All abstracts for Poster Session B, Friday September 16, 2016 11:00am – 12:30pm in Regency III/IV are listed below. Abstracts and information for plenary and concurrent sessions are accessible via the online schedule.
P2-B: Trinitas Cancer Patient Education Initiative Project CARE (Cancer Awareness, Resources, and Education)
Carol S. Blecher1, Timothy Clyne1, Aida Brito2
1Trinitas Regional Medical Center, Elizabeth, NJ, USA; 2Trinitas Comprehensive Cancer Center, Elizabeth, NJ, USA
Abstract: Our purpose is improvement of quality of care and customer satisfaction through a collaborative standardized approach towards patient education. Cancer and its treatment are stressful. The literature on stress and coping demonstrates that patients cope more effectively when they are adequately educated. Effective teaching benefits our patients by improving quality of life through tips on side effect management, decreasing anxiety, promoting adherence, and empowering patients to be involved in their care. The International Council of Nurses maintained that the nurse’s role as educator is an essential component of nursing care (Bastable 2013). Development of standardized processes that help nurses educate patients positively impacts on the delivery of quality nursing care. A number of accrediting organizations such as Joint Commission and NCAQ and the updated ASCO/ONS Guidelines identify patient education as a vital issue in quality care. We adapted materials and created chemotherapy education at a sixth grade reading level which was also translated into Spanish. Reviews were conducted by nurse champions in inpatient and outpatient settings and by English-speaking patients with feedback obtained. Staff was educated regarding use of the module, as well as key issues to include in patient education. A refrigerator magnet was developed which is reviewed and given to patients during their education session. This magnet presents five pertinent self-care tips, created in English with sixth grade readability and translated into Spanish. Our chemotherapy cards are currently being updated and translated into Spanish. With the use of new patient education materials, we see an increased adherence to treatment protocols and improved patient satisfaction. We are demonstrating improved patient education decreases readmission rates. In order to measure our outcomes, we assess overall satisfaction with the education materials, improvement in nurse–patient communication, patient understanding of the materials, and patient perception of adequacy of information. Learning Objectives: The participant will be able to define low health literacy, list barriers to disseminating cancer related materials, demonstrate knowledge of methods in developing educational material for populations with low health literacy, and replicate a program to effectively disseminate cancer education to patients who do not speak English and have low health literacy rates. References: Bastable, S.B. (2013) Nurse as an Educator Principles of Teaching and Learning for Nursing Practice (4th Edition), Jones and Bartlett Learning LLC. Burlington, Massachuesetts. Friedman, A.J. et.al. (2011) Effective teaching strategies and methods of delivery for patient education: A systematic review and practice guideline recommendations. Journal of Cancer Education 26, 12-21. Neuss, M.N. et. al. (2013) 2013 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards Including Standards for the Safe Administration and Management of Oral Chemotherapy. Journal of Oncology Practice Supplement. March 2013 5S-13S.
P5-B: HINTS-ASL: Inclusion of Deaf Adults in Cancer Health and Internet Research
Poorna Kushalnagar, Raylene Paludneviciene
Gallaudet University, Washington, DC, USA
Abstract: Background: For deaf people who use American Sign Language (ASL), including cancer survivors, there are documented reports of difficulties in understanding health information in print, accessing health services, and understanding treatment-related procedures. With funding from the National Institute of Health, the HINTS survey was translated to American Sign Language and administered to 250 deaf signers by a team of deaf researchers who understand and can effectively communicate with these deaf participants. We provide a summary of our deaf sample’s characteristics associated with seeking cancer health information on the Internet. Methods: In cognitive interviews with ASL users with high school education or less, we evaluated the function of the HINTS items and used the results to identify items that required cultural adaptation. We then applied cross-cultural methods to modify and implement HINTS survey items in ASL. These were reviewed and approved by a deaf oncology nurse fluent in ASL and English. The HINTS-ASL survey included sections on health status, Internet use, and patient– physician communication. We used several approaches to recruiting 250 deaf signers across the USA, including Hawaii, Alaska, and Puerto Rico. The survey was administered online, in person, and through videophone. Following data cleaning, we compared our sample to age-matched NCI HINTS’ dataset. Results: After controlling for education and age, deaf signers utilize the Internet at a lesser frequency than the general population, mainly due to language barrier. For patient–physician communication, deaf cancer survivors were more likely to report greater satisfaction and greater trust of cancer-related information compared to deaf non-survivors. Discussion: Although cancer health disparities among the deaf community persist, cancer survivors who are deaf and use ASL report greater satisfaction with patient–physician communication than those who do not have cancer. Possible factors include physician’s specialties, trust in sign language interpreters, and education level. Learning Objectives: (1) Learn about the procedure involved in translating HINTS materials to American Sign Language. (2) Identify factors that contribute to deaf signers’ trust in the Internet and satisfaction with physician communication. References: Health Information National Trends Survey (HINTS) Survey Instruments. 2007. [Accessed 10-20-2014]. http://hints.cancer. gov/instrument.aspx. Lyles, C. R., Sarkar, U., Ralston, J. D., Adler, N., Schillinger, D., Moffet, H. H., & Karter, A. J. (2013). Patient–provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study. Journal of the American Medical Informatics Association, doi:10.1136/amiajnl-2012-001567 Volkman, J. E., Luger, T. M., Harvey, K. L., Hogan, T. P., Shimada, S. L., Amante, D., McInnes, D., Feng, H., & Houston, T. K. (2014). The National Cancer Institute’s Health Information National Trends Survey [HINTS]
P7-B: Tobacco Cessation Education in Tribal Clinics
Eric Vinson, Kerri Lopez, Antoinette Aguire, Ryan Sealy
Northwest Portland Area Indian Health Board, Portland, OR, USA
Abstract: The prevalence of smoking in American Indians and Alaska Natives residing in Idaho, Oregon, and Washington is between 35 and 40 % based on responses to state BRFSS and reporting of clinical indicators as part of the Government Performance and Results Act measures from the Indian Health Service. The difference in smoking rate relative to non-Hispanic White (21 %) contributes to the significantly higher incidence of lung and colorectal cancers. This work is focused on understanding the development of tobacco cessation education in tribal communities. The collection of baseline data from clinics including clinical and procedural measures of tobacco cessation education was completed. Intake data from one state Quitline service was requested from the vendor for AI/AN callers and their demographic responses to the standard intake questionnaire. Key informant interviews from tribal tobacco coordinators and cessation counselors formed the basis of the analysis of the educational cessation methodologies. The clinics utilizing a multimodal approach to cessation education were able to document a higher rate of smokers with a current status of quit or in process of cessation. The application of electronic Quitline referral methods resulted in perceived reduction in provider time needed and a higher use rate amongst referring providers. The in person cessation counseling included tribal clinic pharmacists and nurses along with behavioral health staff. Referral patterns varied based on the advocacy of a local champion for tobacco prevention and the engagement of clinical administration. The varying approaches to tobacco cessation are appropriate for tribal clinics to embrace. Referral systems in place for primary care providers to effectively route smokers interested in quitting are essential to tribal tobacco cessation. The efforts that decrease the prevalence of smoking are necessary if the impacts of cancer and related disease are to the reduced. Learning Objectives: The participant shall be able to explain the process for tribal tobacco cessation education referrals. The participant shall be able to describe three approaches to tribal tobacco cessation education. References: Jamal, A., Agaku, I. T., O’Connor, E., King, B. A., Kenemer, J. B., & Neff, L. (2014). Current cigarette smoking among adults—United States, 2005– 2013. MMWR Morb Mortal Wkly Rep, 63(47), 1108-1112. Moore, K., et al. (2014). Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project. American journal of public health, 104(11), e158-e164.
P11-B: Sustaining a Positive Perspective on Dignity in Care for Undergraduate Nursing Students
Sheila Douglas, University of Dundee, Kirkcaldy, Scotland, UK
Abstract: Background/Purpose: Murphy, Jones and Edwards et al. (2009) state ‘The process of nurse education should promote and support the student to preserve the positive perspectives they arrive with’ in their conclusion to a quantitative single cross-sectional survey whose key finding was that the educational process seemed to reduce nursing students’ caring behaviours. A pragmatic review to capture empirical evidence for how we should educate undergraduate student nurses to deliver dignity in care uncovered several papers with similarly concerning outcomes. Methods: CINAHL Plus, Scopus, ASSIA and ERIC were searched using a predefined search strategy and inclusion/exclusion criteria. Fifty-seven papers were selected. Biggs’ ‘3P’ analysis was used to determine presage, process and product factors emerging from the selected papers and to establish themes for synthesis. Results/Findings: The enduring theme in the selected papers was of a learning journey. Evidence exists for the use of learning and teaching approaches to support professional growth such as reflection, use of arts and humanities, and insider views of patient experience, to promote a transformational journey or threshold concept. Students were influenced by positive role models both in academic and clinical practice. While the majority of papers identified personal and professional growth, a negative pathway of distress also emerged (Gunther 2011). Negative impacts upon patient, individual practitioner, clinical team, organisation and profession can be extrapolated. Discussion: This paper will explore the negative pathway uncovered in this literature review and relate those findings to the wider literature. Unanswered questions will emerge as recommendations for future research. Learning Objectives: By the end of the session, the attendee will be able to identify the volume and quality of empirical evidence for educational preparation of nursing students to deliver dignity in care, consider the application of this evidence to their own work situation and recognise the negative impact of distress on undergraduate nursing students. References: Biggs J B Moore P J (1993) The Process of Learning London Prentice-Hall Third Edition. Gunther M (2011) Empathic anger in junior nursing students Journal of Nursing Education 50(5):242-247. Murphy F Jones S Edwards M James J Mayer A (2009) The impact of nurse education on the caring behaviours of nursing students Nurse Education Today 29:254-264.
