Pamela Catton

University of Toronto, Toronto, Ontario, Canada

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Publications (77)230.71 Total impact

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    ABSTRACT: Introduction Simulation has been effective for changing attitudes towards team-based competencies in many areas, but its role in teaching interprofessional collaboration (IPC) in radiation medicine (RM) is unknown. This study reports on feasibility and IPC outcomes of a team-based simulation event; ‘Radiation Medicine Simulation in Learning Interprofessional Collaborative Experience’ (RM SLICE). Methods Radiation therapy (RTT), medical physics (MP) and radiation oncology (RO) trainees in a single academic department were eligible. Scheduled closure of a modern RM clinic allowed rotation of five high-fidelity cases in three 105-minute timeslots. A pre/post-survey design evaluated learner satisfaction and interprofessional perceptions. Scales included the Readiness for Interprofessional Learning Scale (RIPLS), UWE Entry Level Interprofessional Questionnaire (UWEIQ), Trainee Test of Team Dynamics and Collaborative Behaviours Scale (CBS). Results Twenty-one trainees participated; six ROs (28·57%), six MPs (28·57%) and nine RTTs (42·86%). All cases were conducted, resolved and debriefed within the allotted time. Twenty-one complete sets (100%) of evaluations were returned. Participants reported limited interaction with other professional groups before RM SLICE. Perceptions of team functioning and value of team interaction in ‘establishing or improving the care plan’ were high for all cases, averaging 8·1/10 and 8·9/10. Average CBS scores were 70·4, 71·9 and 69·5, for the three cases, scores increasing between the first and second case for 13/21 (61·9%) participants. RIPLS and UWEIQ scores reflected positive perceptions both pre- and post-event, averaging 83·5 and 85·2 (RIPLS) and 60·6 and 55·7 (UWEIQ), respectively. For all professions for both scales, the average change in score reflected improved IP perceptions, with agreement between scales for 15/20 (75·0%) participants. Overall, perception of IPC averaged 9·14/10, as did the importance of holding such an event annually. Conclusions Team-based simulation is feasible in RM and appears to facilitate interprofessional competency-building in high-acuity clinical situations, reflecting positive perceptions of IPC.
    Journal of Radiotherapy in Practice 06/2015; 14(02):1-9. DOI:10.1017/S1460396915000060
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    ABSTRACT: Purpose Cancer-related fatigue (CRF) is the most prevalent and distressing symptom among cancer patients and survivors. However, research on its prevalence and related disability in the post-treatment survivorship period remains limited. We sought to describe the occurrence of CRF within three time points in the post-treatment survivorship trajectory. Methods A self-administered mail-based questionnaire which included the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and the World Health Organisation Disability Assessment Schedule 2.0 was sent to three cohorts of disease-free breast, prostate or colorectal cancer survivors (6-18 months; 2-3 years; and 5-6 years post-treatment). Clinical information was extracted from chart review. Frequencies of significant fatigue by diagnostic group and time cohorts were studied and compared. Multivariate logistic regressions were conducted to examine the associations between CRF and demographic, clinical, and psychosocial variables. Results One thousand two hundred ninety-four questionnaire packages were returned (63 % response rate). A total of 29 % (95 % CI [27 % to 32 %]) of the sample reported significant fatigue (FACT-F ≤34), and this was associated with much higher levels of disability (p p Conclusions Clinically relevant levels of CRF are present in approximately 1/3 of cancer survivors up to 6 years post-treatment, and this is associated with high levels of disability. Implications for Cancer Survivors Clinicians need to be aware of the chronicity of CRF and assess for it routinely in medical practice. While there is no gold standard treatment, non-pharmacological interventions with established efficacy can reduce its severity and possibly minimize its disabling impact on patient functioning. Attention must be paid to the co-occurrence and need for possible treatment of depression and other co-occurring physical symptoms as contributing factors.
