Presenter(s)
A. S. Chaudhari1, A. T. Kodali2, M. Canavan3, and C. R. Thomas Jr4; 1Dartmouth College, Hanover, NH, 2Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, 3Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, 4Department of Radiation Oncology and Applied Sciences, Dartmouth Cancer Center, Geisel School of Medicine, Lebanon, NH
Purpose/Objective(s): Sexual abuse is a major public health issue. Sexual abuse victims are less likely to receive required cervical cancer screenings compared to the general population. Treating gynecological cancer usually involves frequent pelvic/rectal exams, intravaginal sonograms, and pelvic irradiation; victims may avoid these examinations to avoid triggers. Thus, it is imperative that radiation oncologists are educated on the practices of trauma-informed care (TIC). We interviewed 13 radiation oncologists to identify barriers in provision of TIC.
Materials/Methods: Participants were selected to represent a range of institutions and educational backgrounds, were recruited via email, and interviewed regarding their knowledge and use of TIC in their clinical practice. We reviewed interviews using a thematic analysis approach and applied a coding structure to identify barriers to TIC.
Results: In total, 13 radiation oncologists (7 male, 6 female) completed the interview. Four worked in institutions in the Northeast, 2 in the Midwest, 3 in the South, and 4 in the West. Specialties included gynecological (10), breast (6), and prostate radiation oncology (4), with 1 generalist physician. Our thematic analysis yielded 5 main barriers to provision of TIC. Nine noted resource-based barriers, including a lack of time, shortage of available personnel (e.g., social workers, psychologists), administrative pressures to see more patients, and a lack of informational resources for patients (e.g., pamphlets). Eight noted education-based barriers, which referred to a lack of training on TIC, or experience working with patients with trauma histories. Only 2 interviewees reported having formal TIC training, which was received during obstetrics-gynecology medical school rotation and an obstetrics-gynecology residency, respectively. Four noted role-based barriers, saying that some patients do not want to discuss trauma with their oncologists. Four physicians also noted pain medication-based barriers, specifying concerns about providing too much pain medication to patients, especially those with histories of trauma and related substance use disorders. Four providers noted trauma-based barriers stating they did not want to serve as triggers for patients with past histories of sexual trauma and related medical PTSD; only 4 physicians asked all patients about trauma histories, though 2 who do not routinely ask about trauma noted that trauma and safety are addressed with all patients in check-in forms or conversations with social work.
Conclusion: The most common barriers to provision of trauma informed care (TIC) in our sample of radiation oncologists were resources and education. Providing physicians with informational patient guides, improving staffing, and formalizing TIC in radiation oncology education may improve physician comfort with TIC. Ultimately, further research in delivery of TIC in radiation oncology is necessary to improve care for cancer patients with histories of trauma.