- Title
- Communication and health literacy skills training for radiation therapists
- Creator
- Kelly, Toni
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- INTRODUCTION: The radiation therapistʹs responsibility to their patients includes not only providing treatment but also educating them to better understand their treatment plan and any pre‐treatment instructions. To provide patient‐centred care, the radiation therapist should also ensure that the patientsʹ psychosocial needs are considered. Together these ensure that the desired treatment outcomes for patients are met. Radiation therapists need to have highly competent communication skills. They must gauge the health literacy level of their patient, explain processes at the appropriate level, and they need to ensure the information provided is understood. As communication is a vital aspect of a radiation therapistʹs role, it is essential that communication skills training (CST) starts within their undergraduate degree and continues to develop as their career progresses. This research investigated the communication skills training of radiation therapy students at The University of Newcastle, Australia (Study One) and communication and health literacy training for radiation therapists employed by the Illawarra Shoalhaven Local Health District, Australia (Study Two). This research aimed: 1. To assess University of Newcastle radiation therapy student perception of the success of a clinical reasoning module in teaching communication skills for the clinical environment 2. To explore University of Newcastle radiation therapy student experiences in communicating with patients and radiation therapists during their first clinical placement 3. To develop and evaluate a communication and health literacy training workshop for radiation therapists employed within the Illawarra Shoalhaven Local Health District 4. To investigate radiation therapists’ perceptions of implementing health literacy strategies into their clinical practice after participating in a communication and health literacy workshop. METHODS: The research design was a sequential explanatory mixed method comprising two studies, each with two stages. Study One – Stage One was a retrospective analysis of first‐year studentsʹ evaluations of a clinical reasoning module. Student evaluations were conducted in 2008, 2011‐2016 using Likert scale‐based questions and open‐ended questions via a paper‐based survey. Evaluations were analysed quantitatively using counts and weighted sum averages (WSA) and qualitatively using thematic analysis. Study One ‐ Stage Two was a post‐clinical assessment of student perceptions of the effectiveness of the clinical reasoning module in increasing their confidence with communicating with patients and radiation therapists and in teaching them skills to better communicate in the clinical environment. This stage was divided into two phases. Phase One used a single survey with a combination of five‐point Likert scale‐based questions and open‐ended questions and required the students to reflect on four timepoints (pre‐ and postmodule and pre and post clinical placement). Surveys were analysed quantitatively using counts and WSAs and qualitatively using thematic analysis. Statistical differences between the different timepoints were assessed using chi‐square analysis at the 0.05 significant level. Phase Two used an interpretative phenomenological analysis methodology to explore studentsʹ lived experiences communicating with patients and radiation therapists. RESULTS: Study One ‐ Stage One: Evaluations completed by 319 students over seven years were analysed. Students reported the module to be successful in preparing them for interaction with patients. Feedback from the simulated patient was preferred (WSA: 5.75/6) over the facilitator (WSA:5.6/6) and their peers (5.51/6). Six themes emerged from the thematic analysis. These were ʹexposure to the radiation therapist role associated with patient interactionsʹ, understanding the complexity of ʺpatientʺ interactionsʹ, ʹthe ability toself‐reflect, ʹlearning from peersʹ, preparation/organisation of the moduleʹ, and ʹanxietyʹ. Study One ‐ Stage Two – Phase One: Studentsʹ confidence in communicating with patients increased significantly after completing the clinical reasoning module (WSA:2.88/5) (p=0.039) compared to before (WSA:1.13/5) and increased even more after attending clinical placement (WSA:3.38/5). Study One ‐ Stage Two ‐ Phase Two: Four students were interviewed. Five substantive themes were revealed: ʹmaking sense of the clinical reasoning moduleʹ, ʹthe inner selfʹ,ʹ the art of communicationʹ, ʹthe student as a learnerʹ, and ʹclinical workʹ. The varied clinical experiences of the four students were evident, and the interviews allowed a de‐brief mechanism. Students related the clinical reasoning module to the clinical environment and revealed unexpected reactions and emotional responses. Examples included disclosing the reluctance