    Journal of Cancer Survivorship 04/2015; DOI:10.1007/s11764-015-0450-2 · 3.30 Impact Factor
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    ABSTRACT: To evaluate (1) the quantity and quality of current undergraduate oncology teaching at a major Canadian medical school; and (2) curricular changes over the past decade, to enhance local oncology education and provide insight for other educators. Relevant 2011-2012 undergraduate curricular sessions were extracted from the University of Toronto curriculum mapping database using keywords and database identifiers. Educational sessions were analyzed according to Medical Council of Canada objectives, discussion topics, instructor qualifications, teaching format, program year, and course subject. Course-related oncology research projects performed by students during 2000 to 2012 were extracted from another internal database. Elective choices of clerks during 2008-2014 were retrieved from the institution. The 2011-2012 and 2000-2001 curricula were compared using common criteria. The 2011-2012 curriculum covers 5 major themes (public health, cancer biology, diagnosis, principles of care, and therapy), which highlight 286 oncology teaching topics within 80 sessions. Genitourinary (10, 12.5%), gynecologic (8, 10.0%), and gastrointestinal cancers (7.9, 9.8%) were the most commonly taught cancers. A minority of sessions were taught by surgical oncologists (6.5, 8.1%), medical oncologists (2.5, 3.1%), and radiation oncologists (1, 1.2%). During 2000-2012, 9.0% of students (233 of 2578) opted to complete an oncology research project. During 2008-2014, oncology electives constituted 2.2% of all clerkship elective choices (209 of 9596). Compared with pre-2001 curricula, the 2012 oncology curriculum shows notable expansion in the coverage of epidemiology (6:1 increase), prevention (4:1), screening (3:1), and molecular biology (6:1). The scope of the oncology curriculum has grown over the past decade. Nevertheless, further work is needed to improve medical student knowledge of cancers, particularly those relevant to public health needs. Defining minimum curricular content, emphasizing content based on population needs, and ensuring educational delivery with the support and expertise of oncologists and non-oncologists will be essential next steps. Copyright © 2015 Elsevier Inc. All rights reserved.
    International journal of radiation oncology, biology, physics 01/2015; 91(3). DOI:10.1016/j.ijrobp.2014.11.017 · 4.26 Impact Factor
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    ABSTRACT: Patients treated for lung cancer are often elderly presenting a unique challenge for developing patient education materials. This study developed and evaluated a patient education pamphlet on lung stereotactic body radiotherapy (SBRT) designed specifically for an elderly population. The SBRT pamphlet was developed using a participatory design involving a convenience sample of patients. This prospective study assessed patient’s opinions of pamphlet effectiveness through self-report questionnaires. The pamphlet was deemed “effective” if patients rated 16/18 evaluation statements as “strongly agree” or “agree.” Demographic data and health literacy (Rapid Estimate of Adult Literacy in Medicine short-form (REALM-SF)) were also assessed. Patient opinion of pamphlet “effectiveness” was compared between patients with REALM-SF scores of 7 versus EQ-5D-5L score was compared for patients who did and did not find the pamphlet effective using the Wilcoxon-Mann-Whitney test. Thirty-seven patients participated. The median age was 76 years (range 56–93) and 22 patients (59 %) had ≤high school education. Most patients preferred to have verbal (65 %) or written (78 %) educational materials as opposed to online information or educational classes. Thirty-two patients (86 %) rated the pamphlet as effective. The proportion of patients who found the pamphlet effective was 85.7 versus 86.7 % (p = 1.00) in those with REALM 7 versus EQ-5D score was 67.5 (SD 19.1) versus 71.8 (SD 8.7) (p = 0.84) in those who found the pamphlet effective versus not. Participatory design is an effective method for developing education materials for challenging patient groups such as elderly patients. Despite advanced age and comorbidity, this patient group had adequate health literacy.
