1120 - Radiation Oncology Professional Reflections on Potentially Triggering Clinical Interactions in Breast Radiotherapy
Presenter(s)
M. P. Dimopoulos1, S. Green2, C. Starrs3, K. Minassian3, J. Force4, G. Montgomery4, and J. Schnur4; 1Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York, NY, 2Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, 3Mount Sinai Hospital, New York, NY, 4Icahn School of Medicine at Mount Sinai, Center for Behavioral Oncology, Department of Population Health Science and Policy, New York, NY
Purpose/Objective(s): Survivors of sexual violence (SV) may find provider actions during breast radiotherapy activating due to similarities with prior trauma. Yet relatively little research has sought to ask radiation oncology professionals to reflect on what aspects of their own breast radiotherapy practice might potentially be triggering for patients. Failure to identify these routine but potentially activating interactions may contribute to treatment distress, avoidance, or diminished trust. To inform trauma-informed breast radiotherapy training, researchers analyzed reflections from radiation oncology professionals on the clinical care they deliver.
Materials/Methods: A total of 144 radiation oncology professionals (radiation oncologists, radiation therapists, nurses, and students) completed an asynchronous online Sensitive Practice Training Program between June 1, 2020, and January 1, 2025. Module 3 prompted participants to respond to two open-ended reflective practice questions about aspects of clinical care they deliver that may be potentially triggering for SV survivors. Of the 144 participants, 57 responses specifically described potentially triggering patient-provider interactions related to breast radiotherapy. Free-text responses were analyzed using content analysis, with patient-provider interactions coded iteratively by one reviewer and independently verified by a second reviewer.
Results: Among the 57 responses that identified potentially triggering patient-provider interactions in breast radiotherapy, eight overarching categories were applied. In order of frequency, categories included: physically manipulating the breast during setup or positioning (n = 21, 28%); uncovering the breast (n = 17, 23%); verbally instructing the patient to expose their breast (n = 16, 21%); placing treatment-related objects on the breast (e.g., bolus, markers, or wires) (n = 6, 8%); visually inspecting the exposed breast (n = 6, 8%); conducting a breast examination (n = 3, 4%); standing in very close physical proximity (n = 3, 4%); and instructing the patient to remain still and to not move during positioning and treatment (n = 3, 4%). When asked why participants found these behaviors potentially triggering, the most frequent response was that the perpetrator may have acted towards the patient in a similar way.
Conclusion: Professionals identified routine breast radiotherapy interactions that may be activating for SV survivors. Given that these behaviors are inherent to treatment delivery yet modifiable in approach, findings support the integration of trauma-informed breast radiotherapy training that includes didactics and role-play focused on sensitively navigating touch, exposure, visual inspection, and verbal directives. These interventions may enhance psychological safety without altering treatment quality.