of patients to interact and talking about dying, which became their new normal. METHODS: Study Two ‐ Stage One consisted of developing and evaluating a communication and health literacy training workshop for radiation therapists. The workshop was developed in alignment with evidence‐based knowledge obtained from the literature and evaluated using a survey constructed of five‐point Likert scale‐based questions and open‐ended questions. The evaluations were analysed quantitively using WSAs and qualitatively using thematic analysis. Study Two ‐ Stage Two involved an investigation of the knowledge and confidence radiation therapists gained from the workshops as well as perceived advantages and disadvantages of using health literacy strategies. This stage was divided into two phases. Phase One obtained quantitative and qualitative data using three surveys (pre, post and 3‐month post‐workshop). Phase Two used an interpretative phenomenological analysis methodology to evaluate the lived experiences of radiation therapists using health literacy strategies when communicating with patients. Study Two ‐ Stage One: Two workshops were designed to be delivered one week apart and included didactic elements, group discussions, a video demonstration, small group roleplays and a written exercise. Workshop evaluations concluded that the top‐ranking item was that the ʹworkshops were practical and usefulʹ (WSA:4.25/5) and the role‐play activities were the least favoured (WSA:3.78/5). Seven themes were identified, these were: ʹlearning from othersʹ, ʹsafe environment to share experiencesʹ, ʹopen to learning new methodsʹ, ʹmore time for learningʹ, ʹrole play aversionʹ, ʹgroup size fitʹ, and ʹthinking beyond the workshopsʹ. RESULTS: Study Two ‐ Stage Two ‐ Phase One: At baseline, 56% of participants had heard the termʹ health literacyʹ, 93% ʹplain languageʹ, while 26% knew about the teach‐back method. Confidence levels in using health literacy strategies significantly increased after participating in the workshops (p < 0.05). ʹPlain languageʹ was used more than anticipated (survey 3 versus survey 2), while the teach‐back method was used less. Five themes identified were ʹimproved patient understandingʹ, ʹimpact on professional credibilityʹ, ʹpractice and timing of using methodsʹ, ʹappearing to be condescending to educated patientsʹ, and ʹincreased patient anxietyʹ. Study Two ‐ Stage Two ‐ Phase Two: Six radiation therapists were interviewed. Four substantive themes were revealed. These were: ʹradiation therapist personal attitudes and responses to health literacyʹ; ʹhealth literacy strategies used by radiation therapistsʹ; ʹpatient associated health literacy needs’, and ‘barriers when addressing patient health literacy needs’. Radiation therapists were either person or process‐focused during patient interactions. It was identified that information was provided to patients according to how radiation therapists themselves learn new information. CONCLUSION: The clinical reasoning module was deemed successful in providing first‐year University of Newcastle radiation therapy students the opportunity to develop communication skills required for clinical placement. Students became conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during their communication exchanges. Collaborative critiquing contributed to studentsʹ ability to self reflect to improve clinical interactions. Studentsʹ confidence improved after both the clinical reasoning module and after clinical placement when communicating with patients and radiation therapists. Delving more deeply, differences in their level of communication reflected their ability to make sense of their experiences in the clinical setting. Learning new communication methods provides radiation therapists with options to assist them in educating patients. Understanding barriers to using the strategies and reinforcing the new learning is essential to create change in practice. Opportunities to explore health literacy strategies learnt in the workshops during daily interactions revealed adaptive practices customised to patient needs. While radiation therapists may be person or process‐focused when interacting with patients, the patientʹs needs are always prioritised when providing information, resulting in patient understanding and increased engagement. Developing interpersonal skills at the foundational level as part of the university curriculum is paramount for students to effectively interact and connect with patients during clinical placements. As communication is fundamental to the care radiation therapists provide to patients, they need to continue learning about communication methods to maintain and enhance this vital skill.
- Subject
- radiation therapists; communication; health literacy; treatment plan; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1512208
- Identifier
- uon:56598
- Rights
- Copyright 2022 Toni Kelly
- Language
- eng
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