P13-B: Can the Training Program for Radiographers Improve the Image Quality and the Diagnostic Accuracy of Mammography?
Thiago Silva, Silvia Maria Sabino, Gisele Ribeiro, Edmundo Mauad
Barretos Cancer Hospital, Barretos, São Paulo, Brazil
Abstract: Breast cancer is the most common cancer in women worldwide, with the mortality rates in developing countries showing an increased trend due to a lack of resources for implementation of organized screening programs, accurate diagnosis, and effective treatment. Mammographic screening is the best way to diagnose breast cancer early, before a patient is symptomatic, and at a time when chances of survival are most favorable. However, a Brazilian study reported that 60 % of the mammographic examinations conducted by the public health systems and private clinics exhibited some degree of failures. With expertise based on the European model of population-based organized screening, the Barretos Cancer Hospital started in 2012 the first Brazilian training program for radiographers to ensure the quality of the mammography. Radiographers selected for the 80-h training course submitted 15 days before the course starts a portfolio containing 50 examinations conducted by them for review by the clinical quality control team. Through the evaluation of 18 mammographic positioning quality items stipulated by the European guidelines, it produced a customized practice-oriented training for each student, based on their positioning failures. Since 2012, it has trained 269 radiographers from different states of Brazil. The mean of failures reported per exam was 3.4 at the beginning of the course and 1.2 at the end. The average rate of decrease of failures per exam was 62.1 % (p = 0.001). The most common positioning-related failures reported were absence of the pectoral muscle at cranio-caudal incidence (89.4 %) and pectoral muscle to nipple level (43.6 %) and nonvisualization of infra-mammary angle (52.5 %) at medio-lateral oblique. This experience has shown that these trained professionals become able to perform mammography with higher diagnostic quality, reversing the current national framework, where the majority of mammograms performed have errors that make it difficult to provide an accurate diagnosis. Learning Objectives: The students shall be able to perform mammography with high diagnostic quality, increasing the rate of early diagnosis of breast cancer with all the screened women being benefited. Thus, it is expected that the training could be useful to promote critical thinking on the technicians’ part, to reduce the waste of resources and unnecessary exposure of patients to radiation, to improve the final quality of mammography services offered in a Breast Cancer Screening Program, and to develop a managing tool for quality in mammography in developed developing countries. References: 1. Landsveld-Verhoeven C, den Heeten GJ, Timmers JM, Broeders MJ. The correct mammographic positioning in breast cancer screening. Ned Tijdschr Geneeskd. 2015;159:A9488. 2. van Landsveld-Verhoeven C, den Heeten GJ, Timmers J, Broeders MJ. Mammographic positioning quality of newly trained versus experienced radiographers in the Dutch breast cancer screening programme. Eur Radiol. 2015 Nov;25(11):3322-7. 3- Reis C, Pascoal A, Sakellaris T, Koutalonis M. Quality assurance and quality control in mammography: a review of available guidance worldwide. Insights Imaging. 2013 Oct;4(5):539-53.
P15-B: Caregiver 101: Creating Self-Confident Immunotherapy and Transplant Caregivers
Ann Breen, Seattle Cancer Care Alliance, Seattle, WA, USA
Abstract: Background: The cornerstone of patient safety in an ambulatory setting is caregiver education and comprehension. A Caregiver Competency Checklist (CCC) and Caregiver 101 Skill’s Lab (CG101) were developed to promote caregiver efficacy. Both of these approaches provide for self-directed learning with expert guidance. High-risk caregiver situations are common due to insufficient financial, emotional, or time resources. During the development of the CCC and CG01, a multidisciplinary team was engaged through the Transplant Operational Committee (TCOT) and immunotherapy team. Transition Service Program includes individual consults, classes, and online videos. The CG101 allows active practice, while CCC allows caregivers to selfevaluate their competencies in a more detailed fashion. Due to increasing medical care being provided in ambulatory setting, more care is being shifted to the caregiver. New educational strategies need to be deployed to customize promote patient safety. Description: The intervention promotes active caregiver engagement. CCC provides for self-evaluation of core competencies and the CG101 provides skills practice. This approach utilizes teach back and builds caregiver confidence. Skills include line flushing, home infusion, emergency line care, prevention of infections, safe lifting, and stress management. Evaluation: The class has been well received and appreciated by caregivers and patients. Seven months of class evaluation data, class changes based on data and feedback will be discussed. The class has become part of the education foundation. Usefulness: By using teach back methodology, skills lab, and self-evaluation, caregivers and the educator are able to focus education. The CCC and CG01 focus education using real-world examples of care needs. With time and financial constraints, finding ways to individualize care in a classroom setting is imperative in the future of patient safety. The CCC and CG01 focus education using real-world examples. Other centers can customize this method to their own setting to promote caregiver confidence and patient safety in the home environment. Learning Objectives: The participant will be able to give two examples that could be included in a caregiver skills lab. The participant will be able explain the caregiver self assessment. References: Spoelstra, S et al. A trial examining as advanced practice nurse intervention to promote medication adherence and symptom management in adult cancer patients. Journal of Advanced Nursing, Vol 72(2), Feb 2016, 409-420. Ungar, N etal. A self-regulation based intervention to increase physical activity in cancer patients Psychology, Health and Medicine, Vol 21(2), Feb 2016, 163-175.
P17-B: Evaluating Health Literacy and Levels of Understanding Among Bone Marrow Transplant Patients
Vinita Khanna, Anette Trejo, Mojbata Akhtari
USC Norris Cancer Center and Hospital, Los Angeles, CA, USA
Abstract: Purpose: Communicating effectively with patients prior to engaging in bone marrow transplant (BMT) is a large part of treatment processes. This descriptive study has sought to explore the most effective ways to evaluate and address low health literacy among BMT patients. Preliminary observation exhibited an increasing trend in outpatient visits, urgent care visits, and readmissions post-transplant. Method: The preexisting education medium utilized for BMT patients in the identified hospital consisted of an informational binder with written content and was developed utilizing a multidisciplinary approach. Fifteen participants were randomly selected from within the patient pool admitted into the BMT program. Data was collected across a 2-month period utilizing a 10-question survey performed during the psychosocial assessment. Consenting patients were individually interviewed. Measurements evaluated include education level, language spoken, preference on learning style, and level of understanding. An interview template was developed to ensure consistency of interview style, process, and responses. Results: Level of education by the participants is distributed as follows: elementary (33 %), high school graduates (26 %), and college (40 %). Sixty-six percent of participants were found to speak a primary language other than English. Thirty-three percent of participants reported that they did not understand the risks of treatment having received the informational binder and physician/nursing consultation. Pre-BMT educational classes are in multiple languages and learning modules such as written, verbal, and visual based on preferred learning style. Discussion: The results indicated that a structured curriculum combining visual aids and verbal and written instructions was the most frequently preferred mode of education requested. It is recommended that further evaluation of health literacy curriculum be conducted among BMT patients in transplant centers. Common results in BMT centers may potentially promote an industry standard in health education delivery. Learning Objectives: The primary learning objective of this study is to identify the pertinence of utilizing patients’ preferred learning methods based on individual health literacy levels and observed effects on treatment and recovery. References: Bezler, N.S., Mallyak, A., Guo, D., London, W.B., Mack, J.W., Joffe, S. (2014). Low health literacy and its correlates among allogeneic bone marrow transplant recipients. Journal of Clinical Oncology, 32. Cohen, M.Z., Jenkins, D., Holston, E.C., and Carlson, E.D. (2013). Understanding health literacy in patients receiving hematopoietic stem cell transplantation. Oncol nurs forum, 40(5), 505-515.
