CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
ASSESSMENT, CANCER EDUCATION, SERVICE
·, NEEDS, IN COMMUNITY HOSPITALS
A graduate project submitted in partial
satisfaction of the requiremen,ts
for the degree of Master of
Public Health
by
Noga Luria Liberboim
June, 1978
The Thesis of Noga Luria Liberboim is approved:
Wilfred Sutton
Waleed Alkhateeb, Chairman
California State University, Northridge
i
!
I
l~----- · - -· -·- ·- - - - - - ·-· - - - - · - -· - - - · -· -· - -·- · - - ·- · ·-·-· - -·- - - - - - - __]
To my parents Nhamah and Zvi Luria,
my husband Gidon and our children.
iii
ACKNOWLEDGEMENTS
I would like to express my sincere thanks and
appreciation to my friends Anita Bershtel,· Esther M.
Yardumian, and Zizi Hartouni who have helped in any way
with the preparation of this project.
I
Dr.
also want to thank Dr. Waleed Alkhateeb and
~1ichael
Kline who served on my graduate project
coro.mittee.
iv
TABLE OF CONTENTS
Page
.MSTRACT .
.
.
.
.
•
.
•
INTRODUCTION .
.
.
.
.
.
•
.
.
.
. ·•
.
•
.
.
viii
Chapter
I.
. . . ..
STATEMENT OF THE PROBLEM .
2
JUSTIFICATION OF THE PROBLEM •
5
LIMIT.ATIONS OF THE STUDY .
.
• .
10
DEFINITION OF TERMS
II.
METHODOLOGY
.
.
• .
.
11
• • .
• • • .
I.
Formulation of the Committee
II.
Selection of the Hospitals .
III.
IV.
III.
1
14
14
.
15
Development of the Survey Instrument
18
Selection of the Target Hospitals
19
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS . .
SUMMARY
• • • • .
• .
.
26
26
CONCLUSIONS
30
RECOMMENDATIONS
32
FOOTNOTES
34
BIBLIOGRAPHY •
35
APPENDICES
APPENDIX A - THE M4ERICAN CANCER SOCIETY .
.
39
APPENDIX B - THE AMERICAN COLLEGE OF SURGEONS 46
v.
Page
APPENDIX C - A SN1PLE OF THE STRUCTURAL
INTERVIEW WHICH WAS USED
TO OBTAIN DATA AND INFORMATION FROM THE THREE HOSPITALS
CHOSEN FOR THE PILOT STUDY . . 52
vi
TABLE OF CHART
Page
Chart
1
Selected Hospitals for the Project . . . . . .
vii
16
ABSTRACT
ASSESSMENT, CANCER EDUCATION, SERVICE
NEEDS, IN COMMUNITY HOSPITAl,$
by
Noga Luria Liberboim
Master of Public Health
The purpose of this study was to assess the
cancer education needs of the hospital staff of medium
sized community hospitals in central Los Angeles.
The study concerned itself with eleven medium
sized hospitals which treat 30-120 cancer patients annually, yet do not have the approval of the American
College of Surgeons.
An Ad Hoc Committee of the profes-
sional committee from the central unit of the American
Cancer Society was formed to obtain all the available
data about the hospitals.
Information was gained through
a structural interview format designed by the committee
·which served as a guide for the interviewer to gain all
'
viii
the necessary information.
Three of the eleven hospitals
were selected for the pilot study on the basis of their
cancer patient load, current education programs, location,
and size.
The directors of nursing, social service, and
inservice departments in these hospitals were interviewed.
The following results were considered essential by all
three hospitals involved with the pilot study:
1.
Interest in participating in continuing education
programs; but they desired the programs to be
held in their own hospitals.
2.
The importance of an accredited program for nurses
in regard to license renewal was considered essential by all three hospitals.
3.
Interest in the paitent himself, rather than in
the scientific aspect of the disease.
4.
Providing an appropriate atmosphere for the
patients' social, personal and emotional needs.
As a result of this project's findings, a recommendation
of furthering the scope of Public Education Programs and
Professional Education Programs can be made to the American Cancer Society.
These programs in conjunction with
each other will supplement and increase public and professional awareness in developing more effective technical
and personal methods of dealing with cancer patients.
