Communicating the External Beam Radiation Experience (CEBRE): Perceived Benefits of a Graphic Narrative Patient Education Tool.

Current radiation oncology patient education materials are above national readability recommendations. A graphic narrative educational tool, the Communicating the External Beam Radiation Experience (CEBRE) discussion guide, was developed to facilitate patient-provider communication. A pilot study evaluated perceived benefits of CEBRE for patients and physicians.CEBRE was designed through a collaboration between physicians and designers. Designers interviewed patients, family members, and the clinical team. Interviews were coded for themes leading to design principles which drove the design of CEBRE including a graphic narrative component. CEBRE explains the radiotherapy care path. Readability was measured using the Flesch-Kincaid test. Patients receiving radiotherapy or in follow-up and practicing radiation oncologists reviewed CEBRE and completed independent surveys. Each survey included modified versions of the Systems Usability Score (SUS) and Spielberger State-Trait Anxiety Inventory short form (STAI-S) along with questions unique to CEBRE. Likert-type scores are reported as median [interquartile range].CEBRE scores a 5.4 Flesch-Kincaid grade level. Thirty-four patients and 15 radiation oncologists completed surveys. Patients completed a high school/GED (18%), a 2-year degree or some college (50%), or at least 4 years of college (32%). Patient and physician responses were concordant. On a scale of 1-5 for modified SUS and 1-4 for modified STAI ("strongly disagree" to "strongly agree") the SUS scores were 4[4-5] and 4[4-5] and STAI scores were 3[3-4] and 3[3-3.5] for patients and providers respectively. This indicates CEBRE is usable and would decrease anxiety. Compared to text, the graphic narrative component of CEBRE was rated as "quite helpful" (4[4-5]).CEBRE, a graphic narrative education tool developed through a novel collaboration between designers and radiotherapy stakeholders, is patient accessible and practical to facilitate patient-provider discussion. Perceived benefits demonstrating high usability and potential to decrease patient anxiety warrant further prospective investigation of CEBRE in the clinical setting.