P19-B: Health and Appearance Motivations for Sun Protection Among Adolescent and Young Adult Lifeguards
Jeff Yancey1, Justine Reel2
1Huntsman Cancer Institute, Salt Lake City, UT, USA; 2University of North Carolina Wilmington, Wilmington, NC, USA
Abstract: Background/Purpose: Lifeguards are exposed to high levels of UV radiation over a large percentage of their skin. Appearance appeals have been shown to be effective for reducing UVexposure and increasing sun protective behaviors in a variety of populations. This study evaluated motives for sun protection intentions and behaviors in a sample of lifeguards at public swimming facilities. Method: A questionnaire was administered to evaluate the relationships of appearance and health motives to sun protective intentions and behaviors. One hundred twelve lifeguards completed the questionnaire during the summer of 2013 and spring of 2014. Hierarchical linear regression was used to identify associations of key variables in the data. Results: Hierarchical regression analysis showed that perceived threat to appearance correlated to intentions (Rsquared change = .08, p < .01) and behaviors (R-squared change = .06, p < .05) above and beyond the effects of demographics, natural skin tone, family history, and perceived threat to health. Discussion: Often skin cancer prevention messaging revolves around motives of sun protection to protect ones health. Although protecting skin health is an important message, focusing UV reduction messaging around the effects it may have on skin appearance may resonate more with young lifeguards in the outdoor pool setting. Learning Objectives: The participant shall be able to identify how appearance motives may influence sun protective intentions and behaviors among young lifeguards. References: Merten, JW, Higgins, S, Rowan, A, et al. Sun safety knowledge, attitudes and behaviors among beachgoing adolescents. American Journal of Health Education, 2014;45:37-41. doi:10.1080/19325037.2013.852997. Eaton, DK, Kann, L, Kinchen, S. Youth risk behavior surveillance—United States, 2011. MMWR Surveillance Summaries, 2012;61(4):1–162.
P21-B: Building a Self-Management Infrastructure for Patients and Their Families
Gwen Barton, Lynne Jolicoeur, The Ottawa Hospital, Ottawa, ON, Canada
Abstract: Providing patients and their families with the information they need as well as offering them opportunity to be full and active partners in their cancer care are key components to advancing person-centered care. These are also key components to supporting a self-management approach as they have the potential to improve patient outcomes through a better understanding their condition and taking responsibility for aspects of their health. To be successful, this requires a shift from the more traditional approach to patient education to one where health care providers actively engage patients and provide them with the tools and resources they need help manage their condition. Using results of literature review, patient satisfaction surveys, and health care provider feedback, our team used a collaborative approach in consultation with our Patient and Family Advisory Council to examine more effective ways to support self-management. It was decided that the availability of easily accessible, reliable, high-quality educational resources was an important first step to lay the foundation. As a result, our team focused on three key initiatives (a) establishment of a web-based resource (Patient Learning Links) to improve patient and family access to current, reliable patient education materials, (b) establishing a volunteer-supported patient resource center, thereby ensuring access to educational resources at point of care, and (c) reinforcing the concept of self-management with the health care team. The poster will present the results of the data that encouraged us to move in this direction, an overview of the concepts of self-management, as well as a description of the resources and strategies our cancer program has implemented to support a selfmanagement approach. Learning Objectives: The participant shall be able to have a better understanding of what is meant by “self-management.” The participant shall be able to describe examples of strategies our center has used to lay the foundation of a self-management approach. References: Self-Management Support: A Health Care Intervention: BC Ministry of Health, June 2011. Howell and Harth et al. (2015) Self-management education for cancer patients, Evidence Summary, Patient Education Committee, Cancer Care Ontario, Toronto. Registered Nurses Association of Ontario, (2010) Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients
P23-B: Learning About Cancer and Its Treatment in the Context of Breast Cancer
Heather Campbell-Enns, Roberta Woodgate
University of Manitoba, Winnipeg, MB, Canada
Abstract: Background and Purpose: In the context of a breast cancer diagnosis, women face treatment choices and want to understand basic cancer and treatment information. While there is research that details learning in other populations, none has explored the experience of patients learning in the context of a cancer diagnosis. This study explores the experience of treatment decision making across the lifespan in the early stages of breast cancer with attention to how women learn about breast cancer and its treatment. Methods: The tenants of constructivist grounded theory were followed, guided by a lifespan perspective. Twenty-two women took part in semi-structured interviews that explored the decision-making process. Participant data was grouped by age: younger women, under 45 years, middle-aged women, aged 45–64 years, and older women, aged 65 and older. Data was analyzed using constant comparisons. Findings: Emerging from this study was a model of the ways of learning in breast cancer. The beliefs and values women held about authoritative knowledge influenced their actions and attitudes of learning about cancer and treatment information. Two ways of learning are presented: (1) learning by trusting the healthcare system and (2) learning by trusting a system of connections. Women showed the ability to move between different ways of learning, yet differences were seen between younger and older women. Conclusion: This study addresses the theoretical gap between what we know about specific information needs in cancer and the design of specific interventions to provide patient education regarding cancer and its treatment. Where learning occurs in the early days of a cancer diagnosis, and at a time when patients are likely to be making treatment decisions, an increase in the awareness of this learning among healthcare providers may allow for better information support for patients in this context. Learning Objectives: The participant shall be able to distinguish between two ways that patients with breast cancer learn about their disease and its treatment. The participant shall be able to describe at least one difference between the treatment decision-making experience of younger and older women with breast cancer. References: Coulter, A. (2011). Engaging Patients in Healthcare. McGraw-Hill Education (UK). Elwyn, G., Stiel, M., Durand, M.-A., & Boivin, J. (2011). The design of patient decision support interventions: addressing the theory-practice gap. Journal of Evaluation in Clinical Practice, 17(4), 565–574.
P24-B: Barriers to Information Support Experienced by Women with Breast Cancer
Heather Campbell-Enns, Roberta Woodgate
University of Manitoba, Winnipeg, MB, Canada
Abstract: Background and Purpose: Most patients with cancer want information about their disease, its treatment, and the consequences of treatment. As a result, information support must be provided throughout the cancer experience; however, it is unclear if there are barriers to information support during the cancer experience. This presentation describes the experience of decision making in breast cancer, paying particular attention to the barriers women experience to information support early in the cancer trajectory. Methods: Data collection and analysis followed the tenants of constructivist grounded theory. Semistructured interviews were conducted with 22 women with invasive breast cancer. The average time from diagnosis was 9.5 months, and the average participant age was 55 years. Interviews explored the experience of treatment decisionmaking through open-ended questions which sought the details about the context and process of treatment decision-making. Data was organized using ATLAS.ti software and analyzed using constant comparisons. Findings: Women of all ages have information support needs in breast cancer. Barriers to the provision of information support include (1) emotional distress, (2) patient–provider communication, (3) provider–provider communication, (4) making it personal, and (5) access to information. Similarities and differences between younger and older women are addressed. Conclusion: Women want information about their cancer and its treatment regardless of age. Barriers to information occur at various levels, such as at the level of the individual patient, the provider, and the health system. Implications for research include the need to study the influence of emotional distress on understanding information prior to treatment, as well as research about communication skills training for healthcare providers. Implications for practice include implementing models of care that empower patients to make satisfying treatment decisions that are consistent with their individual wishes. Learning Objectives: The participant shall be able to identify two or more barriers that patients with breast cancer experience in learning information about their cancer and its treatment. The participant shall be able to distinguish between information barriers at various levels of healthcare. References: Matsuyama, R. K., Kuhn, L. A., Molisani, A., & Wilson-Genderson, M. C. (2013). Cancer patients’ information needs the first nine months after diagnosis. Patient Education and Counseling, 90(1), 96–102. Presutti, R., D’Alimonte, L., McGuffin, M., Chen, H., Chow, E., Pignol, J.-P., Szumacher, E. (2014). Decisional support throughout the cancer journey for older women diagnosed with early stage breast cancer: a single institutional study. Journal of Cancer Education, 29(1), 129–135.
