A Direct Patient-Provider Relationship With the Medical Physicist Reduces Anxiety in Patients Receiving Radiation Therapy

Abstract

Purpose: The complex technological processes involved in radiation therapy can be intimidating to patients, causing increased treatment-related anxiety and reduced satisfaction. An intervention was implemented to provide direct consultations between patients and medical physicists to reduce patient anxiety and improve patient satisfaction. A randomized clinical trial was conducted to test the intervention's effect on anxiety, distress, treatment adherence, technical understanding, and satisfaction in patients receiving radiation therapy.

Methods and materials: Eligible patients were recruited into "intervention" and "standard of care" arms within a phase 2 screening randomized trial. Intervention-arm patients met with a medical physicist who provided technical information and addressed patient questions or concerns at the time of treatment simulation and before the first treatment. In addition to baseline information collected before randomization, participants were surveyed (1) before simulation, (2) before the first treatment, and (3) before the completion of treatment to evaluate the study endpoints. Primary endpoints included patient anxiety and distress. Secondary endpoints included patient treatment adherence, overall satisfaction, and technical understanding of treatment. Patients in the intervention arm were surveyed before and after each physicist meeting.

Results: Participant anxiety was significantly reduced in the intervention arm (difference, -0.29; 95% confidence interval, -0.57 to -0.02; P = .038). No differences in distress or treatment adherence were observed between groups. Although measures of technical understanding and satisfaction were evaluated as exploratory objectives, participants in the intervention group were more likely to feel that technical aspects of treatment were adequately explained (difference, 0.78; 95% confidence interval, 0.03-1.54), and all measures of technical understanding and satisfaction were considerably higher in the intervention group at the time of the first visit.

Conclusions: The establishment of a direct patient-provider relationship with the medical physicist reduced anxiety in patients receiving radiation therapy. In addition, increases in patient understanding of the technical aspects of care and in satisfaction were observed at the initiation of treatment.

Fig. 1.

(A) Baseline corrected anxiety and (B) distress. These represent the primary study objectives and were obtained by subtracting the baseline scores from those at visit 1, 2, and 3 (simulation, first treatment, and last treatment, respectively). The data points indicate means, and the vertical lines, 95% confidence intervals (CIs). Overall P values were obtained from a linear mixed-effects model. Estimated group differences and 95% CIs are given for overall and each visit except for distress (90% CI, as indicated by an asterisk).

Fig. 2.

Baseline corrected technical aspects of care. The data points indicate mean values, and vertical lines represent 95% confidence intervals (CIs). Estimated group differences and 95% CIs are given overall and for each visit. Overall differences represent secondary study objectives, whereas individual time point differences were post hoc exploratory objectives. Overall group differences and 95% CIs were obtained from a linear mixed-effects model.

Fig. 3.

Subgroup analyses of baseline-corrected anxiety, distress, technical aspects of care, and overall satisfaction. The mean differences and 95% confidence intervals (CIs) were estimated using linear mixed-effects models. No subgroup analysis was carried out for “male” and “other” for “gender,” owing to the small sample sizes (n = 1 for each group). The red dotted lines indicate the overall estimated group differences. All subgroup analyses represent post hoc exploratory objectives.

Fig. 3.

Subgroup analyses of baseline-corrected anxiety, distress, technical aspects of care, and overall satisfaction. The mean differences and 95% confidence intervals (CIs) were estimated using linear mixed-effects models. No subgroup analysis was carried out for “male” and “other” for “gender,” owing to the small sample sizes (n = 1 for each group). The red dotted lines indicate the overall estimated group differences. All subgroup analyses represent post hoc exploratory objectives.