    Journal of Cancer Education 01/2015; DOI:10.1007/s13187-014-0780-1 · 1.23 Impact Factor
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    ABSTRACT: This study describes the process and outcomes of breast radiotherapy (RT) quality assurance (QA) rounds, seeking to identify variables associated with plan modifications. Real-time data were prospectively collected over 2years. Descriptive statistics determined the proportion of cases requiring no (A), minor (B), or major (C) modifications, which were then subjected to univariate and multivariate analyses. A total of 2223 breast cancer QA cases were reviewed; 47 cases (2.1%) underwent a minor, and 52 cases (2.3%) required a major modification. Common changes included boost, volume, seroma, and bolus. On univariate analysis, regional nodal irradiation (RNI), tumour size, and axillary node dissection were significantly associated with major modifications. Upon multivariate analysis, the only independent predictor was RNI (OR 2.12, p=0.0075). For patients with no RNI, <2cm tumours, no axillary lymph node dissection, and no boosts (n=420); the likelihood of category C was only 1.4%. It is feasible to conduct QA review for all breast cancer cases prior to commencing RT. Patients undergoing RNI had a higher likelihood of plan modifications; a group with low risk of modification was identified, which could direct future re-structuring of QA rounds. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Radiotherapy and Oncology 12/2014; 114(1). DOI:10.1016/j.radonc.2014.11.042 · 4.36 Impact Factor
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    ABSTRACT: Objectives In response to the dearth of consumer health information for patients with gastrointestinal cancers, this study examined the informational needs of these patients to build a plan for future resource development. Although studies have examined informational needs of some such cancers, no published literature has investigated the comprehensive informational needs across all sites of gastrointestinal cancer.MethodsA cross-sectional needs assessment comprising a self-administered questionnaire was conducted at an ambulatory gastrointestinal oncology clinic in Toronto, Canada. Patient informational needs were measured, including importance of information, amount desired and preferred mode of delivery. Informational needs were grouped into six domains: medical, practical, physical, emotional, social and spiritual.ResultsEighty-two surveys were analysed. The majority of the respondents were male (53.8%), over the age of 50 (77.8%), and born outside of Canada (51.9%). While many did not speak English as a child (46.3%), and do not speak English at home (22.2%), nearly all indicated comfort with receiving health information in English (97.5%). The majority of respondents were college educated (79.3%) and married (73%). Multiple cancer types were reported; the most common being colorectal (39%), followed by pancreatic (12%) and cancers of the gallbladder or bile duct (12%). Overall, respondents placed highest importance on medical information (P < 0.001). Preferred education modalities were pamphlets, websites and one-on-one discussions with health-care professionals.Conclusions This study highlights the principal informational needs of patients with gastrointestinal malignancies, along with preferred modality for information delivery. This information will guide the development of educational resources for future patients.
    Health expectations: an international journal of public participation in health care and health policy 11/2014; DOI:10.1111/hex.12296 · 3.41 Impact Factor
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    ABSTRACT: Lung cancer survivors are likely to have low health literacy which is an independent risk factor for poorer health outcomes. The eHealth literacy in lung cancer survivors has not been reported. The purposes of this study were to determine self-perceived eHealth literacy levels in lung cancer survivors and to explore predictors of higher eHealth literacy. A cross-sectional study was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. Survivors completed a survey that collected demographic, self-perceived eHealth literacy (using the eHealth Literacy Scale), and quality of life information. Tumor and treatment details were extracted from medical records. Demographic data was summarized using descriptive statistics and compared against those with high and low eHealth literacy using Fisher's exact test. Eighty-three survivors were enrolled over 7 months. Median age was 71 years (range 44-89); 41 survivors (49 %) were male. Forty-six (55 %) survivors had some college education or higher. Most had access to eResources (78 %) via computer, Internet, or smartphone. Fifty-seven (69 %) scored 5 or greater (7 = excellent) on the overall health scale. Twenty-eight (33.7 %) perceived themselves to have high eHealth literacy. There was no statistically significant correlation between eHealth literacy groups and age (p = 1.00), gender (p = 0.82), living situation (p = 1.00), overall health (p = 1.00), overall quality of life (QoL) (p = 1.00), or histology (p = 0.74). High eHealth literacy correlated with the level of education received (p = 0.003) and access to eResources (p = 0.004). The self-perceived eHealth literacy of lung cancer survivors is generally low.
