Training prostate cancer survivors and caregivers to be peer navigators: a blended online/in-person competency-based training program.

PURPOSE: Cancer navigation improves access to support and reduces barriers to care; however, appropriate training of navigators is essential. We developed the TrueNTH Peer Navigation Training Program (PNTP), a competency-based, blended online/in-person course. In this study, we evaluate the feasibility, acceptability, and effectiveness of the PNTP among prostate cancer (PC) survivors (patients, caregivers). METHODS: We employed an explanatory mixed method study design consisting of course usage data, pre-/post-questionnaires, and focus groups informed by the Kirkpatrick framework and self-efficacy theory. RESULTS: Three cohorts in two Canadian cities (n = 26) received the PNTP. Participants were motivated to support others like themselves (n = 20), fill a gap (n = 7), pay it forward (n = 6), and offer expertise (n = 4). Recruitment, retention, and questionnaire completion were 96.7%, 89.6%, and 92%. Participants contributed a total of 426 posts to the online forums (2 to 3 posts per participant/module). Satisfaction was 9.4/10 (SD = 0.7) and usability was 84.5/100 (SD = 10.1). All learning outcomes increased: understanding of learning objectives t(23) = - 6.12, p < 0.0001; self-efficacy to perform competencies t(23) = - 4.8, p < 0.0001; and eHealth literacy t(23) = - 4.4, p < 0.0001. Participants viewed the PTNP as intensive but manageable, improving knowledge and confidence and enhancing listening skills. Participants valued the flexibility of online learning, interactive online learning, in-person interactions for relationship building, and authentic role-playing for skill development. CONCLUSIONS: A facilitated online training program with in-person components is a highly acceptable and effective format to train PC survivors to become peer navigators. This competency-based peer navigator training program and delivery format may serve as a useful model for other cancer volunteer programs.

A core competency framework for prostate cancer peer navigation.

PURPOSE: Trained peer navigators can offer valuable peer support and mentorship to cancer patients and caregivers due to their highly relevant and unique perspective about the disease experience. In order to define the role of prostate cancer (PC) peer navigators within the cancer care system, it is important to establish the essential competencies of a PC peer navigator. We systematically identified and verified a set of core competencies for PC peer navigators and present a competency framework for PC peer navigators. METHODS: In phase 1, we conducted formative research consisting of a literature review and environmental scan as well as a secondary analysis of qualitative interviews. In phase 2, we drafted and mapped competencies. Finally in phase 3, expert stakeholders completed an anonymous survey to indicate whether they endorsed the competencies and to rank the importance of each competency to the peer navigator role. Open-ended feedback was also provided for each competency. RESULTS: Six core competency domains emerged: (1) self as navigator, (2) communication, (3) knowledge/information, (4) facilitate patient-centred care, (5) eHealth/technology, and (6) caregiver needs. Forty-seven core competency statements were mapped to these domains. Expert stakeholders (n = 27) included cancer survivors, caregivers, and healthcare providers. Most (89%) of core competency statements were endorsed by stakeholders and received high priority ratings, whereas only five of the competencies were less uniformly endorsed. CONCLUSIONS: This is the first attempt to list core competencies for PC peer navigators and may offer guidance for standardizing the PC peer navigator role and training.

Communicating new policy on antibiotic prophylaxis with patients: a randomised controlled trial.

OBJECTIVES: This trial aimed to assess the effectiveness of two different communication tools on the levels of anxiety and concern when a change in patients' treatment was introduced. METHOD: Patients previously advised to have antibiotic prophylaxis before their dental treatments were randomised to receive information about the new policy either through a video accompanied by a written leaflet or just the leaflet. All patients completed a questionnaire to assess anxiety and concern as well as intentions regarding accepting dental treatment without antibiotic prophylaxis at enrolment point, after intervention and after meeting the cardiologist. RESULTS: Ninety questionnaires were analysed (45 in each group). The mean level of anxiety and concern scores were significantly reduced after the intervention point (p <0.05). The ANOVA model revealed a significant reduction in the levels of anxiety and concern during the trial (p <0.001). However, the main effect of group (intervention versus control) and the interaction term were not significant. At the end of trial there was no difference in the number of patients accepting dental treatment without cover in the two groups. CONCLUSION: Patients appear more likely to accept a change if it is communicated directly to them by their practitioners via face to face consultation compared with video or leaflet. When there is a lack of time for in-depth consultation, video could be a more effective method than leaflet alone.

