2561e70 3371e80 2381e90 4Over 90 1

Gender Female 53Male 47

Education No school 2<8 yearsformal schooling

9

Some high school 16Completed high school 31University or college 41

a Nine patients did not fill out this section of the survey.

Breast (64)

Pelvis (58)

Head & Neck (20)

Chest (15)

Abdo (10)

Brain (7)

Bone (6)

Other (4)

Figure 1 Patient demographic variables for treatment site(N Z 174) (some patients chose more than one category).

Comparison between the perceptions of radiation therapy patients and radiation therapists 113

The first section (Section A) consisted of 15 questionswith a stem of ‘‘During my radiation therapy it is importantfor me to know.’’ followed by 15 items such as ‘‘What itfeels like to have treatment’’. The respondent rated thesewith 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 ofreceiving information based on a list of 11 methods (‘‘Iwould like information on my treatment by.’’). There wasalso a section inviting patients to comment in both of theseareas. Finally, there was a request for demographicinformation.

Version 2: therapist surveyThe second (therapist) version of the survey was identicalexcept for 2 things. Firstly the words ‘‘me’’ and ‘‘I’’ in thefollowing stems ‘‘During my radiation therapy it is impor-tant for me to know.’’ and ‘‘I would like information onmy treatment by.’’ were replaced by the words ‘‘pa-tients’’ and ‘‘the patient,’’ respectively, thus asking ther-apists what they feel patients want. Secondly, thedemographic section was different as discussed above.

Results

Patient demographics

The total subject population on the day of the survey was324 patients. One hundred and eighty-three surveys werecompleted and returned, which was a response rate of 56%.In an attempt to ensure the respondents were a represen-tative cross section of the subject population, demographicinformation gathered included, level of education, age,gender (Table 1) and treatment site (Fig. 1).

The demographic information was compared to theprofile of the usual patient population at the cancer centreand indicated no significant gaps in population variables.

The respondents were most commonly of the age group61e70 (33%) and most patients had attended university orcollege (41%). There were 81 males (47%) and 93 females(53%) in the group.

Information on treatment site was also gathered; themajority of patients were having radiotherapy to the breastand pelvis followed by radiotherapy for head and neckcancer. This reflects the typical patient population of thecentre.

Radiation therapist demographics

The total subject population on the day of the survey was77 therapists. Forty-two surveys were completed andreturned (55%). Experience of the respondents was roughlyevenly spread from 1 to 20þ years and the most commonhighest educational level was a bachelor’s degree (30therapists). There were 7 males (17%) and 35 females(83%) in the group. Figs. 2 and 3 show the demographicdata in more detail.

Once again, the results were compared to the depart-mental profile of radiation therapists working at the centre.The results indicated no significant gaps in populationvariables in the areas examined.

What patients want to know (Section A)

Table 2 shows the radiation therapist and patient rankingsfor Section A, ‘‘What Patients Want to Know’’. The twomain topics of interest for patients were both related toside effects: specifically ‘‘what are the side effects’’(ranked first), and ‘‘how to manage side effects’’ (rankedjoint second). Also extremely important for patients was‘‘what happens after radiation therapy is finished’’ (rankedjoint second). Patients also wanted to know ‘‘how radiationtherapy’’ works (ranked third) and desired procedural in-formation on ‘‘how long will I be coming’’ (fourth), ‘‘whatit feels like to have treatment’’ (fifth) and ‘‘what theyshould do to prepare for treatment’’ (sixth).

Therapists identified the same two primary topics ofinterest as the patient group (‘‘what are the side effects’’and ‘‘how to manage side effects’’), although the therapistrankings were reversed. However, the therapists’ jointthird topics of choice were ‘‘how long will I be coming for

1 to 3 yrs (7%)

4 to 6 yrs (21%)

7 to 10 yrs (17%)

11 to 15 yrs (12%)

16 to 20 yrs (17%)

20 yrs + (26%)

Figure 2 Therapist demographic variables for experience(N Z 42).

114 A. Bolderston

treatment’’ and ‘‘if I can work during treatment’’. Topicfive was ‘‘what it feels like to have treatment’’, followedby ‘‘what should I eat’’.