    Journal of Cancer Education 10/2014; 30(4). DOI:10.1007/s13187-014-0744-5 · 1.23 Impact Factor
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    ABSTRACT: Purpose To evaluate the feasibility and educational value of high-fidelity, interprofessional team-based simulation in radiation oncology. Methods The simulation event was conducted in a radiation oncology department during a non-clinical day. It involved 5 simulation scenarios that were run over three 105 minute timeslots in a single day. High-acuity, low-frequency clinical situations were selected and included HDR brachytherapy emergency, 4D CT artifact management, pediatric emergency clinical mark-up, electron scalp trial set-up and a cone beam CT misregistration incident. A purposive sample of a minimum of 20 trainees was required to assess recruitment feasibility. A faculty radiation oncologist (RO), medical physicist (MP) or radiation therapist (RTT), facilitated each case. Participants completed a pre event survey of demographic data and motivation for participation. A post event survey collected perceptions of familiarity with the clinical content, comfort with interprofessional practice, and event satisfaction, scored on a 1–10 scale in terms of clinical knowledge, clinical decision making, clinical skills, exposure to other trainees and interprofessional communication. Means and standard deviations were calculated. Results Twenty-one trainees participated including 6 ROs (29%), 6 MPs (29%), and 9 RTTs (43%). All 12 cases (100%) were completed within the allocated 105 minutes. Nine faculty facilitators, (3MP, 2 RO, 4 RTTs) were required for 405 minutes each. Additional costs associated with this event were 154 hours to build the high fidelity scenarios, 2 standardized patients (SPs) for a total of 15.5 hours, and consumables.The mean (±SD) educational value score reported by participants with respect to clinical knowledge was 8.9 (1.1), clinical decision making 8.9 (1.3), clinical skills 8.9 (1.1), exposure to other trainees 9.1 (2.3) and interprofessional communication 9.1 (1.0). Fifteen (71%) participants reported the cases were of an appropriate complexity. The importance of further simulation events was rated highly at 9.1/10. Conclusions High-fidelity simulation training is feasible and effective in a radiation oncology context. However, such educational activities require significant resources, including personnel and equipment.
    Radiation Oncology 08/2014; 9(1):189. DOI:10.1186/1748-717X-9-189 · 2.55 Impact Factor
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    Journal of Medical Imaging and Radiation Sciences 06/2014; 45(2):166. DOI:10.1016/j.jmir.2014.03.021
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    ABSTRACT: Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.
    Journal of Cancer Survivorship 04/2014; 8(3). DOI:10.1007/s11764-014-0357-3 · 3.30 Impact Factor
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    ABSTRACT: Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated. A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar's test were used to assess changes in outcomes. A total of 148 men completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < 0.0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = 0.015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = 0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ 0.001), and there was uptake of vitamin D supplementation from 44 % (n = 65) to 68 % (n = 99) (p < 0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. -0.22 ± 4.2, p = 0.005) compared to men with normal bone density. Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.
    Supportive Care in Cancer 04/2014; 22(9). DOI:10.1007/s00520-014-2183-6 · 2.36 Impact Factor
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    ABSTRACT: Objectives: The criteria for determining whether resources are included in consumer health library collections are summarized in institutional collection development policies (CDPs). Evidence suggests that CDPs do not adequately capture all of these criteria. The aim of this study was to describe the resource review experience of librarians and compare it to what is described in CDPs. Methods: A phenomenological approach was used to explore and describe the process. Four consumer health librarians independently evaluated cancer-related consumer health resources and described their review process during a semi-structured telephone interview. Afterward, these librarians completed online questionnaires about their approaches to collection development. CDPs from participating libraries, interview transcripts, and questionnaire data were analyzed. Researchers summarized the findings, and participating librarians reviewed results for validation. Results: Librarians all utilized similar criteria, as documented in their CDPs; however, of thirteen criteria described in the study, only four were documented in CDPs. Conclusions: CDPs for consumer health libraries may be missing important criteria that are considered integral parts of the collection development process. Implications: A better understanding of the criteria and contextual factors involved in the collection development process can assist with establishing high-quality consumer health library collections.