In
addition, emphasis should be placed on inclusive programs
ix
conjoined with Heart Associated, Arthritis Agencies and
other medical organizations in order to explore and exchange knowledge, concepts and techniques for understanding the psychological and physical changes taking place
in terminally ill patients.
X.
CHAPTER I
INTRODUCTION
There are over three million Americans alive
today who have a history of cancer.
According to "1978
Cancer Facts & Figures," there will be an estimated 3.5
million cancer deaths in the United States of America in
this decade.
More than ten million persons afflicted will
be receiving medical care for the disease.
In 1978, for
example, approximately 700,000 people will be diagnosed
as having cancer.
Of these 700,000 about 233,000 will be
alive at least five years after treatment. 1
"The National
Cancer Institute's Third Nation~l Cancer Survey," findings
have estimated that of four cancer patients who die, one
might have been saved with prompt treatment.
2
The &~eri­
can Cancer Society contends that "only the results of
research can save these patients.u 3
Therefo,re, the immed-
iate goal of cancer control is saving the lives of at
least half of those who get cancer each year.
Since the
number of persons being hospitalized and treated for cancer is increasing each year, the need for a knowledge of
cancer patient care has become essential.
The·American Cancer Society's Professional
Education Programs currently provide medical students,
nurses, doctors and allied health professionals with
1
2
information and training in the detection, treatment and
rehabilitation of cancer patients.
Films, speakers, pub-
lications and exhibits are available to these and other
organizations for professional education programs. 4
STATEMENT OF THE PROBLEM
The American Cancer Society recognizes the need
for continuing education programs in the areas of care
and treatment of the cancer patient.
In this regard, the
American Cancer Society felt that it was necessary to
develop a formal mechanism which would enable them to
specifically assess the educational service needs of
"medium-sized" community hospitals_in Central Los Angeles.
The medium-sized hospital consists of approximately 100400 beds, and admits between 30-120 cancer patients a
year to their hospitals.
The Cancer Patients' Programs currently operating
'
in Central Los Angeles have a varying amount of knowledge
and interest in the activities of the American Cancer
Society.
Ten of the thirty hospitals in this area are
large, major-medical institutions which have been approved
by the American College of Surgeons.
That is, certain
requirements regarding the quality of care of cancer patients must·be· met before approval by The American College
of Surgeons can be made.
Only hospitals that are
3
,
accredited by The Joint Commission on Accreditation of
Hospitals are surveyed for approval.
Within each of these
approved hospitals a cancer committee must be established
with members from all medical specialties pertaining to
the care of cancer patients, since current treatment involves the use of combined therapy:
surgery, radiation
and chemotherapy. 5
In order to carry out its assigned responsibilities, The Cancer Committee must meet on.regular and frequent intervals depending on the size of the hospital.
An annual report must be distributed to the Staff, giving
evidence of what is happening in the areas of cancer in
the hospital, as well as in the community.
Hulti-
disciplinary educational cancer conferences on at least
a monthly basis are another of the program's basic requirernents.
Selected members of the Cancer Committee must
always be on call for consultation.
Records for every pa-
tient showing patient care evaluations must be readily
available to the survey or upon request.
The ten hospitals meeting the above basic
requirements and having received the approval of the
American College of Surgeons were not a concern of this
project, since it was assumed they were providing effective programs for their cancer patients (owing to their
American Cancer Society Certification) .
4
.
Also, of the thirty hospitals in the Central Los
Ang~les
area, approximately nine treat less than 30 cancer
patients during the year.
In most instances, they refer
their cancer patients to the major medical hospitals in
· the area for treatment.
This Project also excluded these
hospitals from the study focus since their cancer load
was insignificant.
The remaining eleven hospitals were selected as
the target group for this Project, owing to their absence
of an approved cancer program, but because they treated
at least 30 to 120 cancer patients a year.
This Project was specifically implemented in order
to determine if there were significant education and service needs which could be met in these medium-sized hospitals with particular regard to the care and treatment
of the cancer patient.
Since the cancer patient is threatened both by
the disease itself and by the thought of its accompan:ying
extensive surgery, the lack of knowledge (by the hospital
staff) of cancer and its effects on the patient in every
aspect is indicative of the degree of care which the patient will eventually receive.
