Digital Repository Masters Projects Spring 2023 The Use of a Multimodal Education Strategy for Pediatric Cancer Patients and their Caregivers at Diagnosis and Across the Care Continuum Tristyn M. Kruger Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Kruger, T.M. 2023. The use of a multimodal education strategy for pediatric cancer patients and their caregivers at diagnosis and across the care continuum. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP The Use of a Multimodal Education Strategy for Pediatric Cancer Patients and their Caregivers at Diagnosis and Across the Care Continuum Project Title by Tristyn M. Kruger BSN, RN, CPHON, MSN Student Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 2, 2023 Date Tristyn M. Kruger, BSN, RN, CPHON April 2, 2023 Student Name, Credentials Date (electronic signature) 4/4/2023 MSN Project Faculty (electronic signature) Date Melissa NeVille Norton (electronic signature) Date DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. The Use of a Multimodal Education Strategy for Pediatric Cancer Patients and their Caregivers at Diagnosis and Across the Care Continuum Tristyn M. Kruger, BSN, RN, CPHON, MSN Student Weber State University Annie Taylor Dee School of Nursing Abstract A cancer diagnosis for pediatric patients and their caregivers is a devastating event. The emotional and mental tolls come with the need to learn about their new diagnosis and how to care for the disease at home. When patients and caregivers receive an appropriate and adequate education, it can enhance knowledge, quality of life, and self-care, leading to positive health outcomes. This project aims to implement a multimodal education strategy at diagnosis and across the care continuum that can provide consistent education in various ways to meet the educational needs and learning styles of all patients and caregivers. Recommendations for further research and topics are geared towards developing interactive videos, creating hands-on classes, and developing the oncology service line’s website. Patients and their caregivers must have access to various resources. In addition, healthcare providers must work to identify the most appropriate resources for the patient and their caregiver’s needs to create individualized educational plans. Keywords: pediatric cancer, new diagnosis, discharge education, teaching, educational methods, parental educational, multimedia education, barriers, obstacles, teaching strategies The Use of a Multimodal Education Strategy for Pediatric Cancer Patients and their Caregivers at Diagnosis and Across the Care Continuum Cancer is the leading cause of death by disease in children (Cunningham et al., 2018). In 2022 approximately 16,000 children and adolescents under 19 will be diagnosed with cancer (American Cancer Society, 2022a; American Cancer Society, 2022b). In addition to the cancer diagnosis, caregivers, meaning the parents or guardians of the patient, are often distressed and overwhelmed by the knowledge and education they need to safely care for the child at home. Education for newly diagnosed pediatric cancer patients is intensive and involves a large amount of information and learning new skills (Gusman & Cannon, 2022). Caregivers often struggle with the amount of information, comprehension, and retention due to being in crisis mode when receiving education (Rodgers et al., 2016). Furthermore, timing and pacing are often an issue because of the education needed. In addition, the education and skills required of patients and their caregivers do not stop at diagnosis but continue throughout the care continuum (Dobrozsi et al., 2019a). Utilizing enhanced teaching strategies can help overcome the barriers of distress and anxiety associated with a cancer diagnosis. In addition, these strategies can provide additional educational support for continued education throughout treatment. One such teaching strategy that can be effective is the use of a multimodal education plan that includes multimedia resources and formats to enhance the educational experience. When integrated into a patient- and caregiver-centered education plan, multimedia and digital formats allow for flexibility in the teaching process and may create a more engaging and interactive learning environment (Gusman & Cannon, 2022; Lam et al., 2016). Statement of Problem The positive outcomes that result from enhanced patient education have been well established (Flanders, 2018), particularly in those populations with chronic and life-threatening illnesses such as cancer. However, best practices involving methods, timing, and delivery of said education vary widely and currently need to be established in the pediatric oncology population. Therefore, there is a need to provide pediatric cancer patients and their caregivers with the information and skills they need and resources to enhance, create, and continue this knowledge. Currently, multimedia resources are available to educate pediatric cancer patients and their caregivers (Children's Oncology Group, 2022); however, they are not utilized in the current education process at this institution. This master's project strives to ensure that a multimodal educational strategy that includes multimedia resources, such as narrated PowerPoint slides, smartphone applications, and videos, can be used. It will also seek to ensure these patients and caregivers have access to the resources throughout their treatment course to improve their knowledge of their diagnosis and to provide safe care at home. Ways Project Contributes to Intended Recipients This quality improvement project benefits patients, caregivers or guardians, nurses, other multidisciplinary staff, and the healthcare organization. When patients and caregivers