P26-B: Skills-Building Training to Engage Patient and Family Advisors to Actively Participate in the Development of Patient and Family Educational Resources
Mariela Gallo, City of Hope, Duarte, CA, USA
Abstract: A major measure of success for patient and family advisory councils (PFACs) is to participate in the process of adapting patient information to meet the literacy, cultural, and linguistic needs of patients and families (AHRQ, 2013). At City of Hope National Medical Center (COH), both our English- and Spanish-speaking PFACs identified to significantly increase their contributions in this area. In January 2016, a training was developed to on board our PFAC partners in meeting this goal. The training aimed to engage the PFAC to feel better equipped to actively participate in the development of patient and family educational resources in partnership with multidisciplinary teams. A training curriculum was first developed in Spanish by a Senior Health Education Specialist for “El Concilio.” Culturally and linguistically appropriate and interactive content was incorporated to maximize participant engagement. The learning objectives of the training included participants will identify how to effectively use their experiences as a foundation to be a voice for all patients and families, what information they need to know about the project before providing feedback, and different ways to successfully communicate feedback by addressing key areas of interest. Participants expressed feeling better equipped and empowered to be a voice for patients and families. Staff leadership identified the training to be an essential component for on boarding future advisors. In May 2016, the training will be conducted for COH’s English-speaking PFAC. For El Concilio, quarterly evaluations will continue throughout their participation of a major initiative to develop a Spanish chemotherapy class to assess level of engagement and skills applied from the training. Skillsbuilding training for effective PFAC participation in the development of patient and family educational resources is essential to ensuring the sustainability and effectiveness of PFAC-generated impact. Equally important is to continually keep PFACs engaged to actively voice the needs of patients and families. Learning Objectives: Participants will be able to identify at least two benefits of training PFACs on how to effectively participate in the development of patient and family educational resources. Participants will be able to identify at least three essential components the training must include to drive application. Participants will be able to identify how to evaluate the benefits of the training for the PFAC. References: Guide to Patient and Family Engagement in Hospital Quality and Safety. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/ hospital/engagingfamilies/index.html. Patient and Family Advisory Councils-A Review of 2011 PFAC Reports. June 2012. Institute for Patient-and Family-Centered Care, Bethesda, MD. http://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdf
P28-B: Patient as Teacher: Lived Experience as Educational Credential
Jason Oliver, Tamara Harth
Sunnybrook Health Sciences Centre and Odette Cancer Centre, Toronto, ON, Canada
Abstract: 1. Background/Purpose: The patient and family education program at the Odette Cancer Centre/Sunnybrook Health Sciences Centre has integrated patient engagement into current programming as a way of meaningfully capturing the voices and lived experiences of patients, family members, and caregivers as they relate to patient education. The current 2015– 2018 operational plan for the patient and family education program at the Odette Cancer Centre is based on three thematic pillars. The first pillar of patient engagement includes an innovative model of ‘patient as teacher’. 2. Methods: Patient as Teacher will be rolled out in educational products at the Odette Cancer Centre. In all of these products, there is a requirement to include the active patient, caregiver, or survivor voice as not only participant but as an educator. Patient educators provide education via consultations in disease site clinics, as members of interprofessional panels at our education series, as teachers of their lived experiences in disease and symptom management videos, and as contributors to the patient education newsletter. 3. Evaluation: Evaluations have rated “patient as teacher” learning panels as “extremely useful” often rating higher than clinician-lead presentations and panels. Provincial standardized survey in patient education gleaned a desire from patients to receive their education from the experiences of another patient or survivor. 4. Usefulness: Our hope is that this poster will provide conference participants with new and innovative ways to meaningfully engage patients in the development of education products and to leverage the patient as a teacher and expert of their own care. Learning Objectives: Participants will be able to learn how to incorporate patient/caregiver knowledge and experience into an effective patient education intervention, learn diverse engagement strategies of working with patients as educators, and identify gaps in patient learning that could benefit from peer-based approaches. References: Lu, Q., You, J., Man, J., Loh, A., & Young, L. (2014, November). Evaluating a culturally tailored peer-mentoring and education pilot intervention among Chinese breast cancer survivors using a mixed-methods approach. In Oncology nursing forum (Vol. 41, No. 6, p. 629). NIH Public Access. Bell, Emma; Bell, Mary; Britten, Nicky; Embuldeniya, Gayathri; Nyof-Young, Joyce; Sale, Joanna E.M; Veinot, Paula The experience and impact of chronic disease peer support interventions: A qualitative synthesis Patient Education and Counseling Volume 92, Issue 1, July 2013, Pages 3–12.
P30-B: Barriers and Facilitators to Nurses e-Prescribing Patient Education Resources
Chasity Walters, Kermitt Ramirez, Jennifer Wang, Julia Vishnevetsky
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Abstract: Background/Purpose: While providing written materials is a long-standing and effective way to reinforce patient education, the reliance on print materials leads to out-of-date stock, requires space for inventory, and incurs expenses related to printing and dissemination. In response, all patient education resources in this cancer center were made available on the Internet in 2013, allowing for online viewing and/or printing to portable document format (PDF). The launch of the Internet site lead to a 76 % decrease in print waste, 33 % decrease in print distribution, and a 28 % decrease in carrying inventory over 2 years. When accessed from within the hospital, clinicians may use the Internet site to electronically prescribe (eprescribe) educational resources to patients via their patient portal or email. Description: Despite the success of the Internet site, the number of nurses utilizing the e-prescribe feature remains low. Of 2285 outpatient, inpatient, and perioperative nurses, 276 nurses (12 %) have used the e-prescribing feature over a 2-year period. This project sought to identify the barriers and facilitators of nurses e-prescribing educational resources. A total of 168 surveys were sent to nurses to elicit the opinions of both users and nonusers. Evaluation: Fifty-seven nurses (31 users, 26 nonusers) responded to the survey, yielding a 34 % response rate. Barriers and facilitators to eprescribing fell into two groups: technology (e.g., poor search functionality, lack of integration with other systems) and the user (e.g., nurses’ teaching styles, lack of awareness). Usefulness: The majority of people with cancer use the Internet to find information about their cancer, and e-prescribing enables nurses to ensure the information patients receive is reliable and accurate. Understanding the barriers and facilitators to use of the eprescribing feature allowed for the targeting and prioritization of specific challenges. Learning Objectives: The participant shall be able to identify two factors that may facilitate nurses electronically prescribing educational resources to patients. References: Castelton, K., Fong, T., Wang-Gillam, A., Waqar, M., Jeffe, D. B., Kehlenbrinnk, L., Gao, F., and Goviindan, R. (2011). A Survey of Internet utilization among patients with cancer. Supportive Care in Cancer, 19, 1183-1190. Willcox, S., Anglin, C., Dement, F., Spore, S., and Schanback, M. (2011). Supporting patient education and safety using an online patient education handout database. Journal of Consumer Health on the Internet, 15, 1-12.
P33-B: Co-Designing Healthcare with Patients
Sarah Krug, CANCER101, New York, NY, USA
Abstract: There is an evolution underway where we are beginning to understand the value of partnering with patients to revolutionize healthcare. With an emphasis on healthcare innovation, there is an explosive growth of tools, resources, health technologies, and other platforms designed to serve patients and their caregivers. However, with virtually little oversight within the industry, “good ideas” often evolve into innovations to address a perceived issue, yet very few patients have been involved in the design or development of the innovation. To amplify the voice of the patient and caregiver, and empower them to partner with innovators, the Patient Shark Tank® was created in 2011. Imagine an ecosystem where a patient’s/caregiver’s perspective and expertise could be heard loud and clear in the design, the development or even enhancement of any solution that’s designed to serve them, whether its new technology, a mobile app, a new policy or product being developed, patient education and/or research design. An innovator (any person or organization) that has created a patient centric solution pitches their concept or initiative to a panel of patients/caregivers who ask targeted questions based on their experiences to understand how the innovation uniquely addresses their needs and provides direct perspective and feedback. In addition, examples of initiatives that have been co-designed with patients and caregivers will be showcased to highlight the power of partnership with patients. The importance of involving patients and caregivers in identifying the issues through designing the solutions will also be depicted. The insights allow the innovator to either go back to the drawing board, charge forward with the patients’ perspectives, and or re-pitch once they have refined. A 12-part scorecard was co-designed with patients, which patient/caregiver panelists use to assess the innovations with over 400 innovations assessed to date. Learning Objectives: Embrace the impact of patient perspective in innovations designed to serve them. Incorporate a participatory co-design process into the design and development of solutions for patients and their caregivers. References: None provided.