Necrotizing external otitis: a case series.

OBJECTIVES: Necrotizing (malignant) external otitis (NEO) is a life-threatening progressive infection of the external auditory canal, mastoid, and skull base. Here, we review the clinical findings for a series of NEO patients. METHODOLOGY: This case review study includes 18 patients with NEO (males: 11 (61.11%), females: 7 (38.88%), with a mean age of 65.11 years (range: 40-79)), hospitalized at Al-Zahra hospital in Isfahan province, Iran, during 2007-2011. RESULTS: The most common presentations were otalgia 18 (100%), otorrhea 15 (83.33%), edema and erythema of the external ear canal 14 (77.77%), and hearing loss 11 (61.11%). We found osteomyelitis of the skull base that involved cranial nerves (most commonly the facial nerve) in 8 patients (44.44%), which seemed to be a higher incidence than reported in previous studies. Pseudomonas aeruginosa was found in ear specimen cultures in only 7 cases (38.88%), which could be attributed to inappropriate topical and oral use of antipseudomonal agents before proper diagnosis. Nine patients underwent surgical debridement. All cases responded to systemic antipseudomonal antibiotics with no mortality. However, recurrence occurred during the follow-up period in two cases; yet, the patients responded to retreatment. CONCLUSION: The life expectancy is increasing for diabetic and immunocompromised patients; thus, it is necessary to identify those who have a high risk for NEO, especially older diabetic patients who complain of otalgia and otorrhea that are resistant to routine treatment. Immediate diagnosis and proper treatment is crucial to prevent complications and mortality.

Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline.

BACKGROUND: The NICE guideline for antibiotic prophylaxis before dental treatment has made a substantive change and fundamental departure from previous practice that affects long-standing beliefs and practice patterns. There is potential difficulty for healthcare professionals explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. AIM: To explore clinicians' attitudes towards the NICE guidance on antibiotic prophylaxis, their use of the guideline in clinical practice, barriers to the implementation of the guideline, and how best to overcome any perceived barriers. METHODS: In-depth interviews were conducted with seven dental care professionals, two cardiologists and a cardiac care nurse. The data were analysed using the framework method to extract central themes and opinions. RESULTS: Clinicians generally perceived that initially patients would be reluctant to follow the NICE guidance. This was felt to be particularly true of the patient cohort that had previously been prescribed prophylactic antibiotics. They found it difficult to explain the new guidance to patients who have had infective endocarditis and have long believed that they must receive antibiotics before their dental treatment. Concerns were also raised about the legal position of a clinician who did not follow the guidance. Clinicians generally suggested that the provision of accurate information in the form of leaflets and valid websites would be the best way to advise patients about the new guidance. CONCLUSIONS: Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.

Antibiotic prophylaxis in dentistry: part II. A qualitative study of patient perspectives and understanding of the NICE guideline.

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) recommendations in 2008 for antibiotic prophylaxis before dental treatment contradict previous practice. There is a potential difficulty in explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. AIM: This study investigated the patient-related barriers and facilitating factors in implementation of the NICE guidance. METHODS: In-depth interviews were conducted with nine patients concerning their views about barriers and factors that could influence the implementation of the NICE guidance on antibiotic prophylaxis before dental treatment. Data were analysed using framework analysis. RESULTS: For patients the rationale for the NICE guidance was unclear. They understood that at the population level the risk of infective endocarditis was less than the risk of adverse reaction to antibiotics. However, on an individual level they felt that the latter risk was negligible given their previous experience of antibiotics. They were aware that standards of care change over time but were concerned that this may be an example where a mistake had been made. Patients felt that the characteristics of the person advising them about the new guidance were important in whether or not they would accept them - they wished to be advised by a clinician that they knew and trusted, and who was perceived as having appropriate expertise. CONCLUSIONS: Patients generally felt that they would be most reassured by information provided by a clinician who they felt they could trust and who was qualified to comment on the issue by respecting their autonomy. The implications of the findings for the development of patient information are discussed.