    Journal of the Medical Library Association JMLA 04/2014; 102(2):78-84. DOI:10.3163/1536-5050.102.2.003 · 0.99 Impact Factor
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    ABSTRACT: Background Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. Purpose To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. Methods This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. Results A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group inter-vention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. Conclusion This brief intervention appears feasible and has shown promising results in addressing FCR and related sec-ondary outcomes of cancer-specific distress, uncertainty, qual-ity of life, and coping; however, it should be further tested using a randomized controlled study design to more defini-tively assess its efficacy. Implications for Cancer Survivors FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important
  • Lori J Bernstein · Pamela A Catton · Ian F Tannock ·
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    ABSTRACT: Studies assessing cognitive functioning in women treated for breast cancer have used primarily standardized neuropsychological tests and examined accuracy and/or reaction time as outcome measures: they have been inconsistent in identifying the cognitive domains affected and the severity of deficits. In other contexts of neural development and disorders, measures of Intra-individual variability (IIV) have proven useful in identifying subtleties in performance deficits that are not captured by measures of central tendency. This article presents proof of concept that assessing IIV may also increase understanding of the cognitive effects of cancer treatment. We analyzed mean accuracy and reaction time, as well as IIV from 65 women with breast cancer and 28 age and education matched controls who performed the Conner's Continuous Performance Test, a "Go-NoGo" task. Although there were no significant differences between groups using measures of central tendency, there was a group × inter-stimulus interval (ISI) interaction for IIV Dispersion (p < .001). Patient Dispersion was more variable at shorter ISI than controls and less variable at long ISI, suggesting greater sensitivity to presentation speed. Interpretation of IIV differences requires further investigation. Our results suggest that future studies would benefit from designs that allow analysis of IIV measures in studies assessing cognition in cancer survivors. (JINS, 2014, 20, 1-11).
    Journal of the International Neuropsychological Society 03/2014; 20(04):1-11. DOI:10.1017/S1355617714000125 · 2.96 Impact Factor
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    ABSTRACT: Purpose Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile. Methods and Materials A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile. Results Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items). Conclusions We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs.
    International journal of radiation oncology, biology, physics 03/2014; 88(4):961–966. DOI:10.1016/j.ijrobp.2013.12.009 · 4.26 Impact Factor
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    ABSTRACT: There is growing recognition of the importance of patient education given the prevalence and consequences of low health literacy in Canada and the USA. Research has shown that in addition to plain language, the use of theories of learning can contribute to the effectiveness of patient education resources, and as such, various guidelines and toolkits have been put together to help healthcare providers utilize these theories. Despite these efforts, this knowledge is not consistently applied in practice. To address this gap, we describe a new theory-based protocol, the "3Ws and an H," that is designed to guide healthcare providers in the production of effective patient education resources. Adult learning theory underpins each step of the process, and by using the "3Ws and an H," relevant theories are applied as the steps of the protocol are followed. To facilitate the adoption of this process, we describe it using a resource development project for survivors of endometrial cancer as an example.
    Journal of Cancer Education 01/2014; 29(2). DOI:10.1007/s13187-013-0600-z · 1.23 Impact Factor
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    ABSTRACT: Recent media attention about radiation has led to heightened public awareness and concern about radiation therapy (RT). An understanding of concerns and their potential role in patient decision-making can inform education efforts. A multiphase needs assessment survey was designed to ascertain broad public perceptions of radiation (phase I) and the more in-depth cancer patient perceptions of RT (phase II). One hundred forty-six phase I and 111 phase II surveys were completed. Data suggested a prevalence of negative connotations of the word "radiation," often associated with information from the media or secondhand experience. Side effects during and after RT were reported as concerns, including misperceptions about becoming radioactive and impact on fertility. Rankings of quality and safety perceptions suggested confidence in staff training and equipment, though concerns regarding overdoses and protection of healthy tissue were higher amongst those who refused RT. In deciding whether or not to undergo RT, high value was placed on the reputation of the cancer centre and the expected effectiveness of RT. The importance of understanding RT was more highly regarded by those who underwent RT than those who refused it. Perceptions of RT should thus be addressed amongst those in a position to consider RT, to maximize RT utilization where appropriate.
    Journal of Cancer Education 01/2014; 29(2). DOI:10.1007/s13187-013-0598-2 · 1.23 Impact Factor
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    ABSTRACT: Background: Distress in husbands of women with early-stage breast cancer may be equivalent to or even higher than their wives. Husbands often struggle to help and support their wives cope with the illness and its treatment. In response, we developed a five-session group educational counselling intervention (Helping Her Heal-Group (HHH-G)) for husbands of women with early-stage breast cancer. The primary aim of the current pilot study was to determine the acceptability and feasibility of HHH-G and to obtain a preliminary estimate of its impact on participating men's skills, self-confidence and self care. Secondary aims were to assess the impact of the intervention on both the participating spouses' and wives' ratings of marital quality and depressed mood. Methods: The study employed a one-arm, pre-post-intervention design whereby participating men (n=54) and their wives (n=54) independently completed measures at baseline (T0), immediately following the last session (T1) and 3 months after the last session (T2). Results: Overall, there was very high study retention (87%). On the basis of the questionnaire data, we found significant improvements in spouses' self-efficacy (p<0.001) and self-reported skills including wife support (p=0.003) and self-care (p<0.001). In addition, there was a significant improvement in wives' mood scores (p=0.003). Post-intervention interviews support acceptability and impact of the HHH-G intervention, and provide support for the group format of the program. Conclusions: The feasibility and acceptability of HHH-G was supported, and treatment outcomes suggest the potential benefits of the intervention. Phase III evaluation of HHH-G program is warranted.