P35-B: Realist Evaluation of Patient Education Stations as a Resource to Optimize Healthcare Provider–Patient Teaching Across the Cancer Care Trajectory
Aileen Trang1, Nazek Abdelmutti2, Eitan Aziza3, Janet Papadakos1
1Princess Margaret Cancer Centre, Toronto, ON, Canada; 2University Health Network, Toronto, ON, Canada; 3University of Toronto, Wightman Berris Academy, Toronto, ON, Canada
Abstract: Background: The provision of pertinent and timely information can enable patients to better cope with disease and engage in self-management strategies. However, healthcare providers (HCPs) have limited time to teach patients and research shows that patients are only able to recall accurately 14% of spoken medical information. Patient Education Stations are an innovative approach to optimize patient teaching that aims to establish education pathways, standardize information provision, and ensure patient resources are accessible to augment patient teaching. Purpose: The aim is to evaluate PESs as an approach to optimize HCPs’ patient teaching and determine if information needs of patients and caregivers are better met in clinics that have greater HCPengagement with PESs. Methods: We employed a cross-sectional, realist formative approach to evaluate the PESs. The study population includes patients with any type of cancer, their caregivers, and HCPs. Quantitative data was collected via survey, PES order history, and frequency of PES updates since initial setup. Qualitative data included telephone interviews with patients and caregivers. Results: Greater satisfaction with information provided was reported by patients and caregivers from clinics that had greater numbers of resource orders and frequent PES updates. Higher levels of HCP engagement with PESs from clinics that had team communication about the PESs and a designated PES lead. Discussion: Understanding factors that predict greater HCP engagement with PESs will inform a hospital-wide PES update. Incorporating factors that will optimize PES usage will encourage and support HCPs to deliver pertinent patient teaching and augment key learning objectives with resources to optimize patient learning. In turn, this will ensure more patients get the information they need to better cope with cancer. Learning Objectives: The participant will be able to understand what factors can optimize healthcare providers’ delivery of cancer education augmented with resource provision to patients and caregivers. References: Husson, O., Thong, M.S.Y., Mols, F., Smilde, T.J., Creemers, G.J., & van de Poll-Franse, L.V. (2013). Information provision and patient reported outcomes in patients with metastasized colorectal cancer: Results from the PROFILES registry. J Palliat Med 16(3): 281-288. Wong, G., Greenhalgh, T., Westhorp, G., & Pawson, R. (2012). Realist methods in medical education research: What are they and what can they contribute? Med Educ 46: 89-96.
P37-B: Using Preoperative Education Videos to Prepare Patients and Their Caregivers for Short-Stay Surgeries
Jennifer Wang, Julia Vishnevetsky, Chasity Walters
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Abstract: Background/Purpose: The increase in same-day and short-stay surgery has reduced the time available for preoperative education, increasing the demands placed on healthcare providers, patients, and caregivers. The short duration between time of diagnosis and surgery often leads to an abundance of information being given at a single point in time. Description: Three short videos were created to provide information about prostate cancer (video 1), how to prepare for surgery (video 2), and at-home care after surgery (video 3). A pilot was conducted to determine the videos’ usefulness for patients scheduled to meet with one of three surgeons identified. Evaluations were performed using post-video surveys and discussions with patients. Nurses and support staff also recorded the amount of time spent answering patient questions, time patients spent with the surgeon at the consultation, and time spent teaching patients how to prepare for surgery. Evaluation: Forty-three patients who were scheduled for an initial consultation, surgical consent and teaching appointment, or surgery with one of three surgeons were emailed videos 1, 2, or 3, respectively, before their appointments or the day of their discharge. Patients who received video 1 were asked if it helped them get ready for their appointment. Eighty percent of those who watched the video felt it was helpful. For videos 2 and 3, patients were asked if it helped them prepare for surgery and take care of themselves after surgery, respectively. Of the patients who watched each video, 100 % found video 2 and 67 % found video 3 helpful. Usefulness: As these videos separate information based on specific points in the care continuum, patients and their caregivers are not overloaded with information at once. These videos are short, accessible, and can be watched on demand, allowing patients and their caregivers to review them when most convenient. Learning Objectives: The participant shall be able to identify the benefits of separating preoperative education at specific points in the care continuum to help manage patient expectations within their healthcare setting. References: Gilbert, S. M., Sanda, M. G., Dunn, R. L., Greenfield, T. K., Hembroff, L., Klein, E., Saigal, C. S., Pisters, L., Michalski, J., Sandler, H. M., Litwin, M. S., and Weill, J. T. (2014). Satisfaction with Information Used to Choose Prostate Cancer Treatment. Journal of Urology, 191, 1265-1271. King. J., Chamberland, P., Rawji, A., Ager, A., Leger, R., Michaels, R., Poitras, R., Skelton, D., Warren, M. (2014). Patient Educational Needs of Patients Undergoing Surgery for Lung Cancer. Journal of Cancer Education, 29, 4, 802-207.
P39-B: The Road to Better Health: Utilizing a Wellness Framework for Cancer Education
Lonnie Fynskov, Mayo Clinic, Rochester, MN, USA
Abstract: Background and Purpose: Many people in the USA have more than one chronic illness by age 50. Historically, chronic disease selfmanagement education has been taught using a disease model approach for each independent diagnosis. For patients with multiple comorbidities, this can result in confusing, fragmented education. By using a wellness framework for educational materials and sessions, adult learning principles are incorporated and provide patients with an effective integration tool for all existing and future chronic diseases. Description: The Mayo Clinic Cancer Education Program has utilized the “Road to Better Health” framework and materials for various cancer-focused education classes. This framework incorporates six health behaviors that affect the prevention and management of most chronic illnesses such as diabetes, congestive heart failure, hypertension, and also cancer. These include Move Daily to Increase Your Energy and Improve Your Health, Eat Well to Maximize Your Body’s Fuel for Everyday Tasks, Maintain Good Health by Taking Time for Prevention, Relax Every Day to Rid Your Body of Tension and Stress, Sleep Enough to Wake up Renewed and Refreshed, and Discover Meaning and Purpose in Life. These concepts are applicable not only for general healthy living guidance but across the entire cancer continuum. This allows educators to capitalize on the adult learning principle of building on existing knowledge while meeting health literacy needs. It attempts to normalize the suggested lifestyle changes for cancer survivors by putting these actions within the context of a wellness framework rather than a disease model. Evaluation: Patient and staff satisfaction will be evaluated over the next year by patient and staff surveys. Usefulness: Based on evaluation outcomes, this framework may be expanded to future educational offerings. Other cancer centers may be able to adopt a similar wellness framework with little cost and no staffing increases. Learning Objectives: Learning Objective: The participant shall be able to identify how adult learning principles are incorporated into the educational encounter by utilizing a wellness framework for education across the cancer continuum. References: Risendal B., Dwyer A., Seidel R., Lorig K., Katzenmeyer C., Coombs L., Kellar-Guenther Y., Warren L., Franco A., Ory M. (2014, June 6). Adaptation of the chronic disease selfmanagement program for cancer survivors: feasibility, acceptability, and lessons for implementation. Journal of Cancer Education, 29:762-771. McCorkle R., Ercolano E., Lazenby, M., Schulman-Green D., Schilling L., Lorig K., Wagner E., (2011). Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin.61 (1): 50-62. doi:10.3322/caac.20093.
P41-B: When the End Is Just a Beginning—PTSD in Childhood Cancer Survivors
Aluem Tark1, Toby Bressler2
1NYP Columbia, New York, NY, USA; 2Maimonides Medical Center, Brooklyn, NY, USA
Abstract: Background/Purpose: Childhood cancer survivors face challenges, especially when their treatment ends. Many are related to intensity, side effects, and length of treatment. The decrease in morbidity/mortality in childhood cancer has demonstrated an increase in psychological distress among childhood cancer survivors, such as post-traumatic stress disorder (PTSD). There are various risk factors of developing pediatric cancer-related PTSD. The importance of early detection and intervention is crucial to survivorship care planning. This presentation includes various assessment, educational techniques, and strategies that can be implemented for clinicians, patients, and families. Description: For several decades, the cure rate for childhood cancers, acute lymphoblastic lymphoma (ALL), has improved dramatically. According to the NCI, the cure rate in ALL has increased from less than 10 % in the 1960s to 90 %. This increased cure rate correlates with a need for surveillance/follow-up post-cancer treatment. Recent literature focuses on the occurrence of PTSD amongst survivors, yet evidence suggests PTSD is a highly subjective condition with few clear warning signs. It is essential to recognize the occurrence of PTSD and related coping strategies. Evaluation: Participants will be able to identify risk factors when evaluating PTSD among pediatric cancer survivors and will recognize early signs of cancer-related psychological distress and methods to improve cancer education for this vulnerable, underrepresented and growing population. Usefulness: Childhood cancer survivors often undergo prolonged psychological distress. The prevalence of PTSD is an issue that needs monitoring as children are subjected to stressors throughout their crucial developmental milestones. Unlike other late effects of cancer treatments with definitive detection modalities, the psychological effects of cancer treatment often go unnoticed as they are subjective and subtle. Raising awareness will further benefit educators, clinician, and caregivers by broadening their knowledge about detection and appropriate intervention. Learning Objectives: The participant shall be able to identify risk factors of developing PTSD among childhood cancer survivors and be able to recognize early signs of cancerrelated psychological distress. The participants will gain an understanding of the importance of an alliance between healthcare professionals and parents/ caregivers of children related to early identification, recognition, and treatment for PTSD in childhood cancer survivors. The participant shall be able to describe the significance of PTSD in childhood cancer survivorship planning and care of the child and family. References: Wenninger, K., Helmes, A., Bengle, J., Lauten, M., Volkel, S., & Niemeyer, C. M. (2012). Coping in long-term survivors of childhood cancer: Relations to psychological distress. Psycho-Oncology, 22(4), 854-861. Kamibeppu, K., Murayama, S., Ozono, S., Sakamoto, N., Iwai, T., Asami, K., Ishida, Y. (2015). Predictors of Posttraumatic Stress Symptoms Among Adolescent and Young Adult Survivors of Childhood Cancer: Importance of Monitoring Survivors’ Experiences of Family Functioning. Journal of Family Nursing, 21(4), 529-550.