receive appropriate education, it can enhance knowledge, quality of life, and self-care (Flanders, 2018), leading to positive health outcomes. In addition, enhanced educational techniques can empower patients and their caregivers to take an active role in their care while enhancing knowledge and skills (Flanders, 2018). This empowerment allows patients and caregivers to feel confident about providing care at home, and this confidence is necessary to safely provide this care (Wilson Smith et al., 2018). In addition, empowering patients and their caregivers by providing them with the knowledge and skills they need benefits nurses, multidisciplinary staff, and the healthcare organization by leading to improved patient outcomes, decreased healthcare costs, and increased patient satisfaction (Gusman & Cannon, 2022; Kennedy & Parish, 2021). Rationale for Importance of Project This project is essential for various reasons, including delivering patient-centered care and improving patient outcomes. In addition, establishing the nurse's impact on patient outcomes and their importance as educators in providing patient-centered care makes this project important. Education is a multifaceted process, and no single method is effective for all patients (Blevins, 2018). Therefore, developing education to meet the needs and abilities of the learner (Flanders, 2018) while considering barriers and methods of learning (Lasa-Blandon et al., 2019) is essential. Patient-centered care plans, including education plans, are crucial for positively impacting patient outcomes (Gusman & Cannon, 2022; Kennedy & Parish, 2021). When patients and caregivers receive an appropriate and adequate education, it can enhance knowledge, quality of life, and self-care (Flanders, 2018), leading to positive health outcomes. Nurses are with the patient more than any other healthcare worker, making them uniquely qualified to assess the patient and family's unique needs and establish a patient-centered education plan (Rodgers et al., 2016). As a result, nurses are invaluable in creating and delivering patient-centered education and are essential in affecting patient outcomes. Literature Review and Framework Healthcare is in a constant state of change. For changes in clinical practice to be meaningful and produce positive outcomes, supportive evidence for the change is essential. Evidence-based practice (EBP) is the cornerstone of the nursing profession. Evidence-based practice frameworks are essential tools to help guide evidence-based change (Melnyk & Fineout- Overholt, 2019). Therefore, a search was conducted to identify and choose an appropriate evidence-based framework for the implementation of this project. After identifying a framework, a literature search identified supportive evidence for including multimedia resources and material for educational teaching plans for caregivers of patients with pediatric cancer. Framework The framework chosen to guide the evidence-based changes intended with this master's project is the Iowa Model Revised (IMR). The IMR is a multiphase change process that involves seven steps which are (a) identification of the triggering issue or opportunity for improvement, (b) the question or purpose, (c) forming a team, (d) assembling, appraising, and synthesizing a body of evidence, (e) designing and piloting the practice change, (f) identifying and sustaining the practice change, and (g) disseminating the results (Melnyk & Fineout-Overholt, 2019). In addition, with its seven steps and emphasis on team involvement, the Iowa Model is widely considered easy to use and applicable by interprofessional healthcare teams (Melnyk & FineoutOverhold, 2019; Tucker et al., 2021). Finally, this project will likely require continual evaluation and adjustments as the needs of the patient population and healthcare experience change. Therefore, the Iowa model is appropriate for including feedback loops and emphasis on continual evaluation. This master's project focuses on enhanced teaching techniques for pediatric oncology patients to increase knowledge and improve patient outcomes and requires a multidisciplinary team approach. The Iowa Model is simple, clear, and concise, making it a good framework for an interdisciplinary team with members unfamiliar with the evidence-based practice process. In addition, the Iowa Model was developed by nurses and other clinicians for the clinical setting (Melynk & Fineout-Overholt, 2019), making it uniquely applicable to this clinical question surrounding enhanced education for patients and their caregivers. With the initial step of the Iowa Model, identifying a trigger issue (Tucker et al., 2021), a clinical problem was identified with the quality of education and educational resources that families and caregivers receive during cancer treatment. This master's project is a priority for the specialty service area, and a multidisciplinary team has been formed. While assembling, critiquing, and synthesizing the available research, it is already becoming evident that there is a sufficient research base to support implementing a practice change. Strengths and Limitations The Iowa Model offers many strengths to the practice of evidence-based processes. Those that specifically interest this project are the facilitation of a team approach, the easy stepby-step process, and the multiple opportunities for evaluation and decision-making (Tucker et al., 2021). The IMR emphasizes the team approach to evidence-based medicine (Buckwalter et al., 2017). Enhanced education of patients and caregivers requires a nurse and an engaged interdisciplinary team. With clinical practice in mind, the IMR is an easy step-by-step process that guides the user through the evidence-based practice