3A-1: Incorporating the Patient’s Voice to Enhance Oncology Education: Connecting the Roles of Patient and Educator and Engaging Patients in Activity Development

Karen Overstreet¹, Monique Johnson^2
1Imedex, Raleigh, NC, USA; ²Imedex, Alpharetta, GA, USA

Abstract: Background: Improving patient care and health outcomes should be at the heart of all continuing education (CE), regardless of whether an individual activity is designed to attain that level of educational outcomes. After all, at one time or another, virtually all of us are patients or caregivers. The majority of CE activities include only clinicians as faculty. However, patients can play and important and impactful role in shaping education aimed at improving the quality of care. Description: This session will include insights regarding how working in CE impacts educators’ experience as cancer patients and caregivers, how experience as a patient can shape the planning of CE, and how the connections among these experiences can translate to effective education. This session will also include brief case studies from live and online CE activities for oncology physicians and nurses that incorporate video of survivors and patients with cancer. In the videos, the patients and survivors discussed the opportunities and challenges they faced while interacting with members of their care team in making their treatment decisions. Evaluation: The patients and survivors who allowed educators to videotape their stories reported being empowered by contributing to education for clinicians. Several of them were so moved by the experience that they became patient navigators. The videos were the mostviewed and most-downloaded component of several online CE activities. Participant satisfaction with all activities that included the patient videos was very high, and the educational activities resulted in improvements in learners’ knowledge and competence. Usefulness: All CE providers should consider the patient perspectives when planning education. Planners of CE should consider how to incorporate patients into the planning—and even the delivery—of education. Educators should reflect on how our work can facilitate our experience as patients (and caregivers) and vice versa to enrich the educational planning process. Learning Objectives: After this session, participants should be better able to relate experience as a patient or caregiver to the planning of educational activities and assess the impact of incorporating the patient’s voice in the planning of CE activities for oncology clinicians. References: National Learning Competencies. Alliance for Continuing Education in the Health Professions. http://www.acehp.org/p/cm/ld/fid=15. Accessed March 8, 2016. Von Roenn JH. Critically Ill Patients’ Preferences Regarding Aggressive Medical Interventions: Can We Hear the Patient’s Voice? http://oncology.jamanetwork.com/article.aspx?articleid=2457393. Accessed March 8, 2016. Hall LK, et al. The Cancer Experience Map: An Approach to Including the Patient Voice in Supportive Care Solutions. http://www.jmir.org/2015/5/e132/. Accessed March 8, 2016. Hirsch BR. Incorporating the Patient’s Voice in the Continuum of Care. http://www. jnccn.org/content/11/1/116.short. Accessed March 8, 2016.

3A-2: The Influence of Health Literacy, Self-Efficacy, and Patient Activation on Chemotherapy Self-Management Behaviours and Health Service Utilization

Janet Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada

Abstract: Background/Purpose: Increasing demands on Canada’s healthcare system requires patients to take on more active roles in their health. Effective self-management is related to improved health outcomes, and there is some evidence that effective self-management behaviours are linked to health literacy; however, this link has not been established for cancer self-management. Firmly establishing the link between health literacy and cancer self-management is important because those aged 65 years and older comprise the majority of the users of the system, and these individuals are most at risk for inadequate health literacy. As such, the healthcare system may require increased selfmanagement by patients least able to do so and, in doing so, fail to provide adequate care and incur substantial cost. Methods: Using a cross-sectional observational design, the relationship between health literacy and cancer chemotherapy self-management behaviours and health service utilization are explored. Data was collected using a survey that includes five validated instruments including the test of functional health literacy, chemotherapy self-care knowledge, and practice as well as a measure of health service utilization. Results: Two hundred participants in at least the second cycle of chemotherapy completed the survey. Data analysis is underway and will employ multivariate linear regression modeling to explore associations between predictor (health literacy) and outcome variables (chemotherapy self-management and health service utilization). Discussion: Health literacy has a significant impact on self-management behaviours, but its impact in cancer is understudied. It is important to identify risk factors for inadequate health literacy in order to optimize the delivery of self-management interventions in cancer care. Learning Objectives: The participant shall be able to define health literacy and understand its impact on health, understand the impact of health literacy on self-management behaviours, and identify opportunities to improve cancer education for patients and family with limited health literacy. References: Berkman N, Sheridan S, Donahue K, et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technology Assessment: Agency for Healthcare Research and Quality, 2011. Oldach B, Katz M. Health literacy and cancer screening: a systematic review. Patient Ed. Counseling 2014 Feb;94(2):149-57.

