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Development and psychometric testing of an instrument to measure the patient’s experience of external radiotherapy: The Radiotherapy Experience Questionnaire (RTEQ)
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.ORCID iD: 0000-0002-4977-1434
Department of Care Sciences, Faculty of Health and Society, Malmö, Sweden.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University/Austin Health Clinical School of Nursing, Melbourne, Australia.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Abstract

The patient’s perception of radiotherapy (RT) procedures and equipment is important to evaluate as a complement to endpoints such as treatment outcome and reproducibility. There is a lack of a proper, psychometrically robust instrument to evaluate the patient’s comfort and experience of the RT procedure. Hence, this study aimed to develop and test an instrument to measure the patient’s experience during external RT.

 

Material and Methods

A preliminary 34-item questionnaire was generated from research literature, expert consultations and patient interviews, and it was distributed to patients (n = 825) at 8 RT units in Sweden. The answers were subjected to item analysis and reduction by using exploratory factor analysis. The reliability of the final questionnaire was evaluated using Cronbach´s alpha. Mean scale scores were compared across gender, length of RT and treatment area.

 

Results

Most items were highly skewed towards positive responses. Scree plot analyses of the 34-timen correlation matrix identified six underlying themes explaining 68% of the total variance. After item reduction, the 6 themes explained 73% of the variance in a 23-item questionnaire.  Cronbach´s alpha was satisfactory for all themes (between 0.79 and 0.9). Significant differences between treatment areas were found for two scales: situational discomfort and situational coping.

 

Conclusion

The RT Experience Questionnaire is a tentatively valid and reliable instrument to measure how patients experience the RT session process and the environment in the treatment room.

Keyword [en]
patient experience; radiotherapy; questionnaire; instrument
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
URN: urn:nbn:se:umu:diva-127452OAI: oai:DiVA.org:umu-127452DiVA: diva2:1046327
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2016-11-14
In thesis
1. Patient experiences of the radiotherapy process and treatment
Open this publication in new window or tab >>Patient experiences of the radiotherapy process and treatment
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory. RT is often associated with unfamiliar procedures where the technical environment, side effects and interaction with staff seem to play a major role in the patient’s treatment experience. These experiences could sometimes lead to disruption of the treatment which may have negative consequences for the outcome. The overall aim of this thesis was to gain further knowledge about how patients experience RT and the related processes. Such knowledge is of vital importance when developing and improving care within a high-tech RT environment.

Aim

The overall aim of this thesis was to gain further knowledge about how patients experience RT and the related processes. Such knowledge is of vital importance when developing and improving care within a high-tech RT environment.

Methods

To gain further knowledge and understanding about patients experience of RT both quantitative (I, II, III) and qualitative (III, IV) methodology were used. The data in the thesis focused on patients undergoing external RT at different RT units in Sweden. Study I and II, focused on two regions, the northern region of Sweden and the region of Stockholm and Gotland.  Study III and IV were performed at eight different RT units in Sweden.

Results

In Study I, two types of topical agents (Calendula Weleda cream vs. Essex cream) were compared regarding reducing the risk of severe acute radiation skin reactions (ARSR). No difference in severe ARSR was found between the groups and the patients reported low levels of ARSR. In Study II, the influence of an RT unit’s psychosocial climate and treatment environment on cancer patients’ anxiety during external RT was evaluated. Data was collected (questionnaire) from 892 patients. The results showed that both the treatment environment and the psychosocial climate of the RT unit significantly impacted cancer patient anxiety levels. In Study III & IV, a questionnaire to measure the patient´s experience during external RT was developed and tested. The results showed that the RT Experience Questionnaire (RTEQ), with 23 items, was a tentatively valid and reliable instrument to measure how patients experience the RT process and the environment in the treatment room. In Study IV, written comments from the open-ended question “Is there anything else you want us to know?” in the preliminary RTEQ was analysed with qualitative content analysis. This data was abstracted into the following four major categories reflecting the experience of the RT process:  Experiences in the high tech RT environment; Understanding the RT procedures and side effects; Dealing with daily life during RT and The nurses’ role and performance.

Conclusion

The RT environment and the RT related processes seem to impact cancer patients, both physically and psychologically. A person-centered care approach, as well as attention to the design, both of the treatment process and the physical environment could significantly improve the patient experience and patient involvement. The results also highlight the importance of taking patient experiences into account when introducing new RT methods and techniques.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 52 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1860
Keyword
Cancer, radiotherapy, radiation skin reactions, patient experience, treatment environment, anxiety, person-centred care, questionnaire.
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-127456 (URN)978-91-7601-594-0 (ISBN)
Public defence
2016-12-09, Sal E04, Byggnad 6E, Biomedicin, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-11-17 Created: 2016-11-14 Last updated: 2016-11-15Bibliographically approved

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