Advertisement

Patient perspectives on frame versus mask immobilization for gamma knife stereotactic radiosurgery

Published:August 21, 2020DOI:https://doi.org/10.1016/j.jmir.2020.08.001

      Abstract

      Purpose

      To assess patient experiences and perspectives following Gamma Knife (GK) stereotactic radiosurgery (SRS) using frame versus mask immobilization.

      Methods

      Patients who received GK-SRS using both frame and mask immobilization were included in this study. One-on-one semi-structured interviews, led by a third-party expert, were used to gain insight into the patient experience. To reduce memory bias of either immobilization device, patients underwent the interview at their follow-up appointment. Initial assessment of patient transcriptions was completed by one study staff; a second member reviewed transcripts for thematic saturation. All interviews were independently coded for themes to minimize interpretation bias.

      Results

      Fifteen patients were consented; 12 were successfully interviewed (3 lost due to deteriorating health status). Interviews ranged from 30 to 60 min in duration. The most common patient concern regarding the frame was pain (9 patients), while the primary concerns with the mask system were the ability to remain still (6 patients) and claustrophobia (4 patients). Eleven patients chose the mask as their preferred choice in terms of their overall experience. Two themes emerged during the interviews that spoke to patient satisfaction with each process: unexpected pain with frame placement; and tightness experienced while wearing the mask during treatment.

      Conclusions

      From the patient perspective there was overwhelming agreement that the mask was the preferred choice for GK-SRS. The patient experience could be improved by enhanced education to better prepare patients on what to expect during the frame placement and mask treatment processes.

      Résumé

      But

      Évaluer l'expérience et le point de vue des patients après une radiochirurgie stéréotaxique par scalpel gamma (RST-SG) avec immobilization par masque ou par cadre.

      Méthodologie

      Des patients ayant subi une RST-SG avec immobilization par cadre et par masque ont été inclus dans l’étude. Des entrevues semi-structurées individuelles menées par un expert indépendant ont été utilisées pour comprendre l'expérience du patient. Pour diminuer le biais de mémoire face à chacun des dispositifs d'immobilization, l'entrevue avec chaque patient a été menée au moment du rendez-vous de suivi. L’évaluation initiale de la transcription de l'entrevue de chaque patient a été faite par un membre de l’équipe de l’étude; une deuxième membre a revu les transcriptions pour établir la saturation thématique. Pour toutes les entrevues, le codage des thèmes a été fait de façon indépendante afin de minimiser le biais d'interprétation.

      Résultats

      Quinze patients ont accepté de participer à l’étude; des entrevues ont été menée avec succès avec 12 d'entre eux (trois ont été perdus en raison de la détérioration de leur état de santé). La préoccupation la plus courante chez les patients concernant le cadre était la douleur (9 patients), alors que les principales préoccupations par rapport au masque étaient la capacité de demeurer immobiles (6 patients) et la claustrophobie (4 patients). Onze patients ont dit préférer le masque en tenant compte de leur expérience globale. Deux thèmes ont émergé durant les entrevues en ce qui a trait à la satisfaction des patients face à chacun des processus: la douleur imprévue avec le positionnement du cadre; et la sensation de serrement avec le port du masque durant le traitement.