How patients want to receive information(Section B)

For patients, one-on-one teaching with a healthcare pro-fessional was the most popular way to receive information.This option was more than twice as popular as the nextoption, which was written information. Talking to theirfamily doctor was the patients’ third most popular choice,followed by video tapes, talking to other patients infor-mally and a visit to the radiotherapy department.

Least popular choices were phone information servicesand listening to audio tapes.

In the radiation therapists’ group, the most popular twochoices were the same as the patients’ choices, namelyone-on-one teaching with a healthcare professional fol-lowed by written information. The therapists’ third choicewas video tapes, followed by talking to other patients insmall groups, talking to other patients informally andusing the Internet. Least popular choices were also thesame as the patients, namely using phone informationservices and listening to audio tapes. Table 3 illustratesthe comparative radiation therapist and patient rankingsfor Section B.

BSc (30)

Diploma only (8)

Post graduate (2)

Advanced Certification (5)

Figure 3 Therapist demographic variables for professionaleducation (N Z 42).

Study limitations

Limitations of this study include the following:

� Patients have different informational needs at differenttimes in their treatment. This was a cross-sectionalrather than longitudinal study and no attempt wasmade to determine at what point patients were in theirtreatment, or to correlate needs to time.� This survey was only available in English.� Patients with limited literacy were also excluded, as

the survey is self-administered.� There was no attempt to identify the population of pa-

tients who did not return the survey to compare themwith those who did return it. This could have beenaccomplished using coded surveys and access to thepatients’ charts.� This is a preliminary investigation of this topic e more

detailed statistical analysis could be performed on thedata in the future.

Discussion

What patients want to know (Section A)

Table 4 demonstrates the ranking differences betweentherapists and patients in their choice of what patientswant to know. Many areas were similarly ranked, includingthe top 2 patient choices of ‘‘what are the side effects’’,and ‘‘how to manage side effects’’. This is reassuring andhopefully indicates that therapists give these topics highpriority when teaching and supporting patients on treat-ment. This is very consistent with the literature,28 asmany patients desire information about active managementand practical issues when facing the treatment experience.Educating patients about supportive care is a standard ofpractice for radiation therapists and legally mandatedwith the practice of informed consent.

Areas where there was a considerable difference ofopinion between therapists and patients include thefollowing:

1. ‘‘If I can work during treatment’’: This was rankedthird by therapists and fourteenth by patients. Thismay reflect the average age of the patient group (themajority of which were over 61 years old), many ofwhom may have been retired or semi-retired. In manystudies it has been demonstrated that care tends tobe given from the provider’s point of view.20e24 In thiscase, the therapists may have been projecting whatwould be of primary importance for them during a pro-tracted course of treatment e earning money to sup-port growing families, pay the mortgage, etc.Therapists may have viewed continuing to work as im-portant for their quality of life, whereas patients mayhave been primarily concerned with the health crisispresented by their cancer diagnosis, daily treatmentschedules, their associated travel and financial implica-tions, etc.

2. ‘‘How radiation therapy works’’: This topic was ratedas highly unimportant by therapists (ranked last) and

Table 2 What patients want to know (Section A)

Therapists (n Z 42) Patients (n Z 183)

1. How to manage side effects 3.98 1. What are the side effects 3.612. What are the side effects 3.95 2. How to manage side effects 3.593. How long will I be coming 3.64 3. What happens after radiation therapy is finished 3.594. If I can work during treatment 3.62 4. How radiation therapy works 3.385. What it feels like to have treatment 3.57 5. How long will I be coming 3.366. What should I eat 3.55 6. What it feels like to have treatment 3.347. What should I do to prepare 3.52 7. What should I do to prepare 3.338. Who can I talk to 3.5 8. Who can I talk to 3.329. What happens after radiation therapy is finished 3.48 9. Who will I see in the clinic 3.2310. Complementary therapies 3.24 10. Managing my other health concerns 3.2211. What other services are available 3.24 11. How radiation therapy is planned and delivered 3.1512. Managing my other health concerns 3.21 12. What should I eat 3.1513. Who will I see in the clinic 3.0 13. Complementary therapies 3.0814. How radiation therapy is planned and delivered 2.76 14. If I can work during treatment 2.6315. How radiation therapy works 2.73 15. What other services are available 2.53

Comparison between the perceptions of radiation therapy patients and radiation therapists 115

important by patients (ranked fourth). Therapists mayshy away from an explanation of how radiation therapyworks for various reasons; we could speculate that timefor patient interactions is limited and such an explana-tion may be lengthy and thus not a high priority whenthere is so much to cover. Additionally, therapistsmay perceive that the patient may not understandthe underlying concepts or related terminology. How-ever, the literature tells us that patients benefit fromreceiving cognitive information,29 which includes the‘‘how’’ and ‘‘why’’ of a situation, in addition to behav-ioural information (actions to be performed in a situa-tion) so it is unsurprising that patients prioritised‘‘how radiation therapy works’’ so highly.