3A-3: A Pirate’s Guide to Planning Successful Patient-Centered Oncology Education Events

Janine Kokal
Mayo Clinic Cancer Center, Rochester, MN, USA

Abstract: Background/Purpose: Following a guided process for planning, an education event provides a pathway to success while saving time and avoiding pitfalls. Event planning concepts can be applied to patient education events, regardless of audience size, target population, or intended outcomes. Examples include a patient education conference, public awareness event, support group, or survivor’s recognition day. Description: Pirates are excellent at navigating the seas, taking the best from others, and getting what they want.

• Set Sail in the Right Direction and Know Your Destination: Start with a clear purpose; Craft your vision, identify goals, and begin with the end in mind; Know your audience; Identify measures of success and intended outcomes.
• Know Your Crew and Avoid Mutiny: Assemble a winning team; Effective leadership is vital; Collaborate with key partners and know your crew’s skills and strengths; Be creative and make it fun. & Batten Down the Hatches and Run a Tight Ship: Outline and activate event plans; Use tips and tools to keep you organized; Pay attention to the details; Understand the unique needs of the event; Adapt event to size, target population and goals; Execute marketing strategies.
• Secure Treasure for Your Booty: Build a budget; Seek funding opportunities and sponsors.
• Navigate the Waters – “Steady as She Goes”: Maintain process and structure on event day; Keep program on schedule; Engage your crew, volunteers and attendees; Anticipate and solve potential problems.

Evaluation: Review measures of success and intended outcomes. Discuss unintended outcomes and lessons learned. Share pearls of wisdom for future event planning. Usefulness: Our ever-changing healthcare environment and increased demand on resources require careful planning as an integral part of any educational event. This process provides a systematic framework to effectively plan, develop, and execute a successful educational event and can be adapted for use by any healthcare organization or professional. Learning Objectives: The participant shall be able to identify the critical steps for planning a successful patient education event. References: Beers, G, 6-Step Guide to Planning a Conference. (n.d.). Updated December 16, 2014. Retrieved April 04, 2016, from http://eventplanning. about.com/od/conferenceservices/a/Step-By-Step-Conference-Planning Guide.htm. Horsfall, J, Clearly, M. (2008, November). Planning and Facilitating Workshops. The Journal of Continuing Education in Nursing, 39(11):511-516. Padrnos, L., Dueck, A. C., Scherber, R., Glassley, P., Stigge, R., Northfelt, D., Mesa, R. A. (2015). Quality of life and disease understanding: Impact of attending a patient-centered cancer symposium. Cancer Med Cancer Medicine, 4(6), 800-807

3A-4: Using the ADAPTE Methodology for the Development of Self-Management Tools for Patients

Sarah McBain¹, Kate Bak¹, Zahra Ismail¹, Colleen Fox¹, Janet Papadakos², Lesley Moody¹, Esther Green³, Tamara Harth^4
1Cancer Care Ontario, Toronto, ON, USA; ²Princess Margaret Cancer Centre, Toronto, ON, Canada; ³Canadian Partnership Against Cancer, Toronto, ON, Canada; ⁴Sunnybrook Odette Cancer Centre, Toronto, ON, Canada

