Session Item

Introduction

Incidental irradiation of the heart can have long-term consequences. Deep Inspiration Breath Hold (DIBH) is used for patients receiving radiotherapy for breast cancer to reduce heart doses. Using DIBH, mean heart dose can be reduced by up to 67% compared with free breathing.

DIBH is an accepted technique for breast cancer radiotherapy. However, a survey of a breast radiotherapy interest group (BRIG) identified patient compliance, ability to hold their breath for the required time, and reproducibility of breath hold as major challenges to implementing DIBH. Between 12-21% of patients are reported to find the technique challenging; resulting in a proportion of patients missing out on the benefits of DIBH. While coaching can reduce maximum heart dose compared with non-coached patients, formal coaching is unavailable in some centres and no standard patient resource was available to inform patient preparation prior to radiotherapy planning.

Purpose
To develop a series of instructional videos to enhance the number of patients that can achieve breath hold, improve patient self-efficacy and increase patient satisfaction with care.

The Medical Research Council (MRC) framework for complex interventions was adopted.  A co-design methodology involving patient representatives and health practitioners (HCP) was used to develop a series of instructional videos and podcasts.

Co-design workshops were audio recorded and transcribed verbatim.  Video scripts were based upon themes identified through framework analysis. To minimise bias member checking was adopted and patient representatives participated in video scripting; to maintain the outputs' authenticity they also appeared as patients in the videos.

Feedback on the web resources was requested from clinical breast cancer experts (Therapeutic Radiographers/RTTs, Clinical Oncologists), patient advocate groups, and representatives from radiotherapy equipment manufacturers. Modifications to the web resources were made based on this critical feedback.

Five key themes and 35 sub themes were identified from the patient advocates workshop (table 1).  Information needs,  pre-treatment readiness and reducing anxiety prior to radiotherapy were the focus of the key themes. Additional themes from the HCP workshop focussed on DIBH service challenges and teaching the DIBH technique.  Five videos and two podcasts were developed based on the workshop themes and discussions.
Positive feedback from the formal review meant only minor amendments were required prior to the resources going live.The web resources are used by several UK radiotherapy departments and the web site averages 1,800 unique visitors per month.

Knowledge of treatment is a critical component of an empowered patient. This presentation will highlight how participatory co-design facilitated development of patient information, supporting a more effective DIBH experience and greater opportunities for empowerment.