Schofield, P., Jefford, M., Carey, M., Thomson, K., Evans, M., Baravelli, C., & Aranda, S. (2008). Preparing patients for threatening medical treatments: Effects of a chemotherapy educational DVD on anxiety, unmet needs, and self-efficacy. Supportive Care in Cancer, 16, 37–45.

Primary aim: To evaluate effect of an educational DVD about chemotherapy on pretreatment anxiety, self-efficacy, unmet informational needs, and satisfaction with information received

Secondary aim: To determine if effects differ between those who perceived treatment to be curative rather than palliative

Control group patients received usual care and completed questionnaires before beginning their treatment. Experimental group patients were recruited at a later time. They were given a copy of the DVD to take home to watch, several days before their first treatment. They then completed questionnaires on the first day of chemotherapy treatment. The DVD focused on preparation for chemotherapy and self-management of side effects, including nausea and vomiting, constipation, diarrhea, mucositis, fever and infection, hair loss, infertility, and effects on sexuality and intimacy. Content was evidence-based, derived from a systematic review of the literature to support recommended self-care approaches. Most content was delivered by cancer survivors who also discussed their experiences and the self-care strategies they used to manage side effects. An oncologist and oncology nurse presented medical and nursing information. The DVD was 25 minutes long and had been previously pilot tested. Usual care education consisted of a brief description of the procedure and side effects provided by the patient’s oncologist and a 30-minute education session with a chemotherapy nurse. Analysis was done within curative and palliative care patient groupings.

• The study reported on a sample of 100 patients.
• Mean patient age among curative cases was 54 years, and among palliative cases was 56.88 years.
• The sample was 52% male and 48% female.
• A variety of cancer diagnoses were represented. The most common types were head and neck, lung, gynecologic, gastrointestinal, and breast cancers.
• A majority of the sample was employed full- or part-time, and patients were essentially equally distributed across educational levels from less than high school completion to university completion.
• The majority of patients were married.
• All patients had not previously received chemotherapy treatment.

• Single site
• Outpatient setting
• Melbourne, Australia

Patients were undergoing the active treatment phase of care.

The study used a prospective quasi-experimental design with use of historical controls.

• Hospital Anxiety and Depression Scale (HADS)
• Cancer Behavior Inventory (CBI)–version 2: 33-item scale used to measure self-efficacy
• Supportive Care Needs Survey (SCNS)–short form: 31 items to assess unmet needs
• Satisfaction with information assessed with four questions on a five-point Likert scale developed for this study

There were no differences in anxiety or depression scores between usual care and intervention groups. Those who watched the DVD rated themselves as more confident about seeking social support than the usual care group (p = 0.044). There were no differences between groups in any supportive care needs that were unmet. Both curative and palliative patients reported having more psychological needs than any other type of care, and reported sexuality as the least needed area. Those in the intervention group were more satisfied with information they had received (p = 0.026) compared to the control group. There were significant differences between self-perceived curative and palliative patients in confidence for maintaining activity (p = 0.028), stress management (p = 0.044), coping with side effects (p = 0.002), maintaining a positive attitude (p = 0.008), managing emotions (p = 0.005), and seeking social support (p = 0.012).

The intervention appeared to have an influence on aspects of self-efficacy and satisfaction with information received. There were no findings to support an effect on anxiety or depression prior to chemotherapy.

• The study did not have an appropriate control group.
• A convenience sample was used.
• The sample size was not sufficiently powered to detect differences in measured outcomes.
• It is not clear how much information provided in the DVD differed from that provided in usual care by chemotherapy nurses and the oncologist.
• While the DVD was a different format, differences in content were not clear. It was also not clear from the report if intervention patients received the DVD in addition to usual care, or instead of usual care.

Prechemotherapy education is an important part of nursing management of these patients, but there is little evidence to guide the timing, content, format, and style of this type of education. Additional research in this area will be helpful to guide nursing practice. The use of adjuncts to direct face-to-face patient teaching and support by nurses may be helpful in the face of workforce shortages and increasing shifts of patient care to suggest that provision of basic information and orientation to the setting are not sufficient approaches to impact feelings of anxiety. Further study of such approaches can be helpful to determine how to best meet patient needs.