3. ‘‘What happens after radiation therapy is finished’’:Issues of survivorship (including both psychosocial andinformational needs) have been demonstrated as beingextremely important to patients,30,31 and this groupranked the topic as joint second. Conversely the radia-tion therapists ranked this as ninth. Therapists doaddress post-radiation therapy issues. In many depart-ments there is a ‘‘last day teaching’’ session wherepatients may be given a follow-up appointment, sideeffects management strategies are reiterated andcontact information may be given to cover the period

Table 3 How patients want to receive information (Section B)

Therapists (n Z 42) Number

1. Talking to doctors, radiation therapists etc. 402. Reading patient education material 283. Watching video tapes 174. Talking to other patients in small groups 115. Talking to other patients informally 106. Looking on the Internet 87. Researching on my own 58. An organized visit to the centre 39. Talking to my family doctor 110. Audio tapes 011. Phone information 0

before the first follow-up appointment with the physi-cian. However, these issues are often not integratedinto the day-to-day interaction between therapist andpatient and may need to be given a higher priority.

4. ‘‘What should I eat’’: For therapists, an important partof the discussion on side effects is often dietary modi-fications for symptoms such as dysphagia or diarrhoea.It is unsurprising therefore that the therapists rankedthis topic relatively highly. Patients were, however,less concerned with dietary advice. This may be be-cause patients are not aware that managing diet mayhelp ameliorate certain symptoms, so may not rankthis as particularly important. In addition, the largestgroup of patient survey respondents were patientswith breast cancer. This group would have less treat-ment-induced side effects that may be affected by di-etary modifications.

5. ‘‘What other services are available’’ and ‘‘Who will Isee in the clinic’’: For therapists, making appropriatereferrals and ensuring patients have access to availablesupport is extremely important. Radiation therapistswork within a multidisciplinary team and patients canbenefit from the expertise of all team members. Allof these topics involve ‘‘outside’’ resources and sup-port. However, these did not seem to be as important

Patients (n Z 183) Number

1. Talking to doctors, radiation therapists etc. 1642. Reading patient education material 753. Talking to my family doctor 664. Watching video tapes 455. Talking to other patients informally 436. An organized visit to the centre 347. Looking on the Internet 298. Talking to other patients in small groups 289. Researching on my own 1510. Phone information 911. Audio tapes 4

Table 4 Ranking differences between radiation therapists and patients for Section A (What patients want to know)

Question Therapistsrank (n Z 42)

Patientsrank (n Z 183)

Difference in rank

If I can work during treatment 3 14 11How radiation therapy works 15 4 11What happens after radiation

therapy is finished9 2 7

What should I eat 4 11 7What other services are available 10 15 5Who will I see in the clinic 13 9 4Complementary therapies 10 13 3How radiation therapy is planned . 14 11 3Managing my other health concerns 12 10 2How long will I be coming 3 5 2What it feels like to have treatment 5 6 1What are the side effects 2 1 1How to manage side effects 1 2 1Who can I talk to 8 8 0What should I do to prepare 7 7 0

116 A. Bolderston

for patients. There may be several reasons for this. Thesupport services in this particular department may havebeen previously discussed with the patients (prior tothe commencement of treatment) or may be well ad-vertised/signposted, thus patients may feel that theyhave ample information about them. In addition, thepatient group sampled may have felt well cared forby their primary care team and may not have felt theneed for supplemental support.

There are relatively few studies looking specifically ata comparison between patients and healthcare profes-sionals perceptions of educational content in the radiationtherapy realm. In addition, it is hard to make directcomparison with existing studies due to different samplepopulations, different survey instruments and other fac-tors. However, a review of the available literature isimportant to place the data gathered in this study inperspective.

