Orientation and Information Provision
Orientation and Information Provision
Orientation and information provision is giving, to patients and others, information about disease, treatment, and services to be received. Such information often includes information about the organization, staff members with whom the patient may interact, and physical structures and facility layout, such as the location of transportation or parking. Providing orientation and information differs from providing a psychoeducational intervention, in that simple orientation and information provision is generally not interactive and it does not include components such as support or counseling. Orientation and information provision may be done via print or electronic media. Researchers have examined the effects of orientation and information provision on lymphedema and cancer-related anxiety and depression.
Chan, R.J., Webster, J., & Marquart, L. (2011). Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews, 12, CD008273.doi: 10.1002/14651858.CD008273.pub2
To assess effects of interventions that orient patients and carers to a cancer care facility and to the services provided
- Databases searched were Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PsycINFO. Investigators also searched reference lists and abstracts from relevant proceedings. Specific journals were searched separately.
- Authors provide an extensive listing of search terms and specific search language for each database. In addition to all relevant terms for cancer, key terms included patient education, patient information, mass communications, audio, video, cassette, tape, dvd, compact disc, media, multi media, internet, website, pamphlet, booklet, and phone or print material.
- Studies were included in the review if they were randomized controlled trials (RCTs) and quasi-RCTs that compared the effect that orientation achieved in an intervention group with the effect achieved in a control group or compared one orientation intervention with another orientation intervention.
Initial searching identified 14,319 records. Investigators assessed 21 full-text articles for eligibility, and the systemaic review included a sample of four. Two studies were included in meta-analysis. Study quality was assessed using guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.
- The final sample of four studies involved 631 patients.
- Sample sizes were 31–304 and included new patients, over 18 years of age, with cancer.
- All studies allowed family and carers to receive the intervention along with the patient.
- Various diagnoses were represented.
- Studies were generally of low to very low overall quality.
- Components of the oreitnation programs were information about the healthcare team, a clinic tour, information about the facility (parking, hours of operation, etc.), description of clinical procedures, information about supportive services available, treatment-related information, and question-and-answer sessions.
- Formats used were written materials in all studies and videotape in one study. Interventions were delivered via mail or face-to-face. Timing of orientation varied. Intervention intensity could only be measured by length of time taken for reading or watching a video or duration of face-to-face interactions.
Effects of Interventions
- Knowledge and understanding: Two studies reported better knowledge and understanding with the intervention or risks, benefits, and side effects of treatment. Pooled analysis of these results gave a mean difference (MD) of –0.18, 95% CI –1.02 through 0.66.
- State anxiety: Two trials measured effect on state anxiety. Pooled analysis showed MD of –9.77, 95% CI –24.96 through 5.41. In one of these trials, there was a significant difference in trait anxiety between study groups at baseline.
- General anxiety: One trial measured general anxiety by using the Brief Symptom Inventory and found no differences between groups.
- Mood disturbance: Two trials evaluated general distress. Analysis showed significant difference in favor of the intervention group (MD = –8.96, 95% CI –11.79 through –6.13).
- Symptoms of depression: Three studies reported positive benefits of the intervention on symptoms of depression. Postintervention meta-analysis showed no difference in depression scores (MD = –0.4, 95% CI –2.95 through –2.15).
This review shows that orientation programs may reduce distress in patients with cancer at the beginning of their involvement with a cancer care facility, but the quality of the evidence is low. Orientation programs may have some effect on general distress and symptoms of depression; however, findings do not show significant effects on anxiety.
These findings are limited by the small number of trials included, low quality of studies, and high heterogeneity found related to some outcomes.
Orientation of the patient, the patient's family, and those who care for the patient may help to reduce a patient's symptoms of depression and level of distress; however, this study does not reveal strong support for these outcomes. The most effective format and timing of orientation approaches are unclear.
Husson, O., Mols, F., & van de Poll-Franse, L.V. (2011). The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: A systematic review. Annals of Oncology: Official Journal of the European Society for Medical Oncology/ESMO, 22(4), 761–772.doi:10.1093/annonc/mdq413
To complete a systematic review of available literature regarding the relationship between information provision and health-related quality of life, anxiety, and depression
- Databases searched were PubMed and PsycINFO. The search was for original articles published up to February 2010.
- Search keywords were cancer, information, information provision, information disclosure, information needs, information satisfaction, information level, information barriers, written information, oral information, audiotape information, CDROM, quality of life, health status, well-being, anxiety, depression.
- A study was included if it was appropriate to the purposes of the analysis, was the original article, was printed in the English language, and was published in a peer-reviewed journal.
- A study was excluded if it was a care report or a review article, was related to end-stage cancer patients, focused on communication aspects, focused on family members, focused on diagnosis or prognosis, or used a single-item measure of health-related quality of life.
- The initial search found 5,732 articles. In reviewing the abstracts, 37 articles potentially met the study criteria.