P43-B: Depression Measurements Among Cancer Patients In the Deaf Community
Emily Robinson1, Luis Mandujano1, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA; 2San Diego State University, San Diego, CA, USA
Abstract: Background/Purpose: New studies report considerably higher depression rates among cancer patients than the general population. The importance of depression screening among cancer patients is becoming clearer as new research is reporting significant associations with cancer outcomes and mental health. People in the Deaf community are believed to have higher rates of depression than the general population, but in the absence of validated instruments, an accurate measure of their depression rate is unknown. The Deaf community is often overlooked when cancer care programs, and the validated instruments to measure their impact, are being developed. The availability of validated instruments in American Sign Language (ASL) to facilitate the measurement of depression in Deaf cancer patients is imperative for research and to guide clinical care. Methods: This review covers the past ten years of evidence-based research that stands at the interface of three main topics: cancer, depression, and the Deaf community. It used the PsycINFO, PubMed and CINAHL databases and included such key words as: depression; measurement; screening; instruments; cancer outcomes; Deaf; and ASL. Results/Findings: This literature review disclosed no validated depression instruments for use with the Deaf community. Some research has used psychosocial instruments with Deaf subjects, but did so without a standardized translation into American Sign Language (ASL) and mode of administration, and without validation. Since English is poorly understood by many Deaf people and non-standardized ASL translations vary by interpreter, the outcomes are unreliable. Discussion: The Deaf community has its own culture, values, and language, just like other minority communities. Unlike other minority communities, it is often overlooked as this review of the literature demonstrates. To assure equal access to the optimal clinical care and research outcomes, researchers should include Deaf patients in their studies related to depression and cancer. Translated and validated instruments are imperative to accomplish that goal. Learning Objectives: The participant will know at least two barriers that must be overcome to conduct cancer research and guide cancer care for the Deaf community. The participant will know at least two obstacles to translating, normalizing and validating measurements in ASL. References: 1. Barnett S, McKee M, Smith SR, Pearson TA. Deaf Sign Language Users, Health Inequities, and Public Health: Opportunity for Social Justice. Prev Chronic Dis [Internet]. 2011 Feb 15 [cited 2016 Jul 7];8(2). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073438/ 2. Barnett S, Klein JD, Pollard RQ, Samar V, Schlehofer D, Starr M, et al. Community Participatory Research With Deaf Sign Language Users to Identify Health Inequities. Am J Public Health. 2011 Nov 28;101(12):2235–8. 3. Sadler GR, Branz P, Fager M, Seegers S, Shimasaki S. Health promotion via Deaf-friendly ministries. J Cancer Educ. 2012 Dec;27(4):606–11.
P45-B: Cancer Health Disparities: A Review of Literature Focused on Cancer-Related Fatigue among African American Women
Miguel Preciado1, Cesar Arcasi-Matta1, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA; 2San Diego State University, San Diego, CA, USA
Abstract: Background/Purpose: Many health disparities have been reported among African American women who are coping with cancer. A review of the literature yields a better understanding of the multiple factors that can interact to influence African American woman’s ability to cope with, and recover from cancer. Problems ranging from outright discrimination to lack of access to state-of-the-art cancer treatment centers can contribute to the development of cancer disparities. Cancer-related fatigue warrants attention because it is one of the problems commonly associated with cancer and its presence has been shown to negatively influence women’s cancer coping abilities. However, it is unclear how cancer-related fatigue affects African American women. Methods: This literature review from 2006 to 2016 examined publications about cancer-related fatigue and African American women using PubMed, CINAHL, EBSCOhost, and PsycINFO databases. The following key words were used: fatigue, cancer, African American, Black, minorities, disparities, and coping. Results/Findings: The review of the literature disclosed that there are few studies focused on gaining a better understanding of the factors that contribute to the development and maintenance of cancer-related fatigue in African American women. It also disclosed the need for the development of instruments that can more accurately measure fatigue among African American women, a precursor to conducting the research needed to advance knowledge related to reducing that fatigue among African American women. Discussion: Because of the limited number of studies exploring cancer-related fatigue among African American women, the levels and characteristics of cancer-related fatigue for this group when compared to others, are still unclear. One study revealed that the Multidimensional Fatigue Symptom Inventory-Short Form, the most commonly used method to measure fatigue in cancer patients, may not be accurately reflecting fatigue among African American women. More fatigue-related research and better measures are needed to address cancer-related fatigue among African American women. Learning Objectives: The participant will learn about the factors known to contribute to cancer-related fatigue, as well as the limitations and gaps in knowledge for this topic. The participant will also be able to understand the difficulties of measuring valid levels of fatigue among this underrepresented group. References: Asvat, Y., Malcarne, V. L., Sadler, G. R., & Jacobsen, P. B. (2014). Validity of the Multidimensional Fatigue Symptom Inventory-Short Form in an African American Community-Based Sample. Ethnicity & Health, 19(6), 631–644. http://doi.org/10.1080/13557858.2014.885933 Coughlin, S. S., Yoo, W., Whitehead, M. S., & Smith, S. A. (2015). Advancing breast cancer survivorship among African-American women. Breast Cancer Research and Treatment, 153(2), 253–261. http://doi.org/10.1007/s10549-015-3548-3
P47-B: Exploring Cancer Fatalism and Its Role in Cancer Disparities in the Deaf Community
Ana Rosales1, Maria Rosales1, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA; 2San Diego State University, San Diego, CA, USA
Abstract: BACKGROUND/PURPOSE: The Deaf community experiences health disparities and barriers to accessing health information and care. A key factor that may be contributing to those disparities is the dearth of standardized psychosocial instruments that have been translated into American Sign Language, recorded for standardized administration, and validated for use with the Deaf community. Researchers and clinicians use validated psychosocial instruments. The dearth of validated instruments makes Deaf people ineligible to participate in many research studies and compromises their clinical care. Cancer fatalism, for example, has been shown to be related to cancer disparities in other populations, contributing to suboptimal cancer screening and poor adherence to treatment protocols. This study reviewed the scientific literature to explore what is known about cancer fatalism in the Deaf community. METHODS: Articles on cancer fatalism, methods to measure fatalism, and intervention strategies to modify fatalism were selected from PubMed, CINAHL, and PsycINFO, using such keywords as: cancer fatalism; cancer disparities; and scale validation. RESULTS: There were no reports describing validated instruments for measuring cancer fatalism in the Deaf community, cancer fatalism levels in the Deaf community, or descriptions of the interactions between cancer fatalism and cancer-related outcomes. DISCUSSION: To undertake research related to the interaction of cancer fatalism and cancer-related outcomes, it is essential to have psychosocial instruments that have been translated, validated, and normed for use with the Deaf community. The commonly used, fifteen-item Powe Fatalism Inventory could be an option for measuring cancer fatalism in the Deaf community. It was originally designed and validated for use with the African American community and has subsequently been translated into other languages and validated for use. The Powe assesses four components of cancer fatalism (fear, predetermination, pessimism, and inevitable death) and would be a logical instrument to use for evaluating fatalism in the Deaf community. Learning Objectives: The participant will know why it is important to have psychosocial instruments translated and validated for use with minority communities. The participant will know how to translate psychosocial instruments from English into American Sign Language and then validate them for use with the Deaf community. References: Smith, S. A., Alema-Mensah, E., Yoo, W., Ansa, B. E., & Blumenthal, D. S. (2016). Persons Who Failed to Obtain Colorectal Cancer Screening Despite Participation in an Evidence-Based Intervention. Journal of Community Health, 1–5. http://doi.org/10.1007/s10900-016-0221-7 Heiney, S. P., Gullatte, M., Hayne, P. D., Powe, B., & Habing, B. (2016). Fatalism Revisited: Further Psychometric Testing Across Two Studies. Journal of Religion and Health, 55(4), 1472–1481. http://doi.org/10.1007/s10943-015-0159-6
P49-B: Educational Videos about Exercise May Reduce Health Disparities in the Deaf Community
Luis Mandujano1, Emily Robinson1, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA; 2San Diego State University, San Diego, CA, USA