Abstract: Background: Cancer Care Ontario implemented electronic symptom screening using the Edmonton Symptom Assessment System (ESAS), which screens for well-being and other common cancer symptoms. Symptom screening enables the healthcare team to identify and provide interventions to manage symptoms that cause distress. Patients, families, and healthcare providers in Ontario requested patient education to acknowledge, explain, and provide practical tips for managing symptoms, particularly those in the ESAS assessment. Cancer Care Ontario responded by creating patient symptom management guides (PSMGs). This is Cancer Care Ontario’s first standardized, multi-lingual, provincial patient education series. Description: The ADAPTE methodology for clinical guideline development was modified to aid in the development of the PSMGs. The method involves identifying existing patient education materials, appraising their quality, selecting recommendations for inclusion, obtaining expert feedback, and verifying that the recommendations are evidence-based. An inter-disciplinary working group, including patient advisors, collected over 200 materials from across the province. Materials were included if they met specified evaluation criteria from a modified Patient Education Materials Assessment Tool (PEMAT). Included materials were then reviewed and their recommendations evaluated and adapted to create the new patient guides, which were finalized through an external review that included clinical and patient education experts and patient and family advisors. Final guides were translated into French and five additional languages and formatted as accessible PDF’s. Evaluation: The ADAPTE methodology can be used to create evidencebased patient education materials; however, the process is resource intensive and requires the additional application of health literacy universal precautions. An evaluation of the guides is planned after the provincial launch. Usefulness: Given the large number of existing patient education materials and trend towards self-management in oncology, strategies to leverage existing work should be developed and evaluated. Other organizations can use this process and lessons learned for the development of patient education materials. Learning Objectives: The participant shall be able to describe the steps in the ADAPTE methodology and its usefulness in creating patient education materials that can be translated into other languages, describe the advantages and limitations of using the ADAPTE methodology, and evaluate whether it is an appropriate tool for the creation of their patient education materials. References: Fervers, B et al. Guideline adaptation: An approach to enhance efficiency in guideline development and improve utilisation. BMJ Qual Saf, 2011; 20(3):228-36. McCorkle, R et al. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA: A Cancer Journal for Clinicians, 2011; 61(1):50-62. 

3A-5: Empowering Patients Through Education—Development and Evaluation of a Multimedia Patient Education Tool to Ensure Patient Preparedness for Planning CT Scan for Prostate Cancer (Randomized Study)

Ewa Szumacher¹, Krista Dawdy², Katija Bonin², Agnes Ryzynski¹, Tamara Harth¹, Christopher Townsend¹, Stanley Liu², William Chu², Patrick Cheung², Hans Chung², Gerard Morton², Danny Vesprini³, Andrew Loblaw², Xingshan Cao^4
1Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ²Odette Cancer Centre, Toronto, ON, Canada; ³Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; ⁴Institute of Clinical Evaluative Sciences, Toronto, ON, Canada