process (Melynk & Fineout-Overholt, 2019). Finally, the multiple evaluations and decision-making points presented in the Iowa Model align with the goals of this project to ensure that the project is relevant, has sufficient evidence, and that the change is appropriate for the clinical setting (Buckwalter et al., 2017). A limitation of the Iowa Model is that despite its easy-to-follow steps, it can be lengthy, with many points for decision-making and re-evaluation. In addition, the IMR offers little guidance on approaching obstacles or the best methods for disseminating results (Buckwalter et al., 2017). To enhance knowledge and patient outcomes in mind, a process that takes considerable time to work through may not be desirable, and guidance on sharing results with the team and other colleagues would be helpful. Seeking others using the IMR for similar projects will help overcome this obstacle. Analysis of Literature In 2022 approximately 16,000 children and adolescents under 19 will be diagnosed with cancer (American Cancer Society, 2022a; American Cancer Society, 2022b). With these words comes overwhelming stress that can affect a parent's ability to learn and process new information (Rodgers et al., 2016). Providing education in multiple formats (Mohammadi et al., 2021), across the continuum of care (Dobrozsi et al., 2019a), and in an individualized manner (Rodgers et al., 2016) can help to overcome stress and anxiety related to cancer treatment as well as other barriers related to enhanced education. This literature review aims to present evidence supporting the utilization of a multimodal educational strategy at diagnosis and throughout the continuum of care to increase knowledge for pediatric cancer patients and their caregivers. Evidence suggests the need for consistent, individualized education that utilizes the patient's or caregivers' learning preferences through various learning methods at the initial childhood cancer diagnosis and across the continuum of care. Qualitative data provides parents' experiences with the overwhelming amount of information they are presented and required to learn during diagnosis and throughout their child's care. A literature review identified themes related to the education of caregivers of children newly diagnosed with cancer, including barriers to enhanced learning, the need for individualized education plans, the importance of assessing health literacy before education, and the importance of the nurse in the educational process. Search Strategies A literature search was conducted to identify the current evidence using CINAHL, Weber State University's Stewart Library's OneSearch and Advanced Search (which span multiple databases), and Google Scholar to direct the initial exploration. Only articles from 2016 through 2022 were included in this literature review for the most current information. The search included the keywords: pediatric cancer, new diagnosis, discharge education, teaching, educational methods, parental educational needs, adult learning, multimedia education, barriers or obstacles, and teaching strategies. Various Boolean combinations were created with the abovementioned keywords to create a broad search. Barriers to Enhanced Learning Widely acknowledged is the fact that the information and education that parents of newly diagnosed children with cancer receive are intensive and overwhelming when they are already experiencing high emotions and increased stress (Gunter & Duke, 2018). However, emotional state and increased stress are only two barriers to enhanced learning that healthcare professionals must overcome during the initial diagnosis and education phase. In addition, multiple studies identified significant barriers when making education plans (Dobrozsi et al., 2019a; Rodgers et al., 2016; Wilson Smith et al., 2018). For example, Wilson Smith et al. (2018) found that poor planning and a lack of a cohesive teaching strategy were significant barriers to enhanced learning. These barriers led to delayed and rushed teaching, causing increased stress for parents and frustration for the nurses. In addition, Hockenberry et al. (2021) and Mills et al. (2021) cite a lack of consistency in education as a significant barrier to enhanced learning for caregivers of children with cancer. Similarly, Rodgers et al. (2016) identified that the pacing of presented information was a significant barrier. In addition, they determined that caregivers felt there was a lack of incorporation of their individual learning preferences. Dobrozsi et al. (2019a) (n=23) identified that the ability of caregivers to absorb and retain information is highly compromised if their initial fear and anxiety, as well as external stressors, are not addressed promptly. Adolescent and young adult (AYA) patients and their caregivers ranked Emotional Adjustment to Diagnosis as the most crucial topic to discuss after receiving the initial diagnosis. Individualized Educational Plans One of the striking themes from this literature search was the need for individualized education plans. Stuart et al. (2021) and Dobrozsi et al. (2019a) concluded the need for an early learning and psychosocial assessment, respectively. While Stuart et al. (2019) (n=30) showed no statistical significance in their pre-learning assessment, there was a statistically significant difference (p<.05) in post-tests in favor of a multimodal education plan along with teach-back methods. This theme illustrates the need to assess early for knowledge gaps and individual needs before beginning education to accurately determine the effectiveness of educational efforts and tailor information and methods to the caregiver. Dobrozsi et al. (2019a) (n=23) identified that a psychosocial assessment