An early study conducted by Lauer et al.25 comparednurse and oncology patients’ perceptions of learning needsand found that nurses and patients did not have the samepriorities for patient learning. Lauer’s study populationwas dissimilar to the present group; they studied inpatientsreceiving chemotherapy and/or radiation therapy. How-ever, the authors did break down the results and presenta small subset (n Z 9) of patients receiving radiation ther-apy separately. In this subset, both radiation therapypatients and nurses ranked information about the purposeof radiation therapy as most important (which may be con-sistent again with ‘‘how radiation therapy works’’). Nursesranked ‘‘skin care’’ and ‘‘potential side effects’’ as secondand third, respectively, while patients ranked side effectsequally with more procedural information such as ‘‘sched-ule for receiving information’’ and ‘‘length of time forreceiving information’’.

Eardley,32 asked staff in a radiation therapy department(including nurses, therapists, physicians, porters and recep-tionists) what they felt would be important to patients.

Results were fairly consistent with this study (althoughthe categories were different); the top choice was side ef-fects information followed by procedural information(‘‘does radiotherapy hurt’’ and ‘‘how long is the treat-ment’’). Tied in last ranking was ‘‘what is radiotherapy’’,which could be considered the same category of the four-teenth ranked category ‘‘how radiation therapy works’’.

Skalla et al.26 used a qualitative methodology to deter-mine the preferences of patients with cancer and theirneed for information about the side effects of cancer treat-ment (chemotherapy and/or radiation therapy). They dis-covered that patients undergoing active treatmentdesired information about the process of getting treat-ment, specific side effects that might occur, and the impactof treatment on their lives.

In a recent Italian study looking at early-stage prostatecancer patients receiving radiation therapy, Capirci et al.10

found that the information priorities of healthcare profes-sionals (radiation therapists, nurses and physicians) weremore similar to each other than they were to the prioritiesof the patients. However, the priorities were most similarbetween patients and radiation therapists e the authorsspeculated that this is because ‘‘of the three professionalgroups, the RTs spend most time with the patients’’(p. 179).

How patients want to receive information(Section B)

Currently a combination of information provision (verbaland printed) with support from healthcare professionalsis considered ‘good clinical practice’. This enables thehealthcare professional to respond according to anindividual patient’s information needs.13

There have been a plethora of studies investigatingthe acceptability and effectiveness of using many ofthe above mentioned methods of educational delivery,

Comparison between the perceptions of radiation therapy patients and radiation therapists 117

including video, written information and audio tapes amongothers.12e16

Table 5 demonstrates that the majority of methods werecongruent between the two groups, most notably the topranked item, talking to healthcare professionals. Studieshave demonstrated that patients overwhelmingly prefer in-teractive, interpersonal communication with a healthcareprofessional. In addition, the prevailing second preferreddelivery method was print materials to support and en-hance the one-on-one discussion(s). Healthcare profes-sionals identified by radiation therapy patients to deliverinformation in previous studies were nurses, radiation ther-apists and physicians.33e36

Noticeable differences of opinion between patients andradiation therapists were demonstrated in the followingareas:

1. Talking to my family doctor: This was ranked as thirdby patients but ranked ninth by therapists. It may bethat radiation therapists do not consider family physi-cians when it comes to provision of information. How-ever, radiation therapy follow-up care is increasinglybecoming part of family physicians’ practices. Ser-geant37 has reported that family physicians wish toplay a larger role in their cancer patients’ care andhave significant learning needs in this area, althoughimportant practice and systemic challenges toimproving care exist.

2. Talking to other patients in small groups: Therapistsranked this as fourth, but patients ranked this aseighth. Educational programs involving groups of pa-tients and their families have been proven to be a usefultool in providing both information and psychosocial sup-port to patients receiving radiation therapy.38 In addi-tion, this method can be an economical use ofresources and can help patients learn from each other’sexperiences. However, group teaching may not be thepreferred option for some patients who may be uncom-fortable in such settings.

