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The influence of a department's psychosocial climate and treatment environment on cancer patients' anxiety during radiotherapy
Umeå University, Faculty of Science and Technology, Umeå Institute of Design.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Karolinska Institute, Department of Learning, Informatics, Management and Ethics.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
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2016 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 20, 113-118 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The objective of this study is to determine whether there is a relationship between cancer patients' perceptions of the person-centeredness of their treatment experience and their anxiety levels during treatment.

METHOD: A questionnaire was distributed to adult cancer patients going through external beam radiotherapy (RT) with curative intent at a university hospital in Sweden (n = 892), which included two surveys, the State Trait Anxiety Inventory-state specific questions (STAI-S), and the Patient-centered Climate Questionnaire (PCQ) and additional treatment-specific questions. Eligible patients were provided with the questionnaire on their seventh day of RT by an RT-nurse.

RESULTS: Statistical analysis showed a significant negative relationship between STAI-S scores and PCQ scores, and a significant positive relationship between the Treatment Environment questions and the STAI-S scores. Multivariate regression modeling found the PCQ subscale of safety to have the strongest negative association with STAI-S scores, showing that a climate of safety can significantly decrease patient situational anxiety levels. On the other hand, difficulty tolerating the overall treatment experience, worry about the treatment equipment, or feelings of isolation or claustrophobia within the treatment room all significantly factor into increases in patient-reported situational anxiety levels.

CONCLUSION: Both the treatment environment and the psychosocial climate of the RT clinic significantly impact cancer patient state anxiety levels. These findings suggest that actively employing a person-centered approach during RT, and designing the treatment environment to be more attentive to the patient experience can both play a significant role in decreasing patient situational anxiety during treatment.

Place, publisher, year, edition, pages
2016. Vol. 20, 113-118 p.
Keyword [en]
Patient experience, Anxiety, Radiotherapy, Person-centered care STAI, PCQ, Treatment environment
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-111272DOI: 10.1016/j.ejon.2015.06.009ISI: 000368745800016PubMedID: 26153544OAI: oai:DiVA.org:umu-111272DiVA: diva2:885706
Available from: 2015-12-20 Created: 2015-11-11 Last updated: 2016-11-14Bibliographically approved
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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Mullaney, TaraOlausson, KristinaZackrisson, BjörnEdvardsson, DavidNyholm, Tufve
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