should be one of the first milestones after the initial diagnosis to assess coping abilities, social support, and external stressors. They also concluded that this assessment should identify specific learning needs to better present information understandable to the specific caregivers. Qualitative data also indicates the need for individual assessments. Kennedy & Parish (2021) emphasized the need for learning assessments to design patient-centered education. They emphasized that patient-centered education impacts patient satisfaction and outcomes. Rodgers et al. (2016) again identified the need for tailored education for the individual learner in their systematic review involving 20 parents of newly diagnosed children. They further concluded that individualized plans should extend to partners. Rodgers et al. (2016) suggest the necessity of assessing and individualizing learning styles and considering caregiver preferences regarding the timing and content of their education. Lambourne et al. (2019) found that caregivers desired education tailored to their needs and situation. They quoted caregivers expressing that they were all different and their needs were unique. Health Information Literacy Health literacy is "the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves or others" (CDC, 2022, para. 1). Various articles note the need to assess a caregiver's health literacy and that efforts should focus on presenting education and information aligned with the caregiver's literacy level. In addition, the US Department of Health and Human Services has emphasized the importance of health communication and literacy in its Healthy People 2030 objectives. In their randomized controlled trial, Giuse et al. (2016) (n=88) demonstrated the necessity of presenting educational materials to account for the patient's health literacy and learning style, which helps to increase the learning of complex health topics. The intervention group received consumer-level education, including videos adapted to multiple learning styles. As a result, the intervention group showed a statistically significant increase in knowledge (p<.05) compared with the control group. Thus, Giuse et al. (2016) concluded that when caregiver education considers health literacy, the caregivers can understand and interact with health information effectively. Similarly, Peipert et al. (2021) (n=129) found that the addition of multimedia videos and access to cancer-specific educational software for patients with low health literacy were significant for increasing cancer knowledge (p<.05) and that patients saw an increase in healthrelated quality of life. One of the core objectives of Healthy People 2030 (n.d.) surrounds health communication, with health literacy being a primary focus. In addition, the health communication objective includes measures surrounding how well providers ensure that patients understand education and presenting education in a language the patient can understand. These goals illustrate the importance placed on ensuring patients have access to health information and education in a manner they can understand. In addition, these goals speak to the importance of ensuring that healthcare workers have the resources to educate patients and ensure their understanding effectively. Importance of the Nurse in the Educational Process The importance of the nurse in the educational process cannot be overstated. As the healthcare provider that spends the most time with the patient (Rodgers et al., 2016; Tassiou, 2021), nurses interact and assess the patient continually, providing them with countless opportunities to become familiar with the patient and their caregiver, unique characteristics, and education methods that may be best suited for them (Withycombe et al., 2016). Tassiou (2021) reviewed 26 articles on the multifaceted role of the nurse in patient education and demonstrated the importance of the nurse in educating the patient on the prevention and management of complications from a chronic disease. Furthermore, they demonstrated the nurse's unique abilities in providing tailored patient care, including tailored education, according to the patient’s needs. Tassiou (2021) concluded that this patient-centered care and education could lead to significant mental and emotional well-being in patients. Withycombe et al. (2016) surveyed educational practices at institutions with pediatric oncology programs. While various healthcare disciplines delivered education, they found that at 90% of the facilities surveyed, nurses were responsible for education on most topics, including central line care, infection prevention, and how and when to call the provider. In relation, Rogers et al. (2016), in their study on actual and preferred educational content, timing, and methods among the caregivers of children with newly diagnosed cancer, found that practices should include assessment of influencing factors, providing anticipatory guidance, and incorporating patients' and caregivers’ preferred learning styles. They concluded that the nurse, the healthcare provider spending the most time with the patient, was positioned with the most significant opportunities to carry out these practices. These reasons demonstrate the nurse's unique ability to assess the barriers to learning, including health information literacy, and to create individualized patient education plans. However, they need the appropriate resources to carry out these plans. Summary of Literature Review Findings and Application to the Project The literature review on enhanced education for caregivers of children with cancer suggests many barriers, such as emotional state, inconsistent educational content, and educational pacing, timing, and setting. In