The other methods detailed in this survey are readilyavailable at many cancer centres and form part of theeducational ‘‘menu’’ for patients. Differing methods aresuitable for patients with different learning styles, English

Table 5 Ranking differences between radiation therapists ainformation)

Method Therapists rank

Talking to my family doctor 9Talking to other patients in small groups 4Researching on my own 7An organized visit 8Watching video tapes 3Looking on the Internet 6Audio tapes 10Phone info 11Talking to doctors, radiation therapists, etc. 1Reading pt ed material 2Talking to other patients informally 5

comprehension and limitations in processing capacity. Thisincludes, for example, patients who are fatigued or are inpain who may have attention deficits.39 Studies have shownthat orientation visits, videos, internet research, audiotapes, etc., can reinforce verbal and written information,as well as increase retention and satisfaction with informa-tion provision.13,19,40e42

Conclusion

There were many areas of congruence between therapistsand patients in both content of education and method ofeducational delivery demonstrated in this study. However,there were also a few areas of notable disagreement, whichis a concern. This may mean that when therapists interactwith patients they concentrate on areas that are not ofinterest to the patient.

Patients’ education needs vary considerably, not onlyin what they want to know (and how they prefer thisinformation to be delivered) but how much informationthey feel comfortable receiving. In addition to this wehave seen that therapists may utilise methods or addresstopics that are not a high priority with patients. Caprici’srecent study10 found a large amount of variability in thetypes of information deemed important by patients andconcluded that setting a standard ‘curriculum’ for patienteducation will not meet the needs of many patients. Theauthors conclude ‘‘meeting the subjective standard .willdemand both extra time and effort in order to determinewhat is important for each individual patient’’ (p. 180).In reality, though, there are usually a few core issuesthat radiation therapists deem essential for each patientto know, for example, what side effects to expect andhow to deal with them (or where to go for extra informa-tion when symptoms manifest). It may be more realisticto produce a short list of mandatory items to discusswith patients and leave time to address specific pa-tient-centred issues and questions. We can help by askinga few key questions as we teach and support patients(such as ‘‘what would you like to know about today?’’or ‘‘what are your concerns at this moment?’’).

Information retention can be improved in several ways.Patients who are happy with their teaching retain more

nd patients for Section B (How patients want to receive

(n Z 42) Patients rank (n Z 183) Difference in rank

3 68 49 26 24 17 1

11 110 11 02 05 0

118 A. Bolderston

information than those who feel their concerns are ignoredor minimised. Using multiple teaching episodes with a vari-ety of different methods (e.g. one-on-one teaching sup-ported by written information) also improves retention.Time is at a premium in a busy radiation therapy de-partment. However, we have seen that patients relyprimarily on healthcare professionals for their informationneeds. It is therefore vital to build this teaching time intodaily schedules. In addition, supporting written informationshould be readily available and up to date. Evaluatingpatient comprehension and satisfaction is very important.This can be as straightforward as checking understandingwith simple questions, or a more rigorous analysis with atool such as a questionnaire.

The patient population in this study was a cross sectionthroughout the treatment course. This will have influencedthe results, as patients have different needs for informa-tion at different times throughout treatment. Informationalneeds tend to be high in radiation therapy patients,especially at the beginning of a course of treatment,43 al-though Harrison et al.3 demonstrated consistently highneeds until the last day of treatment. Adults become readyand receptive to new learning when they experience a needto learn to cope with immediate problems or issues.44 Inaddition, a study by D’Haese et al.45 demonstrated thatprovision of patient information in a stepwise format couldlead to less treatment-related anxiety and improve patientsatisfaction. It is fairly common practice to have severaltimes during treatment reserved for patient teaching,such as prior to simulation, first day of treatment, lastday, etc. However, patients may need to hear more aboutside effects management (for example) around the secondweek of treatment, or may be more amenable to hearingabout ‘‘what happens next’’ a week or so beforecompletion, etc.

Patient education for radiation therapy patients canfulfil three important functions. It can increase thepatient’s sense of control by allowing them to activelyparticipate in their treatment, it can reduce anxiety andhelp the patient to prepare and deal with treatment andrelated side effects.34 By tailoring our informationalcontent and delivery method to the patient’s preference(as opposed to our own) we can optimise the positiveoutcomes of this important aspect of patient care.

Acknowledgements

The author would like to thank Cathryne Palmer and LoriHolden for their editing help, and the staff and patients atToronto-Sunnybrook Regional Cancer Centre where theresearch took place.

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