Abstract: Purpose: A review of patient preparedness for prostate radiotherapy (RT) showed that 13/55 patients were prepared and 42/55 needed to be re-scanned due to inadequate bladder or rectum filling. To decrease additional scans, a video outlining proper preparation for prostate RT was created. The purpose was to determine the effectiveness of a video versus an educational handout to improve CT planning preparation for prostate RT. Methods: The video was created and revised based on clinical feedback from an interprofessional team of patients, radiation oncologists, nurses, and radiation therapists. Patients were accrued by the research assistant (RA) in clinic and randomly assigned to the control group (received handout) or the experimental group (watched video and received handout). The RA followed up with patients at their planning CT appointment to gather bladder and rectum volume and to evaluate patients’ satisfaction with their specific preparation materials. The Likert scale was used to determine patients’ satisfaction outcomes. Results: Fifty-six of 65 patients completed the study with 28 patients in each arm. In the control group, 20/28 were prepared for planning CT scan and 7/28 needed to be rescanned due to full rectum (5/28), empty bladder (0/28), or both (2/28). In the experimental group, 20/28 were prepared and 9/28 needed to be rescanned due to full rectum (4/28) or empty bladder (5/28). Patients in the experimental group watched the video 1.4 times on average and felt more prepared for their appointment than the control group. Patients indicated that they liked the length of the video and would recommend the video to other patients with prostate cancer. Conclusion: The CT re-simulation rate decreased by 51 % in the control group and 44 % in the experimental group compared to the initial review. Despite no statistical difference in re-simulation rates between the groups, patient satisfaction in the experimental group was higher. Learning Objectives: (1) The participant shall be able to identify the interdisciplinary process used to create and implement the video into a clinical setting. (2) The participant shall be able to reflect on the presentation and discuss the role and usage of multimedia and videos within cancer care. References: Marini, B., Funk, K., Kraft, M., Fong, J., Naanos, R., Stout, S., and Wagner, D. (2014). The effects of an informational video on patient knowledge, satisfaction and compliance with venous thromeombolism prophylaxis: a pilot study. Patient Education and Counseling. 96(2):264-267. Morley, L., McAndrew, A., Tse, K., Rakaric, P., Cummings, B., and Cashell, A. (2013). Patient and staff assessment of an audiovisual education tool for head and neck radiation therapy. J Canc Educ. 28:474-480.

4A-4: Patient Navigation Education for Community Health Representatives in Tribal Communities

Mary Koithan¹, Agnes Attakai^2
1University of Arizona College of Nursing, Tucson, AZ, USA; ²University of Arizona, College of Public Health, Tucson, AZ, USA

Abstract: Background: In Native American populations, cancer care disparities are multi-focal arising from reduced health literacy and access to services as well as cultural values and beliefs that delay and impede treatment. Patient navigation provided by community health representatives (CHRs) is one way to address these barriers and improve cancer care equity. Methods: This presentation will describe development, content, and evaluation of a two-part CHR navigation curriculum. The Tribal Patient Navigation Program (part 1) was developed through key informant interviews to deliver a 2-day (16 h) interactive curriculum focused on (a) roles/responsibilities of CHR navigators, (b) advanced communication, (c) traditional healing, and (d) cultural sensitivity. Part II, tailored to match CHR roles/responsibilities and the needs of an individual AI community, delivers eight additional modules focused on (a) basics of cancer pathophysiology, (b) cancer prevention, (c) diagnosis and treatment, (d) symptom management, (e) survivorship, and (f) end-of-life care. Part 2 is tailored to within which the program is delivered. Evaluation and Conclusions: To date, part 1 has been delivered to 90 participants representing 12 tribes in Arizona. Surveys indicate that 73 % of the participants strongly agree that the training “addressed a gap in knowledge of skills” and 76 % could competently apply the knowledge gained as a result of the activity.” Part 2 curriculum has been tested with 12 participants representing 1 tribe with patient/family surveys indicating that the most valuable CHR/navigation services are social and emotional support, education about cancer care treatments, and brokering of community/healthcare services. Patient/family interviews indicate overall satisfaction with the care provided by CHRs who attended the expanded program, one stating “I would not be here today without the care and help my navigator provided.” These programs can be delivered using a train-the-trainer model. Additionally, online interactive, casebased training modules are being developed to extend program dissemination efforts. Learning Objectives: The participant will be able to (1) identify five essential components of a AI patient navigation program and (2) describe how the educational program can be tailored to individual tribal community needs and practice patterns. References: Burhansstipanov, L. Harjo, L. Krebs, L. Marshall A. Lindstrom. D. (2015). Cultural roles of native patient navigators for American Indian cancer patients. Frontiers in Oncology. 5, 79. Harjo, L. Burhansstipanov, L. & Lindstrom, D. (2014). Rationale for “cultural” native patient navigators in Indian country. Journal of Cancer Education, 29(3), 414–419.