    Psycho-Oncology 09/2013; 22(9). DOI:10.1002/pon.3263 · 2.44 Impact Factor
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    ABSTRACT: A curriculum gap exists in radiation oncology medical residency programs relating to imaging. This study, using an interprofessional approach, aimed to identify elements of an imaging literacy competency profile and current best educational practice. Radiation medicine professionals and trainees affiliated with a single radiation oncology residency program were invited to participate in interprofessional, semistructured focus groups. Questions concerned the definition of imaging literacy, current teaching best practices, and required competencies. Audio recordings were transcribed verbatim and data coded and analysed iteratively. Themes were identified using the constant comparison method. Ten physicians (three staff, seven trainees), eight radiation therapists, and six physicists participated in four focus groups, averaging 52 minutes (range, 47-59 minutes) in duration. Imaging literacy was defined as the knowledge of indications for imaging, and skills for image manipulation through all stages of diagnosis, treatment, and response assessment. Shortcomings in the current training program include a lack of imaging expertise, defined objectives, or structured assessments. A need for an interprofessional approach to teaching imaging literacy was expressed. Participants provided a comprehensive picture of imaging literacy for radiation oncologists unachievable with a uniprofessional approach. Suggested competency elements require further refinement with input from interprofessional colleagues, especially therapists and physicists, prior to implementation within residency programs.
    Journal of Medical Imaging and Radiation Sciences 09/2013; 44(3):150–156. DOI:10.1016/j.jmir.2013.03.002
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    ABSTRACT: Purpose: Advances in breast cancer treatment have increased survival and contributed to longer periods of survivorship as reported by the Committee CCSsS (Canadian Cancer Statistics) (2011) and Hewitt et al. (2005), increasing the relevance of survivorship care. Survivorship care includes encouraging survivors to acquire the knowledge, skills and confidence to manage their life, as well as engaging survivors through post-diagnosis disease self-management and self-care strategies. The Survivorship Consult (SC) was designed to help survivors reflect on their needs, establish goals and create an action plan. Methods: Twenty-six breast cancer survivors who participated in the SC at Princess Margaret Cancer Centre took part in semi-structured interviews to assess the survivor experience and effectiveness of the SC. Data from these interviews were coded, and themes were identified using a modified grounded theory approach. Results: Themes that emerged regarding the experience and effectiveness of the SC included (1) the supportive experience of collaborative dialogue with supportive care clinicians (i.e. nurses, social workers, occupational therapists, etc.), (2) the development of personalized goals that motivated individuals to implement recommendations, (3) an enhanced understanding of their health condition, team and options, (4) an improved ability to identify needs and (5) an increased sense of confidence to manage issues related to care. Conclusions: The assessment of the SC improved the experience of breast cancer patients by providing a supportive environment where they could feel cared about, by increasing understanding of their condition and its treatment, by improving communication with the care team and by motivating patients to manage care issues. Further research is needed on survivors who conduct the SC before the treatment phase of their cancer trajectory.
    Supportive Care in Cancer 03/2013; 21(8). DOI:10.1007/s00520-013-1760-4 · 2.36 Impact Factor

Publication Stats

1k Citations
230.71 Total Impact Points


  • 2000-2015
    • University of Toronto
      • • Department of Psychiatry
      • • Department of Radiation Oncology
      Toronto, Ontario, Canada
  • 1997-2015
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2014
    • University of Ottawa
      • School of Psychology
      Ottawa, Ontario, Canada
  • 2002-2014
    • University Health Network
      • Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2005
    • Ontario Institute for Studies in Education
      Toronto, Ontario, Canada