addition to these barriers, the need for individualized education plans that include health literacy application is apparent. These findings support the need to look at a multimodal education strategy at diagnosis and across the care continuum that can provide consistent education in various ways to meet the educational needs and learning styles of all patients and caregivers. Project Methodology This master's project strives to ensure that multimedia resources, including narrated PowerPoint slides, smartphone applications, and videos, can be utilized in and throughout the teaching process. This goal will be accomplished by researching and gathering multimedia resources, implementing their use, and educating staff on using them and what constitutes effective education for patients and caregivers. Four deliverables have been developed or gathered for the introduction and development of this project for the Pediatric Center for Cancer and Blood Disorders Service Line at a major pediatric hospital. A service line in healthcare focuses on specific clinically related conditions (Fine & Kuhlenbeck, 2021), such as pediatric cancer and other blood disorders. The first is a handout from The Children's Oncology Group with information on their KidsCare app. This handout pairs with the service line's current journey board, where a QR code to download the app has been added. The second is an educational infographic on effective teaching techniques and interventions for staff. The third deliverable is a pre-and post-surveys for staff, and the fourth is a questionnaire for patients and families. Interdisciplinary team input and feedback on the resources implemented and their value to the current teaching process will be sought. Patient and caregiver feedback on the effectiveness of the resources utilized in helping them understand the education provided will also be sought. Description and Development of Project Deliverables Four deliverables have been gathered or created for the purpose and implementation of this project. Each is described in detail below, along with the intended use and reason for inclusion in this project. Continual evaluation and refinement of these deliverables will occur throughout their implementation to ensure their continued usefulness. Children’s Oncology Group KidsCare App Handout and Journey Board with QR Code The first deliverable is a handout on an app developed by the Children's Oncology Group (see Appendix A) for patients and caregivers (Children's Oncology Group, 2022b). This app is a supplemental resource to the handbook that patients and caregivers receive upon diagnosis. The app is an easy-to-use resource that allows patients and caregivers to conveniently access the essential information they receive at diagnosis on their phones. In addition, the app allows patients and caregivers to track the patient’s treatment course and any side effects the patient may be experiencing. Patients and caregivers can also store information on their medical team, such as names and contact information. Along with the app, a QR code has been added to the service line’s new diagnosis journey board to allow easy downloading (see Appendix A). Effective Patient Education Infographic for Staff The second item is an infographic for staff (see Appendix B) on effective teaching techniques and items to consider when teaching patients and caregivers. This infographic provides staff with necessary information regarding barriers to enhanced education, strategies to overcome these barriers, learning styles, and elements of effective education (Cutilli, 2020; Flanders, 2018; Kennedy et al., 2021; Lambourne et al., 2019). This infographic can also continue to be used and adapted for the instruction of new staff and annual continuing education. Pre- and Post-Surveys for Service Line Staff The third deliverable (see Appendix C) consists of a pre-and post-survey of the multidisciplinary team members. The pre-survey will collect data on the current education process, staff opinions of the process, current techniques and resources used for patient education, and suggestions for improvement of the current process. This information will then be compared to the staff’s experiences and satisfaction with the implemented multimedia resources. This information will be gathered from the post-survey. Questionnaire for Patients and Caregivers The fourth deliverable for this project is a questionnaire for patients and their caregivers (see Appendix D) evaluating the multimedia resources included in their teaching plan. In addition to feedback from staff, receiving feedback from the patients and their caregivers will be essential. Feedback from patients and their caregivers on their perception of the benefits of multiple resources, their usability, and the enhancement of knowledge will be compiled and utilized to determine their effectiveness and any need for alteration. Plan and Implementation Process This master's project will begin with the approval of the service line leadership and director. Then, the project will begin with a pre-survey of multidisciplinary team members on their perception of the current educational process for patients and their caregivers. In addition, the survey will solicit ideas and opinions on critical educational topics to be covered and certain stages across the care continuum requiring specific education, such as diagnosis, treatment completion, relapse, and end-of-life care. The acceptance and buy-in by the multidisciplinary team are vital to the success of this project. At nurses' mandatory education and discipline-specific meetings, educational sessions will occur with the service line staff. These sessions will include information on the new resources, how