With increased availabil-
ity of material and educational provisions, increased
awareness of the overall needs of the cancer patient
become manifest.
This is essential for the effective
5
care of any patient.
But in this Project it is the needs
of the cancer patient which need to be addressed.
The purpose of this Project, therefore, was to
assess the need for continuing education of professional
staffs of medium-sized community hospitals, in order to
plan effective educational and patient service programs
for improved cancer patient care.
JUSTIFICATION OF THE PROBLEM
Because educational programs are not available at
many hospitals, or if they are, they are not adequate
enough to provide the staff with continual ongoing education in the field of cancer and related subjects, an
assessment of their educational and service needs was .
strongly indicated.
A program of continuing education
could essentially provide the hospital personnel with updated knowledge in these specific areas.
With the estab-
lishment of this type of program, staff will be increasingly attuned to the needs of the cancer patient.
Vernice Ferguson, in her article, "The Learning
Climate," states that, "nurses capitalize on the hospital
as one of the influences to enhanve personnel performance
and gain personal fulfillment.
Nurse administrators and
educators should make every effort to capture and maintain
an excitement in daily practice for the entire staff."
6
6
Carol Londoner conducted a survey which "involved
examining an existing continual education program.
It
was found that filling educational needs tend to make
hospital workers a more efficient and cohesive working
"t • 117
un~
In the study, Evaluation of On-Campus Continuing
Medical Education in Alberta, again the importance of
continuing education using the classroom is demonstrated.
During the 1971-72 academic year, several oncampus continuing education programs were studied in
order to study the effectiveness of researchable criteria.
A multiple choice examination was taken by the participants before each course, and after attending the course,
the third examination was given to them a few months later.
The result was that after each course was taken 7
there was a substantial increase in the participant's
knowledge.
But after the third examination, the knowledge
had decreased because of the time.lapse between the third
examination and the last course taken.
The conclusion is that the effectiveness of the
program justifies its continuation.
In the study by Schlessinger, Lowery, Glaser,
Milliones, and Maza, 8 the importance of continuing education and its success can be seen.
7
The prenatal care personnel utilization project
was done in 1967 at the University of Pittsburgh under
the maternal and child health program of the Graduate
School of Public Health and the Department of Obstetrics
and Gynecology of the School of Medicine.
For the purpose of that study two groups were
used:
one for the study itself, and one control group.
The control group of expectant mothers was taken
care of by obstetricians, and the study group by unexperienced registered nurses that had been trained for this
purpose.
The result was that in the two groups, an almost
identical distribution of abnormalities occurred during
the neonatal period.
The preriatal care personnel project
shows the possibility of using R.N.'s for prenatal care
following a relatively short per·iod of orientation and
training.
The performance of the maternity nurse examiner
proved highly creditable in the group served, compared
with the group seen by the obstetrician
in the area of
clinical attendance, acceptance, complication of labor
and delivery and outcome of pregnancy.
At the end of the
project, the R.N.'s that were trained for this study continued to work successfully in the prenatal care clinic.
These studies all underscore the importance of
continuing education using various methods:
the
8
classroom, courses, small group discussion, lectures, and
literature.
'
The success of these continuing educational
programs is demonstrated by the improvement of quality
of treatment, and the increase of knowledge on the part
of the hospital employee which naturally leads to increased self-satisfaction and participation.
The greatest importance, however, will be
exhibited in the eventual impact this increased knowledge
and perception will have on the patient and on the care
which he will receive, both physically and emotionally.
This is especially essential among terminal cancer patients who need a great deal more psychological and emotional support.
Edward Brandt' findings support this
kind of learning for physicians as well.
He states:
"The
goal of continuing education for physicians is to maintain
a high standard of treatment fo~ patients."
9
An article advocating another form of this same
type of educational process indicates that "the quality
of treatment can increase when the doctor is told about
. .
.
.. 10
. d e f"~c~enc~es.
h ~s
In establishing this pilot project, the chief
concern was in developing better communication between
the patient and the staff.
It was not found enough to
simply treat the patients' physical needs by administer. ing injections, providing medicine, radiotherapy, etc.