      Conclusions

      Du point de vue des patients, il y an un large consensus sur le choix du masque comme préférence pour la RST-SG. L'expérience des patients pourrait être améliorée par une meilleure éducation afin qu'ils sachent mieux à quoi ils doivent s'attendre durant le processus de positionnement du cadre et le traitement avec le masque.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Landis S.H.
        • Murray T.
        • Bolden S.
        • et al.
        Cancer statistics, 1999.
        CA Cancer J Clin. 1999; 49: 8-31
        • Brown P.D.
        • Jaeckle K.
        • Ballman K.V.
        • et al.
        Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial.
        J Am Med Assoc. 2016; 316: 401-409
        • Hillard V.H.
        • Shih L.L.
        • Chin S.
        • et al.
        Safety of multiple stereotactic radiosurgery treatments for multiple brain lesions.
        J Neuro Oncol. 2003; 63: 271-278
        • McDonald D.
        • Schuler J.
        • Takacs I.
        • et al.
        Comparison of radiation dose spillage from the gamma knife perfexion with that from volumetric modulated arc radiosurgery during treatment of multiple brain metastases in a single fraction.
        J Neurosurg. 2014; 121: 51-59
        • Ramakrishna N.
        • Rosca F.
        • Friesen S.
        • et al.
        A clinical comparison of patient setup and intra-fraction motion using frame-based radiosurgery versus a frameless image-guided radiosurgery system for intracranial lesions.
        Radiother Oncol. 2010; 95: 109-115
        • Ruschin M.
        • Komljenovic P.T.
        • Ansell S.
        • et al.
        Cone beam computed tomography image guidance system for a dedicated intracranial radiosurgery treatment unit.
        Int J Radiat Oncol Biol Phys. 2013; 85: 243-250
        • Jaffray D.A.
        • Siewerdsen J.H.
        • Wong J.W.
        • et al.
        Flat-panel cone-beam computed tomography for image-guided radiation therapy.
        Int J Radiat Oncol Biol Phys. 2002; 53: 1337-1349
        • Li W.
        • Cho Y.B.
        • Ansell S.
        • et al.
        The use of cone beam computed tomography for image guided gamma knife stereotactic radiosurgery: initial clinical evaluation.
        Int J Radiat Oncol Biol Phys. 2016; 96: 214-220
        • Li W.
        • Bootsma G.
        • Von Shultz O.
        • et al.
        Preliminary evaluation of a novel thermoplastic mask system with intra-fraction motion monitoring for future use with image-guided gamma knife.
        Cureus. 2016; 8: e531
        • Tomlinson J.S.
        • Ko C.Y.
        Patient satisfaction: an increasingly important measure of quality.
        Ann Surg Oncol. 2006; 13: 764-765
        • Egestad H.
        • Halkett G.K.B.
        A delphi study on research priorities in radiation therapy: the Norwegian perspective.
        Radiography. 2016; 22: 65-70
        • Bolderston A.
        Five percent is not enough! Why we need more qualitative research in the medical radiation sciences.
        J Med Imag Radiat Sci. 2014; 45: 201-203
        • Cox J.
        • Halkett G.
        • Anderson C.
        • et al.
        Australian radiation therapists rank technology-related research as most important to radiation therapy.
        J Radiother Pract. 2011; 10: 228-238
        • Goldsworthy S.D.
        • Tuke K.
        • Latour J.M.
        A focus group consultation round exploring patient experiences of comfort during radiotherapy for head and neck cancer.
        J Radiother Pract. 2016; (FirstView): 1-7
        • Hsien J.W.K.
        • Rosewall T.
        • Wong R.K.S.
        In their own words: a qualitative descriptive study of patient and caregiver perspectives on follow-up care after palliative radiotherapy.
        J Med Imag Radiat Sci. 2013; 44: 209-213
        • Clifford W.
        • Sharpe H.
        • Khu K.J.
        • et al.
        Gamma knife patients' experience: lessons learned from a qualitative study.
        J Neuro Oncol. 2009; 92: 387-392
        • Doyle C.
        • Lennox L.
        • Bell D.
        A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.
        BMJ Open. 2013; 3: e001570
        • Parse R.R.
        Qualitative Inquiry: The Path of Sciencing National League for Nursing.
        Jones and Bartlett Publishers, 2001
        • Bolderston A.
        Conducting a research interview.
        J Med Imag Radiat Sci. 2012; 43: 66-76
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Jefford M.
        • Tattersall M.H.N.
        Informing and involving cancer patients in their own care.
        Lancet Oncol. 2002; 3: 629-637
        • Cashell A.
        • Qadeer J.
        • Rosewall T.
        Exploring the experiences of left-sided breast cancer patients receiving radiation therapy using the active breathing coordinator.
        J Med Imag Radiat Sci. 2016; 47: 323-328
        • Dixon W.
        • Pituskin E.
        • Fairchild A.
        • et al.
        The feasibility of telephone follow-up led by a radiation therapist: experience in a multidisciplinary bone metastases clinic.
        J Med Imag Radiat Sci. 2010; 41: 175-179
        • Boothroyd D.A.
        • Hodgson D.
        The prevalence, detection and intervention for depression and anxiety in oncology.
        J Radiother Pract. 2012; 11: 33-43
        • Grimm M.A.
        • Köppen U.
        • Stieler F.
        • et al.
        Prospective assessment of mask versus frame fixation during gamma knife treatment for brain metastases.
        Radiother Oncol. 2020; 147: 195-199
        • MacDonald R.L.
        • Lee Y.
        • Schasfoort J.
        • et al.
        Real-time infrared motion tracking analysis for patients treated with gated frameless image guided stereotactic radiosurgery.
        Int J Radiat Oncol Biol Phys. 2020; 106: 413-421