to incorporate them with current resources, and a discussion on effective teaching techniques. Once all staff education is complete, implementing multimedia resources will begin with the education provided to newly diagnosed pediatric cancer patients and their caregivers. Utilization of these resources will continue for a three-month period, during which patients and caregivers will be asked to complete a questionnaire regarding their experience with their new diagnosis teaching, the resources utilized, and their perception of the usefulness of these resources. After the three months, staff will be given a post-survey evaluating the new resources and their added benefit to the teaching process. Once data from the questionnaires and surveys are compiled, the trial period will be evaluated. Interdisciplinary Teamwork The care of the pediatric cancer patient is complex and lengthy and involves multiple disciplines working together to provide the best care possible (Dobrozsi et al., 2019b). Education is a critical part of that care and is delivered at multiple points during the care continuum and by various individuals from all disciplines. Each discipline has the expertise and unique perspectives toward the patient’s care that they can share with the team. Providing consistent teaching and messaging is essential for ensuring patient understanding and optimizing care. Ensuring that all multidisciplinary team members understand the educational resources implemented and how to utilize them will be essential to the success of this project. The multidisciplinary team members involved in the projects are discussed in greater detail below. Providers. Provider participation is essential to the success of this project. They have unique expert knowledge of this patient population and can provide insight into specific knowledge gaps that patients may have. In addition, providers have a unique view of the patient’s overall treatment plan and when specific education elements may be needed. In addition, providers should be aware of service line educational practices, processes, and resources to help guide their patients' education and care. Bedside Nurses. Bedside nurses are paramount to this project as they will deliver most patients' initial and ongoing education. Nurses spend the most time with patients and their caregivers. They are uniquely positioned to assess the patient and their caregiver's individual learning needs, which are essential to the creation and success of individualized education plans. They are vital in providing education and assessing the understanding of this education. Nurse input and feedback on resources and practices are essential for evaluating this project. For the project's success, nurses must find value in the resources and processes. Otherwise, they will not utilize them. In addition, ensuring that nurses understand their importance and responsibility in the education process is paramount. Disease-Based Care Coordinators. Care coordinators follow the patient throughout treatment and constantly communicate with them regarding treatment courses, test results, and appointment times. In addition, they provide education at specific patient care points and in-themoment education when questions or concerns arise. Knowing service line educational practices, processes, and resources is vital for care coordinators to utilize them and direct patients to specific team members that can help. In addition, directing them to the available resources is an essential role of the care coordinators. Service Line Educators. Unit educators will help to provide initial education to staff, ongoing education, and education updates related to patient and caregiver teaching. Educators have expertise in providing effective education to team members and staff. They are also essential in teaching team members and staff the most effective ways to teach patients and caregivers. In addition, they will be a valuable team member in collecting data and evaluating this project. Service Line Social Workers. Patients in the service line are assigned a personal social worker upon diagnosis. The social worker for a patient has unique knowledge of the patient and caregivers' social needs. Therefore, they are in a unique position to help assess the individual learning needs and preferences of the patient or caregiver and share this information with the team. Service Line Directors. Directors oversee all service line financial aspects. Therefore, their input and participation in this project are essential for approval and moving this project forward. In addition, their assistance will be necessary if there are financial needs, such as purchasing products or funding for certain aspects like website development or additional educational positions. Timeline Establishing a detailed timeline will help to organize the project and keep the implementation of the project on track. As described in the implementation section, initial coordination and approval will occur with the service line leadership. Pre-surveys to service line staff will start in the third quarter of 2023. In addition, a chart review will occur to gather data on compliance with the current educational process and existing resources. During the fourth quarter of 2023, the introduction of the resources to the service line staff, in addition to training the staff on effective teaching and education techniques, will occur. The education will occur in educational in-services for nurses and at various discipline-specific quarterly meetings. This educational approach will allow us to utilize multimedia resources for patient and caregiver education during the first quarter of 2024. In addition, we will gather feedback from patients and their