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Reducing Anxiety in Cancer Patients Using 3D Videos

Hunter New England Local Health District
Project Added:
6 January 2016
Last updated:
20 January 2016

Reducing Anxiety in Cancer Patients Using 3D Videos

Summary

Hunter New England Local Health District (HNELHD) staff volunteered their time to develop information videos incorporating 3D animation for patients undergoing radiation therapy. Patient engagement led to videos that were tailored to specific treatment situations and information needs.  

Aim

To reduce anxiety in patients who are completing radiation therapy and avoid common misconceptions about treatment.

Benefits

  • Provides high-quality information to patients that explains complex concepts clearly and succinctly.
  • Ensures information provided to patients is consistent and not subject to staff variability.
  • Helps patients understand treatment processes and provides them with resources to explain it to family and friends.
  • Reduces fear and anxiety related to cancer treatment.
  • Allows clinicians to collaborate with patients and facilitate better communication.
  • Embeds standard education processes, with resources quickly and reliably accessed via the intranet.
  • Empowers patients to contribute in meaningful ways and drive the process of improvement.

Project status

Key dates

Project start: March 2014

Status

Sustained - The initiative has been implemented and is sustained in standard business.

Background

Radiation therapy is the use of powerful x-rays to treat cancer. It is typically delivered in daily sessions over several weeks. Research shows that patients often experience anxiety during initial radiotherapy appointments, due to misconceptions about the treatment and what to expect.

Rounding sessions delivered as part of the HNELHD Excellence Program highlighted the need for patient resources to address this challenge. Patients indicated they were struggling with complex concepts such as how their computed tomography (CT) scan related to the movements of the treatment machine.

PEARL 3D visualisation software was available at North West Cancer Centre (NWCC).  This software is normally used for educating students. It provides an interactive model of the treatment environment, including machine lights, movement and sounds.  The patient’s CT scan and treatment plan can be loaded into the software, to allow a visual representation of the relationship between the scan, the targeted treatment and the radiation beams. This concept cannot be demonstrated with real-life footage.

Staff members recognised that patients had a clear, urgent need for quality information that could be provided with this type of footage. It was decided to incorporate PEARL 3D videos into all preparatory consultations for patients undergoing radiation therapy.

Implementation 

  • Patient consultation and a literature review informed the content of the videos, with footage of treatment processes augmented by PEARL 3D visualisation software. 
  • Feedback from the initial videos led to the creation of videos for other specific situations, such as post-mastectomy radiation. Patients voluntarily had their treatments filmed to facilitate this. 
  • Five videos were produced by NWCC staff: one for the general treatment process and four for disease and site-specific processes. Patients were shown the most relevant video during the preparatory consultation, with each video accessed via the intranet on the clinician’s computer.
  • Password-protected online versions and DVD copies were made available for patients who wanted to watch the video again at home or explain treatment processes to family who could not attend consultations.
  • Continuous quality improvement was managed with an ethics-approved survey.  Responding to patient suggestions such as providing closed-captions and copies to take home improved the content and use of the videos throughout the project.
  • Typical costs of an information video produced by an external company is around $30,000 (based on NWCC staff experience at St. George Hospital and the Peter MacCallum Cancer Centre). No budget was available to engage a production company, so staff donated their own time and expertise to the production of these videos. This included video editing and the loan of video production equipment. In-house production meant that it was possible to rapidly redraft videos in response to patient feedback or changes requested by the multidisciplinary team. It also means additional edits are possible in the future, without having to engage an external production company.
  • A scholarship from Hunter New England Research, Innovation and Partnerships has allowed production of additional videos and a detailed statistical analysis of their effectiveness to be undertaken, in preparation for journal publication.
  • Professional presentations have resulted in considerable interest from other hospitals, with several adopting the existing movies and others creating their own resources based on NWCC’s approach.

PEARL 3D visualization of the treatment room with virtual patient
Figure 1. PEARL 3D visualization of the treatment room with virtual patient.

Virtual patient rendered semi-transparent with CT anatomy displayed
Figure 2. Virtual patient rendered semi-transparent with CT anatomy displayed.

CT anatomy with labelled 3D structures displayed in relation to virtual treatment machine
Figure 3. CT anatomy with labelled 3D structures displayed in relation to virtual treatment machine.

Implementation site

  • North West Cancer Centre, HNELHD.

Partnerships
 

  • Research, Innovation and Partnerships, HNELHD.
  • Royal Australian and New Zealand College of Radiologists, Faculty of Radiation Oncology.

Results 

  • Patient feedback was overwhelmingly positive. Statistical analysis of the first 60 survey results found 98% of patients reported the video was useful for one or more of the listed purposes. These included understanding the treatment process (85%) and using it at home to explain the treatment to family and friends (47%). 
  • In total, 50% of patients reported a reduction in fear and anxiety as a result of watching the video. When looking specifically at the 25 patients who reported being anxious prior to viewing the video, the proportion that experienced mental health benefits increased to 75%. 
  • The use of PEARL 3D visualisation software was strongly commended by patients, for explaining the rationale of a specific CT scan (71%), the importance of keeping still (80%) and the rationale of machine movements (80%). In terms of completeness, only 11% of respondents indicated that there were still parts of the treatment process they were uncertain about.
  • The program has received professional recognition for quality and originality, with the Royal Australian and New Zealand College of Radiologists including it its ‘Targeting Cancer’ public awareness campaign.

Awards

  • 2015 HNELHD Quality Awards: Patients as Partners
  • 2015 ACI Rural Innovation Award
  • 2014 Tamworth Hospital Quality Award: Partnering with Patients 

Lessons Learnt

  • Collaboration of patients and staff to achieve this shared goal not only resulted in high-quality resources for patients, but also a sense of pride among the team. Patients involved in the filming and those who completed surveys all indicated that they felt a sense of doing something significant for their fellow patients.
  • As a new regional cancer centre, delivering a program that is recognised as innovative is an important part of building partnerships. It also helps to promote the service’s proactive attitude and strong commitment to patient care.
  • Budgetary constraints resulted in the healthcare team producing the content rather than hiring a third party production company.  This avoided the need to first educate the production team on the problem and the domain. Staff involved could readily interact with patients and iteratively improve the videos in response to feedback without additional production cost.  These advantages need to be considered against the capacity of relevant staff to produce high-quality videos, but should not be underestimated.  

Further reading 

  • Mills M, Sullivan K. The importance of information giving for patients newly diagnosed with cancer: a review of the literature. Journal of Clinical Nursing 1999; 8: 631-642.
  • Zeguers M, De Haes H, Zandbelt I et al. The information needs of new radiotherapy patients: how to measure? Do they want to know everything? And if not, why? International Journal of Radiation Oncology Biology and Physics 2012; 82: 418-424.

Contact

David Willis
Chief Radiation Therapist
Hunter New England Local Health District
Phone: 02 6767 7244
David.Willis@hnehealth.nsw.gov.au

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