Can radiation therapists detect and manage patients experiencing anxiety in the radiation oncology setting?

Abstract

Oncology patients have complex medical needs and treatment regimens, which may be accompanied by high levels of psychosocial distress, anxiety, and depression. Many patients treated with radiation therapy have unmet psychosocial needs which may result in poorer compliance to treatment, self-care, and overall health outcomes. National and international psychosocial guidelines state all healthcare professionals (HCPs) involved in patient care are responsible for patients’ psychosocial well-being. However, multiple studies show HCPs fail to detect and manage patients’ psychosocial needs, and patients may not raise these. Radiation therapists (RTs) are members of the multidisciplinary team who directly interact with oncology patients on a daily basis. The aim of this research was to explore RT ability to detect and manage patient anxiety. A systematic review was conducted, which identified 12 publications related to RT-led interventions to reduce patient anxiety. Subsequently, an online survey was developed to investigate RT values, skills, training and knowledge regarding patient anxiety and psychosocial support. A cross-sectional survey was designed using qualitative and quantitative items. RTs from Canada, Australia and New Zealand (ANZ) participated. In total, 859 RTs responded, and 582 datasets were analysed. RTs most frequently recognised overt signs of anxiety such as nervousness/agitation, endorsed by 304 (95.6%) ANZ and 262 (99.2%) Canadian respondents; and/or physiological reactions, endorsed by 239 (75.2%) ANZ and 207 (78.4%) Canadian respondents. In vignette 1, respondents described the patient as anxious 553 (95.0%), and/or worried 532 (91.4%). In vignette 2, descriptors endorsed were distressed 508 (87.3%), anxious 505 (86.8%), angry 500 (85.9%), and/or worried 424 (72.9%). In vignette 1, frequently endorsed strategies to manage anxious patients were acknowledge and encourage 548 (94.2%) and/or discuss referral with patient 285 (49.0%); and in vignette 2, acknowledge and encourage 455, (78.2%); and/or contact RO/nurse prior to treatment 450 (77.3%). This research resulted in the following recommendations: 1. enhance RT knowledge and recognition of less overt signs of anxiety, 2. ensure appropriate training in communication and psychosocial care to enhance RT ability to detect and manage patient anxiety, and 3. increase RT confidence when dealing with patients with anxiety by enabling RTs to provide effective psychosocial care.