“How are you today?”: Partnering with Patient Volunteers to Enhance Documentation in Radiation Therapy Practice

Person centred care (PCC) is fundamental to the provision of quality care. Inherent in PCC is the need to embed the voice of the person in all aspects of care by sharing their voice with the healthcare team through clear and consistent documentation. Recognizing this importance, the Radiation Therapy Department sought to improve documentation by Radiation Therapists (MRT (T)) through the adoption of SBAR: a validated tool for structured communication in health care. While SBAR had been introduced to radiation therapists it was not widely used in practice. A novel training approach was developed to reintroduce SBAR, adhere to the principles of PCC and support patients in the role as educators. The documentation committee designed a training session to facilitate knowledge to practice transfer by providing MRT(T)s the opportunity to build confidence with and an appreciation of SBAR in a simulated environment. Central to the experiential learning design was the adoption of patient ‘actors’ into the training sessions. While providing relevant theoretical information on SBAR, the focus of the sessions was the interaction, including documentation, between the patient “actors” and the MRT(T)s. Through a series of simulated role plays, the MRT(T)s were provided with peer and patient ‘actor’ feedback on verbal and written documentation. Patient ‘actors’, as participants in the documentation process, provided feedback based on their perception of how the documentation represented their voice. Facilitators from the working group were present to guide the participants through each scenario, assist with utilizing the framework and promote reflection by participants. Evaluation was conducted through pre, post and six week post surveys. The pre- session survey was framed to gain insight into therapists’ self-reported knowledge of SBAR and use in practice. Post session evaluations included questions directed at therapists’ confidence to use the SBAR tool and their commitment to implement the tool into practice. Nineteen training sessions were conducted with 111 MRT(T)s, 14 facilitators and 13 patient volunteers. Scheduling challenges were overcome by the support of administration, peer MRT(T)s and volunteer services coordinators. Design of the sessions was purposeful to foster a supportive learning environment and addressed concerns of potential unease of MRT(T)s with the incorporation of patients as active participants in the training. Having patients as participants created an authentic simulation of patient/therapist interaction and offered MRT(T)s the opportunity to receive feedback on the effectiveness and style of their communication. Comparison of surveys resulted in a 50% increase in MRT (T) confidence with SBAR use. This increase in confidence in ability to use SBAR was maintained in the 6 week post mark. Commitment to use SBAR in practice post session was 90% with 85 % of respondents at 6 weeks stating they had applied SBAR in their documentation. The survey comments support for the interactive, collaborative and practical nature of the sessions with the majority valuing the contribution of the patient volunteers. By situating the training in a simulation environment, the MRT(T)s were provided with practice opportunities and received immediate feedback from multiple sources. Furthermore, by involving patient volunteers, the sessions provided the opportunity to embed patient voice into the training process.