- The study consisted of (1) design: prospective, cross-sectional, (2) study population: size, diagnosis, stage, (3) measuring instruments, (4) types of information provision instruments, (5) results, and (6) overall methodological quality based on a scoring system. The evaluation criteria for methodological quality included the validity of measurements, clearly stated inclusion and exclusion criteria, the inclusion of sociodemographic variables, participation or response rates higher than 75%, sample size, a prospective study design, comparisons of results to other groups or times, and sound data analysis.
Other comments on literature evaluated: Investigators did not conduct meta-analysis.
- The final number of studies included in the sample was 25. All the studies had been conducted from 1996 through 2009. After detailed evaluation, three investigators selected 25 of the 37 articles.
- Sample size across the studies was 30–3,197.
- Participants were cancer survivors with diverse cancer types at various stages.
Phase of Care and Clinical Applications:
- Phase of care: long-term follow-up
- Clinical applications: late effects and survivorship
- No part of the study was evaluated as being of low quality.
- Prospective studies showed that satisfied patients—that is, patients who reported to receive large amounts of clear information—reported better mental health-related quality of life (HRQoL) and global health-related quality of life. Cross-sectional studies found a positive relation between HRQoL and fulfilled information needs, information satisfaction, information quality or clarity, and fewer information barriers.
- Cross-sectional and prospective studies reported that patients with information satisfaction in general had less anxiety and depression.
- Of eight intervention studies that aimed to improve information provision, only one showed a positive association with better HRQoL. No benefit was found regarding depression or anxiety. Types of interventions and measured construct varied across the studies, making interstudy comparisons difficult. A lack of effect may be associated with the limited surplus value of the additional information given in the experimental conditions, the neutral mode of information provision without patients' active participation, the short duration of some of the interventions, and low compliance.
Additional research is needed before making definitive conclusions about information interventions is justified; because of methodological constraints, the results in the studies examined did not reach statistical significance. The fast and recent development of the field of patient-reported outcomes in cancer survivorship will make conducting studies of better quality possible.
Research Evidence Summaries
Wysocki, W.M., Mitus, J., Komorowski, A.L., & Karolewski, K. (2012). Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: A randomized clinical trial. Acta Chirurgica Belgica, 112, 111–115.
To evaluate the impact of information, provided preoperatively, on the anxiety and knowledge of women undergoing mastectomy for breast cancer; to assess the specific impact of additional, structured preoperative information (delivered by means of educational/informational video) on perioperative anxiety and treatment- and disease-related knowledge in women undergoing mastectomy for breast cancer
Intervention Characteristics/Basic Study Process:
Routine information was delivered to both arms of the study. Information was not standardized and included the typical conversation with the attending surgeon, surgical informed consent, and practical information from nurses. The treatment arm provided additional information delivered preoperatively via video; the information was recorded by a breast cancer survivor. Information in the video was obtained from the National Cancer Institute’s website. All patients were prospectively followed for one month (further follow-up was performed according to local treatment protocols) at 24–36 hours, 7 days, and 30 days postoperatively.
- The study reported on a sample of 58 female patients.
- Mean patient age was 60 years in the intervention group and 55 years in the control group.
- Patients had a diagnosis of breast cancer needing mastectomy, with cytologically or histologically proven invasive breast cancer. More than 80% in both arms had IIA and IIB stage disease, and 76% were diagnosed with ductal carcinoma.
- Women were older than 18 years of age and had the physical and psychological ability to use a visual analog scale and to complete requested questionnaires.
- Women were excluded from the study if they were admitted for breast-conserving therapy, neoadjuvant treatment for breast cancer, disseminated breast cancer, vision and/or hearing impairment, previous treatment for other malignancies, medical education, and other factors (geographical and familial) that would interfere with the protocol requirements.
- Department of Surgical Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Krakow, Poland
Phase of Care and Clinical Applications:
- Phase of care: active treatment
- Clinical applications: late effects and survivorship
Open-labeled, randomized controlled trial
- To measure anxiety: A visual analog scale (VAS) for anxiety was validated and shown to be the clinical equivalent of the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI).
- To measure level of knowledge: Investigators used a VAS (a subjective measure) as well as a self-administered questionnaire (an objective measure) containing specific questions about breast cancer treatment and familial risk.
- Authors noted no significant differences in anxiety levels between the intervention and control arms over all four time points.
- Authors noted no significant differences in subjective or objective knowledge between the intervention and control arms over all four time points.
- The number of patients confirming the association of the participant’s disease with an elevated risk for breast cancer in children or close blood relatives increased in the intervention arm from 40% preoperatively to 70% postoperatively.
Patients who participated in the study showed no evident or significant improvement in perioperative anxiety or treatment- and disease-related knowledge, with the exception of knowledge concerning available primary treatment modalities.
- The study had a small sample size, with fewer than than 100 participants.
- The outcomes of this study may result from having no a priori sample size estimation or power analysis. Interpreting results was difficult.
Patient education, as well as emotional support, should always be important preoperatively and must continue postoperatively.