Abstract: Background: Health disparities are commonly attributed to ethnicity, environment, and genetic make-up. Those disparities are magnified in the presence of physical challenges, such as deafness. Encouraging people to increase their exercise is a well-accepted strategy for promoting health and reducing health disparities, including many related to cancer control. Little is known about fitness in the Deaf community. This study evaluated the Deaf community’s knowledge of exercise, as a precursor to offering an exercise promotion program for the Deaf community. Methods: IRB-approved flyers and one-to-one recruitment enabled researchers to accrue a well-diversified sample of 215 volunteers from the Deaf community: 110 men and 105 women, aged 18 to 87 years. Their education ranged from no formal schooling to college graduation and beyond. Participants completed self-report surveys about their exercise knowledge and behaviors. The written consenting process and all other study-related communications were conducted in American Sign Language (ASL) and English, as appropriate. Results: Education level, while controlling for age, was significantly associated with pre-test knowledge about exercise. However, age and gender were not associated with exercise knowledge. Discussion: This analysis identified a direct correlation between level of formal education and amount of exercise-related knowledge. This finding suggests that better-educated Deaf people gained and retained greater access to health promoting information than less well-educated. While it is impossible to rapidly change education levels within the Deaf community, it is possible to produce highly-focused health promoting educational programs that can then be delivered in their preferred/accessible mode of communication, ASL. This can give the Deaf community equal access to medical information associated with exercise and disease prevention, along with clear instructions about how to exercise. Other factors will also need to be considered in efforts to increase exercise levels, such as intimidation by gym equipment, safety training, and self-motivation to exercise. Learning Objectives: The participant will be able to identify disparities associated with the Deaf community and Cancer prevention due to disadvantages in exercise knowledge. In addition, the participant will be introduced to the possible neglect in health equity readily available to this underserved group. Lastly, the participant will learn about the social injustice associated with the lack of properly trained ASL healthcare providers and their impact to reduce Cancer and chronic diseases in the Deaf community. References: Barnett, S., McKee, M., Smith, S. R., & Pearson, T. A. (2011). Deaf Sign Language Users, Health Inequities, and Public Health: Opportunity for Social Justice. Preventing Chronic Disease, 8(2). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073438/ Zazove, P., Meador, H. E., Reed, B. D., Sen, A., & Gorenflo, D. W. (2012). Effectiveness of Videos Improving Cancer Prevention Knowledge in People with Profound Hearing Loss. Journal of Cancer Education, 27(2), 327–337. http://doi.org/10.1007/s13187-011- 0292-1
P51-B: How a documentary film featuring Deaf breast cancer survivors has educated thousands of Deaf people, healthcare providers and interpreters across North America
Anita Buel, Deaf Community Health Worker Project, Minnesota, USA
Abstract: The purpose, or reason for making a documentary film about deaf breast cancer survivors was simply because nothing like this film existed. The language of Deaf people is not English nor is their based on English. Their language is visual, their literature is storytelling. If the purpose and need was to educate Deaf women about breast cancer there was only one way to do it—film breast cancer survivors telling their stories so others could learn from them in their language. The film appeared at seven film festivals and was screened at seven national conferences for health providers and educators. Sales of the film to medical organizations and Deaf communities across the country spanning five years have surpassed all expectations, indicating the need to continue to reach out to the Deaf community and those who provide healthcare to them. Several techniques were used to make the “characters” in the film “real” to a hearing audience, which often includes hearing family members who do not know how to sign and have never had an in-depth conversation with their Deaf sibling or adult child. Actors from the Guthrie were chosen to “play the characters” by giving voice to signed thoughts and feelings. Husbands wanted to tell their story, giving a broader view of how cancer impacts a family. The film bridged gaps and healed old wounds that have existed for decades. In the words of an an oncologist and a nurse who appear in the film: The film has changed how I practice medicine forever. Learning Objectives: Participants should be able to experience a real encounter with Deaf breast cancer women within the context of the healthcare environment, their families and their core focus of socialization and support—the Deaf community. Participants should be able to identify barriers to communication within the physical context of the exam room and office. Participants should be able recognize how a visual to English some and written language presents health literacy challenges and misunderstandings. References: (The continued scarcity of health related hour all articles about this population is not current) Health Care Interactions with Deaf Culture, Helen E. Meador, PhD and Philip Zazove, MD, J Am Board Fam Med May 1, 2005 vol. 18 no. 3 218-222. Assessing Deaf Cultural Competency of Physicians and Medical Students, Lisa Hoang & Sheila F. LaHousse & Melanie C. Nakaji & Georgia Robins Sadler, J Canc Educ (2011) 26:175–182 DOI 10.1007/s13187-010-0.
P53-B: Tumor Board Shadowing for Medical Students as a Means of Early Exposure to Multidisciplinary Oncology Education
Malcolm Mattes, Robert Gerbo, Richard Dattola
West Virginia University, Morgantown, WV, USA
Abstract: Background/Purpose: Tumor board conferences provide a unique opportunity to give students exposure to the multidisciplinary aspects of oncology, but there is no medical literature on a tumor board’s educational value in undergraduate medical education. Methods: In this prospective study 18 first year medical students at our institution were randomly selected to shadow an oncologist in a tumor board setting, observing the patient discussions and then debriefing with their assigned physician after the tumor board. A follow-up survey was used to determine the perceived value of the experience. Students were asked to compare the tumor board experience to other shadowing experiences they had during the first year of medical school using a Likert Scale from 1-5 (1=much worse, 5=much better). Results/Findings: The survey response rate was 100%. Students participated in thoracic (44%), breast (39%), and lymphoma/myeloma (17%) tumor boards, with a surgical oncologist (39%), radiation oncologist (33%), or medical oncologist (28%). Sixty-six percent of students felt more comfortable interacting with oncologists after this experience. In comparison to other traditional shadowing experiences, students felt that the tumor board shadowing experience was most beneficial in terms of exposure to a new field (mean Likert rating 4.1/5.0), but was also above average in terms of educational content (3.5/5.0), organization (3.4/5.0), and the overall experience (3.4/5.0). Seventy-eight percent felt that the most important thing they learned was a greater appreciation for the multidisciplinary aspects of oncology. Discussion: A tumor board shadowing experience is feasible and well received by first year medical students, with the primary benefits including exposing students to a new area of medicine, helping them feel more comfortable interacting with oncologists, and giving them a better understanding of multidisciplinary care. Learning Objectives: The participants shall be able to identify at least two benefits of early medical student exposure to multidisciplinary tumor boards. References: Pavlidis N, Vermorken JB, Stahel R et al (2012) Undergraduate training in oncology: an ESO continuing challenge for medical students. Surg Oncol 21:15–21. DeNunzio NJ, Joseph L, Handal R et al (2013) Devising the optimal preclinical oncology curriculum for undergraduate medical students in the United States. J Cancer Educ 28:228–236. Kwan JY, Nyhof-Young J, Catton P, Giuliani ME (2015) Mapping the future: towards oncology curriculum reform in undergraduate medical education at a Canadian medical school. Int J Radiat Oncol Biol Phys. 91:669-77.
P55-B: The Inclusion of the Care of the Cancer Survivor in Undergraduate Nursing Curricula
Mary Dietmann, St. Vincent’s College, Bridgeport, CT, USA
Abstract: Background/Purpose: While more people are being diagnosed with cancer at earlier stages and surviving cancer for longer periods of time than ever before, nurses are ill prepared to deal with the unique concerns that cancer survivors face on a daily basis. It is estimated that there are nearly 14.5 million cancer survivors in the United States who require follow-up for the detection of recurrences and new primary tumors, diagnosis and treatment for the late effects of cancer treatments (Chubak et al., 2012; DeSantis et al., 2014). The Institute of Medicine (IOM, 2005) recommends that all health care providers are educated on the care of cancer survivors. Methods: This descriptive qualitative study explored faculty beliefs and practices regarding the inclusion of caring for the cancer survivor in undergraduate nursing curricula through semi-structured interviews of 14 nursing faculty. Faculty knowledge of the term “cancer survivor” and their beliefs and practices regarding the placement of theory and clinical experiences on cancer survivorship were explored. Qualitative content analysis revealed themes and patterns related to the barriers and facilitators for disseminating information on the gap in content on care of the cancer survivor. Results/Findings: While faculty believe that survivorship content belongs in undergraduate curricula, teaching practices do not support inclusion of this content. Seven themes were identified as a result of the content analysis. Discussion: Implementation of cancer survivorship content in undergraduate nursing curricula is believed to be appropriate by this sample of faculty. While barriers to inclusion of survivorship content were identified by faculty, many facilitators were also generated by the study participants. Dissemination of facilitators may increase teaching practices in undergraduate nursing programs. Learning Objectives: The participant shall be able to: identify nursing faculty beliefs regarding the definition of the term “cancer survivor.” Identify nursing faculty beliefs regarding the inclusion of the care of the cancer survivor in undergraduate nursing curricula. Identify nurse faculty teaching practices in undergraduate nursing programs on cancer survivorship care. Explore barriers and facilitators to the inclusion of cancer survivorship care in undergraduate nursing curricula. References: Institute of Medicine of the National Academies. (2005). From cancer patient to cancer survivor: lost in transition. Report recommendations. Retrieved from http://iom.edu/Reports/2005/From-Cancer-Patient-To-Cancer-Lost-in-Transition.aspx. Irwin, M., Klemp, J. R., Glennon, C., & Frazier, L. M. (2011). Oncology nurses’ perspectives on the state of cancer survivorship care: Current practice and barriers to implementation. Oncology Nursing Forum, 38(1), E11-E19. doi:10.1188/11.ONF.E11-E19. Such Lockhart, J., Galioto, M., Oberleitner, M. G., George, K., Van Deusen-Morrison,J. K., Davis, A., & Mayer, D. K. (2013). A national survey of oncology content in prelicensure registered nurse programs. Journal of Nursing Education, 52(7), 383-390. doi:10.3928/01484834-20130529-01.
