Prospective Pilot Study to Measure Baseline Radiation Knowledge Prior to Radiotherapy After Standard Education at Consultation

Abstract

Background Pre-operative patient education has been shown to reduce patient anxiety and increase patient medical comprehension. This prospective pilot study hypothesized that patient knowledge related to the radiotherapy treatment process would be low after receiving traditional radiation educational materials and counseling at the time of initial consultation. Methods Patients with non-metastatic cancer receiving definitive or adjuvant radiotherapy at three suburban radiation therapy clinics affiliated with an academic medical center completed a 34-question survey. Patients received traditional radiation educational materials. The survey included questions on demographics, the Spielberger State-Trait Anxiety Inventory short-form (STAI-S-6), a modified radiotherapy Amsterdam preoperative anxiety and information scale (mRT-APAIS), and radiotherapy knowledge. Patients also provided qualitative responses. Surveys were administered prior to the patient's CT-simulation scan. Descriptive statistics were performed. Results 22 patients were enrolled in this prospective pilot study. 19 (86%) patients were female. The median age was 66 (range: 38-80). 14 (64%) patients were white, 7 (32%) black, and 1 (4%) American Indian/Alaskan Native. 6 (27%) patients received a high school degree or GED, 10 (46%) obtained a 2-year degree and 5 (22%) received a 4-year degree or higher. 16 (73%) patients had breast cancer with the others having lung, brain, gastrointestinal, gynecologic, or other malignancies. The median radiotherapy knowledge score was 35.0 [IQR: 31.0 - 39.5] and 58% of patients endorsed low overall radiotherapy knowledge (score < 35). Patients reported low levels of knowledge related to radiotherapy set-up (41%), immobilization (41%), x-ray use (64%), and sensation (tactile 41%, auditory: 59%). The median STAI-S-6 score was 43.3 [IQR: 36.7 - 46.7] and the median mRT-APAIS score was 18 [IQR: 14.8 - 20.0]. 68% of patients were "anxious" by STAI-S-6 (score ≥ 40) and 77% by mRT-APAIS (score ≥ 12). Discussion A majority of patients reported low levels of knowledge related to the radiotherapy treatment process prior to CT simulation. These findings suggest an educational intervention at the time of consultation may be beneficial to reduce patient anxiety and increase patient knowledge related to the radiotherapy treatment process. Accrual is ongoing in this prospective pilot study. Future research directions include a phase 3 multi-institutional stepped-wedge clinical trial to investigate the impact of a novel patient education tool such as the Communicating the External Beam Radiotherapy Experience (CEBRE) discussion guide used during initial consultation to reduce patient anxiety and increase patient knowledge about radiotherapy. Pre-operative patient education has been shown to reduce patient anxiety and increase patient medical comprehension. This prospective pilot study hypothesized that patient knowledge related to the radiotherapy treatment process would be low after receiving traditional radiation educational materials and counseling at the time of initial consultation. Patients with non-metastatic cancer receiving definitive or adjuvant radiotherapy at three suburban radiation therapy clinics affiliated with an academic medical center completed a 34-question survey. Patients received traditional radiation educational materials. The survey included questions on demographics, the Spielberger State-Trait Anxiety Inventory short-form (STAI-S-6), a modified radiotherapy Amsterdam preoperative anxiety and information scale (mRT-APAIS), and radiotherapy knowledge. Patients also provided qualitative responses. Surveys were administered prior to the patient's CT-simulation scan. Descriptive statistics were performed. 22 patients were enrolled in this prospective pilot study. 19 (86%) patients were female. The median age was 66 (range: 38-80). 14 (64%) patients were white, 7 (32%) black, and 1 (4%) American Indian/Alaskan Native. 6 (27%) patients received a high school degree or GED, 10 (46%) obtained a 2-year degree and 5 (22%) received a 4-year degree or higher. 16 (73%) patients had breast cancer with the others having lung, brain, gastrointestinal, gynecologic, or other malignancies. The median radiotherapy knowledge score was 35.0 [IQR: 31.0 - 39.5] and 58% of patients endorsed low overall radiotherapy knowledge (score < 35). Patients reported low levels of knowledge related to radiotherapy set-up (41%), immobilization (41%), x-ray use (64%), and sensation (tactile 41%, auditory: 59%). The median STAI-S-6 score was 43.3 [IQR: 36.7 - 46.7] and the median mRT-APAIS score was 18 [IQR: 14.8 - 20.0]. 68% of patients were "anxious" by STAI-S-6 (score ≥ 40) and 77% by mRT-APAIS (score ≥ 12). A majority of patients reported low levels of knowledge related to the radiotherapy treatment process prior to CT simulation. These findings suggest an educational intervention at the time of consultation may be beneficial to reduce patient anxiety and increase patient knowledge related to the radiotherapy treatment process. Accrual is ongoing in this prospective pilot study. Future research directions include a phase 3 multi-institutional stepped-wedge clinical trial to investigate the impact of a novel patient education tool such as the Communicating the External Beam Radiotherapy Experience (CEBRE) discussion guide used during initial consultation to reduce patient anxiety and increase patient knowledge about radiotherapy.