caregivers after receiving their education. During the second quarter of 2024, a post-survey will be administered to staff, allowing us to compare the satisfaction and perceived benefits or issues with the implemented resources. Evaluation will commence in the third quarter of 2024. The timeline allows for a timeframe spanning five quarters, allowing for pre-implementation activities involving data gathering and education, implementation of the project, and evaluation (see Appendix E). Plan for Evaluation of Project Evaluation of this master’s project will involve compiling feedback from patients and caregivers after receiving new diagnosis education that includes multimedia resources, comparing pre-and post-surveys from service line staff, and completing chart audits on the frequency of resource use and topics covered. Comparison between the pre-and post-surveys from service line staff will indicate whether the implementation of multimedia resources is better, worse, or the same as the current education process. In addition, staff will be asked about their satisfaction with the new resources. Higher patient and caregiver questionnaire results will indicate success in patient and caregiver satisfaction with the teaching process and multimedia resources. In addition, the questionnaire will solicit feedback on the education presentation, areas for improvement, and additional resources and subjects they feel are necessary to educate newly diagnosed cancer patients. Ethical Considerations Ethical considerations for this project include the four main principles of ethics, autonomy, beneficence, justice, and nonmaleficence (Haddad & Geiger, 2022). In addition, diversity is an essential ethical consideration for this project. This project has its foundations in justice, diversity, and equity. It strives to provide thorough and enhanced education for all learning styles and levels using a multimodal education approach with various multimedia resources. Justice will be sought by ensuring that all newly diagnosed pediatric cancer patients and their caregivers can utilize all available resources for their learning. In addition, diversity will be respected by ensuring resources are available in various languages and with interpretation services utilized during the education process as needed. Finally, beneficence, autonomy, and nonmaleficence are essential (Haddad & Geiger, 2022). Therefore, all patients and their caregivers can determine the extent to which resources are utilized and will not be required to utilize any that they do not feel are effective for them. In addition, participation in the feedback questionnaire will be entirely voluntary. Discussion Hearing a cancer diagnosis is undoubtedly life-changing for pediatric patients and their caregivers. In addition to facing the emotional, physical, and mental toll that this diagnosis brings, patients and their caregivers face gaining an immense amount of new knowledge and learning to care for this life-threatening disease. Patients and their caregivers need and want personalized education offerings that make sense to them. Providing patients and caregivers with education through various methods enhances learning, creates confidence for the caregiver (Flanders, 2018), and improves health outcomes (Gusman & Cannon, 2022). As this project unfolds, examining the importance to the field of nursing, acknowledging the strengths and limitations of this project, and evaluating future areas of growth are essential for success. Evidence-based Solutions for Dissemination Dissemination of the results is essential for service line learning and the continuation of this project. A poster presentation for the service line will be initiated and allow for easy and mass education distribution to the service line. This project's research, literature review, and beginnings have begun to be shared with the service line leadership, including clinical and business directors, physician lead, and social work leadership. A goal of this project is a poster presentation at the Association of Pediatric Hematology and Oncology Nurses (APHON) annual conference, allowing for sharing information with other institutions that have similar programs and challenges. The evolution of this project will continue to be explored, with additional multimedia formats to be recommended. Significance to Advance Nursing Practice Patient education is essential for creating positive healthcare outcomes (Kennedy & Parish, 2021). Nowhere is that more apparent than in life-threatening diagnoses such as cancer (Peipert et al., 2021). As healthcare and technology evolve, the need for diverse and various educational methods for patients and caregivers also does. For example, with advancements in treatment options for pediatric cancer patients, more flexible and personalized learning options are necessary (National Cancer Institute, 2021). Nurses are vital to the success of enhanced patient and caregiver education (Withycombe et al., 2016). Nurses spend significant time with patients and their caregivers; therefore, providing nurses with the tools and resources necessary to assess and provide enhanced education is essential. This project looks to provide nurses with the needed resources and education about patient teaching and incorporate their feedback and assessment of said resources to continually improve the educational process for patients and caregivers. Implications This project addresses the critical healthcare topic of patient education, which is essential in controlling healthcare costs and creating positive patient outcomes. It provides examples of practical educational components and the rationale for including multimedia resources in individualized patient and