P57-B: Evaluating the Impact of Caregivers Knowledge by Providing Prostate Cancer Education to Newly Diagnosed Prostate Cancer Patients and their Caregivers
Janelle Barrera Ikan1, Jennifer Damonte1, Moffitt Cancer Center; Brian Rivers2, B. Lee Green1
1Moffitt Cancer Center, Tampa, FL, USA; 2Morehouse School of Medicine, Atlanta, GA, USA
Abstract: Background: Prostate cancer (PCa) patients are faced with choosing between ranges of treatments with varied impacts on quality of life. Previous studies have found that patients commonly report unmet educational needs. It is crucial for PCa patients to retrieve education to determine treatment decision. Although many studies have documented the importance of patient educational needs, less is known for caregiver information needs. Few studies have identified factors associated with distress among caregivers of early stage PCa patients. Caregivers’ use of information, problem solving, open communication, and positive reappraisal to cope has been associated with less stress. This study investigates the effect of education materials for both patients and caregivers in randomized control trial. Methods: Patients and caregivers received the Personalized Health Information Navigator (PHIN), an interactive psycho-educational intervention on iPad or the Prostate Education Guide, a collection of NCI informational booklets. The education materials include PCa detection, treatment, and side effects. All participants were assigned to a community navigator to identify any barriers and provide assistance. Participants’ PCa knowledge was measured by the Prostate Cancer Knowledge Questionnaire (PCKQ) before and after the intervention period, as well as 2 additional follow up points. Results: Overall, both patients and caregivers benefitted from the education. During baseline, caregivers were less knowledgeable about PCa, but had higher increase in knowledge post-intervention with PHIN. More detailed findings from the PCKQ and correlations between PCKQ scores and demographics will be presented. Discussion: Although patients overall had higher score in the PCKQ, caregivers’ rapid increase scores demonstrate their tremendous effort and support. Caregivers’ willingness to seek information influences the patient to also increase their knowledge. Despite cancer education focusing heavily on patients, our results suggest that it is crucial to also include caregivers’ education needs because of the severe impact they have on treatment decision making. Learning Objectives: Participants will be able to identify the increase of patient’s prostate cancer knowledge. Participants will be able to identify the increase of caregivers’ prostate cancer knowledge. Participants will be able to identify the impact that caregivers provide. References: Banthia, R., et al., The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer. J Behav Med, 2003. 26(1): p. 31-52. Ptacek, J., et al., Social support in spouse of cancer patients: what do they get and to what end? Personal Relationships, 1997. 4: p. 431-449.
P59-B: Keeping patients on the right ‘trach’: development of a health literate tracheostomy self-care video for head and neck cancer patients
Naa Kwarley Quartey, Julian Cardozo, Romeo Cruz, Jennifer Deering, Natalia Evitch, Andrea Gomes, Chris Hau, Natasha Icliates, Janet Papadakos, Meredith Giuliani, Vincenzo Addario, Tina Papadakos
Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Abstract: Background: Some head and neck (H&N) cancer patients require a tracheostomy (trach) to help them breathe after treatment. Trach care involves multiple and complex self-care behaviours that present significant challenges for patients to manage on their own. However, patients must master these behaviours to prevent serious complications such as infections that can lead to hospitalization or Emergency Department use. Since limited health literacy is prevalent in individuals aged 65 and over, many H&N patients are at risk of it. Limited health literacy is associated with reduced adherence to treatment and other self-management behaviours. Thus H&N patients may be at an increased for risk of non-compliance to critical health information like trach self-care. To compliment face-to-face trach self-care teaching and to optimize patient outcomes associated with trach self-care, we developed a trach self-care teaching video. Videos can be a good medium for teaching individuals with limited health literacy as they rely on visual and aural senses rather than on an individual’s reading skills. Purpose: To develop an educational teaching video for H&N cancer patients to compliment face-to-face teaching on trach care. Description: The development of this video involved multiple disciplines including a nurse practitioner, speech language pathologist and respiratory therapist. The Patient and Family Education Program, which includes patient education specialists and a web & digital team, worked closely with expert healthcare professionals and patients to develop the video ensuring it followed effective health literacy principles. This involved developing key messages, refining learning objectives, breaking up information to make it digestible and easy to understand and use of plain language. Evaluation: The curricula was developed and evaluated together with an interprofessional team to ensure it meets the needs of H&N cancer patients and those with low health literacy. Usefulness: There is a dearth of health literate teaching videos on trach self-care to augment face-to-face teaching. Learning Objectives: The participant shall be able to identify effective methods for developing a health literate educational video about tracheostomy care. References: McDevitt, J., Cancela Mde C., Kelly, M., Comber, H. & Sharp, L. (2016). Tracheostomy and infection prolong length of stay in hospital after surgery for head and neck cancer: a population based study. Oral Surg Oral Med Oral Pathol Oral Radiol. 121(1):22-28. Sium, A., Giuliani, M., Papadakos, J. (2015). The Persistence of the Pamphlet: On the Continued Relevance of the Health Information Pamphlet in the Digital Age. J Cancer Educ.
P61-B: Lifestyle Health Behavior Interventions: Impact Among Long Term Cancer Survivors
Noreen Aziz1, Aziz Rahman2
1NIH, Bethesda, MD, USA; 2University of Maryland, College Park, MD, USA
Abstract: BACKGROUND/PURPOSE: Of the 14.5 million cancer survivors in the US, 64% will survive beyond 5 years. However, the aggressive therapeutic regimens enhancing survival can cause significant morbidity as time since diagnosis increases. Long-term survivors (LTS), defined as individuals surviving 5 or more years beyond their initial cancer diagnoses, are especially vulnerable to adverse health outcomes, chronic comorbidities, and their combination. Lifestyle health behavior interventions (LHBI) may ameliorate such adverse outcomes in this population. METHODS: In order to examine the number, impact, and characteristics of LHBIs among long-term survivors, we conducted a detailed literature review, utilizing Medline, of all such published studies over the past 10 years (2006-2016). RESULTS: We identified 162 papers presenting physical activity, weight loss, diet, and smoking cessation LHBIs among LTS. Only 9 (of 162) papers met eligibility criteria. Article reference lists yielded 7 more papers (final sample, 16). Surprisingly, 10 of the 16 papers emanated from just 3 studies! To maximize inclusivity, all 16 eligible papers were examined because they represented new analyses. Published papers presenting LHBIs targeting LTSs are rare (16 / 162, or only 5.55%). Most interventions (13 / 16) were called successful, but were only so among better functioning, physically active LTSs in better overall health. Only 3 / 16 papers explored ethnoculturally-diverse/medically underserved LTSs (not statistically significant). CONCLUSIONS: Continuing gaps in research include LHBIs addressing poorly functioning survivors, understudied cancers, and ethnoculturally diverse/underserved survivors. Education/Training is needed at 3 levels: healthcare-provider, researcher, and survivor regarding adverse health outcomes in LTSs and the need for LHBIs to manage adverse outcomes. Our study underscored the lack of research regarding LHBIs among all LTSs, especially diverse/underserved. Future research must elucidate optimal timing, setting, intensity, barriers/facilitators of LHBIs, and whether LTSs may benefit from less intense, home-based interventions when health status is compromised. Learning Objectives: The participant shall be able to identify 3 examples of late-effects affecting long-term cancer survivors. The participant shall be able to identify 3 populations as under-represented in research: long-term cancer survivors, ethnoculturally diverse cancer survivors, and underserved populations of cancer survivors. References: Bloom JR, Stewart SL, D’Onofrio CN, Luce J, Banks PJ. Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change? J Cancer Surviv. 2008 Sep;2(3):190-204. Buchannan ND, Houston K, Richardson LC. The Essential Role of Public Health in Preventing Disease, Promoting Life, and Promoting Health of Cancer Survivors. Am J Prev Med 2015; 49:S467-S469.