Development and Implementation of an Online Educational Module for the Deep Inspiration Breath-Hold Technique


Purpose: To develop an online educational module for patients undergoing breast radiotherapy treatments using the Deep Inspiration Breath-Hold (DIBH) technique. The goal was to assist the patient with breathing control by developing new pedagogical approaches and interactive training materials that augment understanding, increase patient satisfaction, decrease anxiety, and enhance the overall treatment delivery efficiency.

Methods: The current procedure in our clinic is to ask the patient to attend a breathing control training session and to get familiar to the visual/audio breathing control equipment before the CT simulation appointment. However, with the level of stress and fatigue typical to cancer patients and the waiting time of several weeks between the training and start of treatment, patients tend to forget, or selectively remember important parts of the information conveyed during the training session. Ideally, the patient should be given the opportunity to prepare in advance of the training session and be able to review the highlights of the DIBH technique after the training session and before their actual treatment. Our approach was to develop an online educational material using still images, animations and simple text with suitable levels of interactivity and opportunities for guided discovery and self-pacing. To this end, a professional animator attended a live patient-training session in order to gather the information needed to produce the animations. These images and associated text were compiled as a pamphlet as well as a more comprehensive and dynamic on-line module. The online module consists of an animated movie and a series of still images as a step-by-step guide that takes the patient through a breath-hold breathing practice and describes the entire radiotherapy treatment workflow. The team consisted of 1 radiation oncologist, 3 medical physicists, 2 radiation technologists, 1 health educator and 1 patient representative. Objective assessment preceding implementation of the education materials was conducted via transition-phase questionnaires, so as to identify (1) the needs/priorities and the type of information for patient education material from the perspective of the patient; (2) assess patient satisfaction, comprehension and level of treatment-related anxiety. Objective evaluation and assessments were implemented via post-implementation questionnaires and patient teach-back sessions, so as to (1) collect patient feedback on the implemented education material; (2) assess patient satisfaction, comprehension and level of treatment-related anxiety.

Results: The population that is seen in our clinic is multicultural, multilingual, with different levels of literacy, education and stress. The highly visual nature of multimedia-based imagery, as well as its potential for interactivity makes teaching clearer. The patients that receive the pamphlet and access the online module prior to the teaching session are more informed and prepared for their treatments. The challenges we have experienced are with those patients who are not habitually using a computer/internet or have no time to consult the online module.

Conclusions: Providing pertinent support for patients undergoing cancer treatment through patient education actively involves the patient in their treatment, fosters team building amongst different professions and has the overall benefit of a better treatment.

In Journal of Medical Imaging and Radiation Sciences
John Kildea
John Kildea
Assistant Professor of Medical Physics