caregiver education plans. In addition, this project provides the service line team with the education and resources they need to provide enhanced education to pediatric cancer patients and their caregivers. Furthermore, this project is essential in establishing best practices for patient education as the service line and organization see continued growth and expansion. Limitations of this project include its limited size since it will only be implemented at one institution. However, once implementation and results have occurred, the results can be disseminated, encouraging similar projects. Patients and caregivers may choose to refrain from participating in utilizing specific resources or, if they do, provide feedback on those resources. These choices could hinder the collection of accurate data. To overcome this challenge, nurses will be encouraged to explain the importance of this project and its impact on patient and caregiver education now and in the future. Recommendations This project identified gaps in the current patient education process for newly diagnosed pediatric cancer patients and their caregivers. These gaps include the need for multimedia resources to facilitate various styles and levels of learning. This project sought resources that were readily available and able to implement in a short period. Recommendations for further research and topics are geared towards developing interactive videos, creating hands-on classes, and developing the service line’s website. In addition, the development of a patient education program is needed due to the growth of the pediatric cancer program at this large healthcare corporation, the vast geographical area that the program serves, and the opening of other sites in the near future with the growth of the organization. Conclusions Effective patient education is critical to high-quality healthcare (Peipert et al., 2021). Research suggests that effective education empowers patients and their caregivers to take an active role in their care and promotes better health outcomes (Flanders, 2018). This goal is vital for pediatric patients and their caregivers, where better health outcomes equal less frequent hospitalizations, lessening of side effects from treatment, and survival (Withycombe et al., 2016). Effective education for patients and caregivers should be multifactorial. It can take many forms, including written materials, videos, online resources, interactive smartphone applications, and one-on-one discussions with healthcare providers. It is essential that patients and their caregivers have access to various educational resources and that healthcare providers work to identify the most appropriate resources for the patient and caregiver needs and create individualized educational plans. References American Cancer Society. (2022a). Key statistics for childhood cancers. https://www.cancer.org/cancer/cancer-in-children/key-statistics.html American Cancer Society. (2022b). Key statistics for cancers in adolescents. https://www.cancer.org/cancer/cancer-in-adolescents/key-statistics.html Blevins, S. (2018). The art of patient education. Medsurg Nursing, 27(6), 401-402. https://web-sebscohost-com.hal.weber.edu/ehost/pdfviewer/pdfviewer?vid=6&sid=e94346ae-6ee64c91-bcc2-b82a0f080290%40redis Buckwalter, K. 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(2016). A comprehensive survey of institutional patient/family educational practices for newly diagnosed pediatric oncology patients: A report from the children’s oncology group. Journal of Pediatric Oncology Nursing, 33(6), 414-421. https://doi.org/10.1177/1043454216652857 Appendix A Children’s Oncology Group KidsCare App Handout COG KidsCar e App For parents and caregivers of children with cancer Free! Download today! Journey Board with COG KidsCare App QR Code Start Here I received my education binder I can tell you about my diagnosis Download COG KidsCare app (p.7) I can describe ways to reduce infection (p.51-53) I can describe methods of coping Primary Children's Hospital Cancer Website (p.63-90) I can list common lab and procedure tests Meet with: q Child Life q Social Work (p. 23-31) q q q q Tour unit Rounding Preferences Teaching Schedule Teaching Outline Complete I can recognize and manage s/s of pain I can recognize s/s and treatment of bleeds I can verbalize dehydration & constipation (p.50-55) (p.56-57) (p.61) I can describe dietary guidelines (p.58) Meet with: q Dietician I can describe medications and their purposes (p.41, handouts) Meet with: q Pharmacist Meet with: q Case Manager q Care Coordinator I have follow-up appointment (s) scheduled I can identify methods to reduce nausea I know how to care for my child's central line (p.56) I can explain handling of body fluids (handout) q Central Line booklet q Central Line Teaching Outline I know when and how to check for a fever I know the red flags and who to call for what HOME! (magnet) From COG KidsCare App for Parents and Caregivers of Children with Cancer, by the Children’s Oncology Group, 2022 (https://childrensoncologygroup.org/downloads/COG_KidsCare_App_Flyer_for_Parents_English.pdf). In the public domain. Appendix B Effective Patient Education Infographic Appendix C Pre-and Post-Surveys for Staff Appendix D Patient and Caregiver Questionnaire Appendix E Timeline 2024 2023 •Pre-Survey to key stakeholders •Chart Audits •Begin use of resources in the education of newly diagnosed patients •Patient/Caregiver Questionnaire Fourth Quarter Third Quarter 2024 •Evaluation of project, surveys, questionnaires, and chart audits Second Quarter First Quarter Third Quarter 2023 2024 •Introduction of new resources •Education to service line staff •Gather feedback from patients/caregivers •Chart audits on usage/education