Purpose: Deep inspiration breath hold (DIBH) is a technique commonly used to achieve accurate radiation delivery and spare the heart for left-sided breast cancer patients. DIBH requires active participation from patients, presenting challenges with setup consistency resulting from anxiety. Increased understanding of the DIBH technique and empathy from clinicians may improve their coaching skills and efficiency and thereby the quality of DIBH treatments, but an effective way to prepare clinicians to assist patients is unknown. This study evaluated the change in empathy and understanding of DIBH from physics and clinical staff with a pilot study using simulation-based training for the DIBH technique.
Methods: Experts in both medical education and DIBH were consulted. Focus groups were used to determine the baseline DIBH knowledge of clinical staff. Learning objectives distilled from these meetings were used to guide the design of a one group pre- and post-test study with the workshop as the intervention. The workshop consisted of a presentation followed by a hands-on portion. The presentation introduced the DIBH technique and the institutional workflow briefly. Workshop instructors then simulated DIBH treatments with a motion phantom and through role-playing with participants assuming the roles of patient and coach. The test questionnaire including demographics, empathy, knowledge, and competency-based questions was distributed before and after the workshop.
Results: Physicists, residents, and physicians participated in the training. Comparing the mean questionnaire scores before and after the training showed significant increases in each category (p < 0.02). Empathy, knowledge, and perceived competency increased by 9%, 28%, and 70% respectively. Knowledge questions were scored for accuracy, and mean Likert scores were used to evaluate empathy and competency.
Conclusion: Simulation-based training is an effective technique for preparing clinical staff to assist patients through DIBH treatment. Future studies should employ simulation techniques for homogeneity of training for DIBH.