3574 - Evaluation of a Graphic Narrative Patient Education Tool to Reduce Pre-Treatment Anxiety for Patients Receiving Radiotherapy in a Latin American Hospital

A. G. L. Vannier¹, A. Gonzalez^2,3, M. Caicedo⁴, M. P. Montenegro-Gómez^2,3, J. K. Gómez-Muñoz^2,3, S. Avila¹, L. Gutiérrez-Babativa^2,3, A. Prada-Álvarez^2,3, A. Haydon¹, C. Bregio¹, M. K. Rooney⁵, I. I. Franco⁶, B. Callender⁷, E. A. Guerrero-Lizcano⁴, H. Ballesteros⁴, O. I. Olopade⁸, P. Ortega⁹, T. Ichikawa¹⁰, I. Bobadilla², and D. W. Golden¹¹; ¹University of Chicago Pritzker School of Medicine, Chicago, IL, ²Fundación Centro de Tratamiento en Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia, ³Grupo de Investigación GIGA, CTIC/Universidad El Bosque, Bogotá, Colombia, ⁴Instituto Nacional de Cancerología, Bogotá, Colombia, ⁵Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ⁶Department of Radiation Oncology, Harvard Medical School, Boston, MA, ⁷Department of Medicine, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, IL, ⁸Division of Hematology Oncology, University of Chicago Medical Center, Chicago, IL, ⁹Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, Chicago, IL, ¹⁰Institute of Design, Illinois Institute of Technology, Chicago, IL, ¹¹Department of Radiation Oncology, RUSH University Medical Center, Chicago, IL

Purpose/Objective(s): Radiotherapy can induce anxiety in patients. Education may reduce this anxiety, but existing radiotherapy patient education materials often exceed recommended readability levels. Additionally, there is a dearth of non-English radiotherapy patient education materials. These problems are exacerbated in low- and middle-income countries. A graphic narrative education tool designed to reduce pre-radiotherapy anxiety, the Communicating the External Beam Radiation Experience (CEBRE) discussion guide, was developed and translated into Spanish (CEBRE en Español). This study measures baseline patient anxiety and knowledge prior to radiotherapy in Bogotá, Colombia, and assesses the impact of CEBRE en Español on anxiety. We hypothesize that patients will report lower anxiety following CEBRE education than at baseline. Materials/

Methods: In this ongoing study, patients initiating radiotherapy at one institution in Bogotá, Colombia, complete a pre-radiotherapy anxiety assessment, receive CEBRE education from a nurse, and are then immediately re-assessed for anxiety. The survey collects basic demographic information and includes the Radiation Oncology Knowledge Assessment Survey (ROKAS; range: 0-8), Hospital Anxiety and Depression Scale (HADS; range 0-21), and Spielberger Trait Anxiety Inventory Short-Form (STAISF; range: 20-80). ROKAS, HADS and STAISF are reported as mean±standard deviation. A paired t test is used to compare pre- and post-CEBRE STAISF.
Results: 75 participants are accrued thus far. Mean age is 58.9 (range 26-89) with 47 females and 28 males. The most common diagnoses are breast (n=23) and prostate (n=19). Mean pre-CEBRE ROKAS is 3.9±1.3. Mean pre-CEBRE HADS-A score is 5.2±3.4 and HADS-D is 4.9±3.6. Mean pre- and post-CEBRE STAISF scores are 38.0±10.8 and 33.5±10.1 with a mean reduction of 4.5±11.2 (p<0.001).

Conclusion: This ongoing project is the first to establish baseline levels of knowledge and anxiety among patients initiating radiotherapy in Latin America. Preliminary results are encouraging that the application of CEBRE is associated with a reduction in pre-treatment anxiety. Final evaluation of the effect of CEBRE en Español on patient anxiety will be completed after full enrollment of study participants. Future directions include a stepped-wedge trial to prospectively evaluate graphic narrative education over traditional education methods and translation of CEBRE into additional languages.