Background: Radiation therapy (RT) is a common yet challenging treatment for people to understand. Consistent and timely information helps patients feel prepared for treatment and alleviates anxiety. We developed a novel psycho-educational Talking Book (written booklet, with accompanying audio-recording) using low literacy design principles, to facilitate communication between patients, radiation therapists and nurses.
Aims: To examine the effect of the tool on knowledge, anxiety, question asking, concerns and communication, and obtain acceptability and feasibility feedback regarding use in RT departments.
Methods: Patients with a range of cancers planned for external RT were recruited from two Sydney hospitals. In a pre-post design participants completed two surveys before and after receiving the tool. Outcomes assessed included: knowledge, anxiety, and concerns about RT. Qualitative interviews were conducted with patients (n=40) and health professionals (n=11) to obtain feedback on format, content and utility of the tool, and perceived challenges and benefits of using it.
Findings: We recruited 40 participants, mean age 64 years (r47-82), 29 female, 18 completed some high school, and 24 localised cancer. Their health literacy was high (37). Total knowledge scores (out of 20) improved significantly from 13.9 points (95% CI: 12.8, 15.0) to 17.7 (17.1, 18.2) to 17.7 (17.1, 18.2) p<0.001. Concerns about RT decreased significantly (p=0.004). State anxiety decreased from 37.4 (33.2, 41.6) to 32.4 (28.6, 36.1) (p=0.02). Anxiety about receiving radiation therapy was moderately correlated with state anxiety baseline r=0.4340; follow-up r=0.5658. Participants significantly increased understanding (p<0.0001) of, and preparedness for RT (p=0.009). Qualitative analysis support these findings with patients reporting feeling better prepared for their planning appointment and treatment, and able to ask more informed questions after reading the tool. Although health professionals found it useful in education sessions, they wanted further communication training on how to use the tool in routine practice.
Conclusions: The findings indicate that the Talking Book improved knowledge, preparedness for radiation therapy, and reduced anxiety. It was perceived as useful, informative and easy to understand by patients with lower and higher education levels, and health professionals.