9
Those directing and assisting in the care of the patient
must also be aware of his emotional and psychological
needs.
Sutherland and Orbach again point out, that "when
{a) patient is unable to relate to medical personnel, the
vulnerability to anxiety or emotional problems is greatly
increased.
event
If the patient cannot escape from the feared
~urgery)
and, because of mistrust, is unable to
gain support from others, anxiety can increase to the
point of total breakdown.
Mistrust is reinforced by the
impersonality of clinic and ward procedures and the 'faceless surgeons'."
11
Through a continuing educational program, the
doctor and nurse can improve upon patient-staff communication; the patient may therefore respond better to his
treatment and possess a healthier emotional attitude.
Considering all this:
more knowledgeable staff
members, increased efficiency, available and necessary
patient services, and thus better.patient care, it is
ce~tainly
justified to recommend the implementation of
an effective continuing educational and patient service
program.
10
LIMITATIONS OF THE STUDY
The overall limitation of this entire study was
the literature available ori the subject.
Since studies
of this nature have neither been conducted, nor written
about, materials and ideas that might otherwise have assisted the direction of the study were simply not available for use.
The development of the structural interview
involved an amalgamation of personal ideas and extractions
of ideas used from other unrelated fields.
The commonal-
ity was that those subjects needed to contain basically
the same desired outcomes.
This Project's effectiveness
could have been greater with additional facts from a
related and similar field.
Unfortunately, as a result of this lack of·
knowledge and unavailability of data and with the various
problems that arose throughout the undertaking of this
Project, ·the findings that have come out of this Project
are applicable only to those hospitals involved with the
Project."
That is, individual needs must be peculiar to
each hospital.
What may be recommended as beneficial for
one hospital, may in fact, serve as ineffective for
another.
11
DEFINITION OF TERMS
The American Cancer Society
The American Cancer Society is a voluntary
organization dedicated to the control and eradication of
cancer.
Programs of research, education and service to
the cancer patient are planned by The American Cancer Society.
The Society's long-range objective is to eliminate
cancer entirely as a human disease.
Its immediate goal
is to save more lives and to diminish suffering from
cancer to the fullest possible extent.
Cancer
Cancer is a large group of diseases characterized
by uncontrolled growth and spread of abnormal cells.
If
the spread is not controlled or checkedi it results in
death.
Ad Hoc
Co~~ittee
A committee formed specifically to assist with a
special case and limited in length to the resolution of
that one problem.
Professional Education Committee
A
Corr~~ttee
obliged to sustain and elevate inter-
est of the medical professions.
Its intent is to support
with knowledge the capabilities of these medical
12
disciplines to best serve their patients when cancer
diagnosis or treatment may be the objective of consultation.
They provide the medical profession with specially
developed cancer-oriented films, literature, newsletters,
publications and seminar opportunities in order to assist
the constant effort to keep the medical profession
abreast with knowledge.
Public Education Committee
A Committee whose intent is to provide
infor~ation
to the public about, and stressing the impor-
tance of early cancer detection and prompt effective
treatment, cancer prevention; encouraging people to see
their physicians and dentists routinely, even when there
are no symptoms of illness.
The mnerican College of Surgeons
An organization founded for the purpose of
developing methods for advancing the quality of care for
all. patients requiring surgical methods of treatment.
The Commission is composed of a representative cross
section of the surgical community.
The American College
of Surgeons has promoted the establishment of special
hospitals based on programs designed for improved quality
of care for patients with cancer.
13
Nurses License Renewal
The State of California requires renewal of
nurses licenses every two years upon completion of 30
hours of continual education classes pertaining to their
field.
CHAPTER II
METHODOLOGY
The inception of this project came in April of
1976, with a decision by the Investigator to work in a
cancer study with The American Cancer Society.
The
Project's involvement centered in central Los_Angeles,
and concerned itself with finding and assessing the educational and service needs of cancer patients in the
medium-sized hosptial of this area.
-Selection of a com-
mittee rGas made, its members consisting of interested
persons desiring involvement with this type_of project.
Of the five volunteers selected by The American Cancer
Society, three were R.N.'s and two were _cancer researchers.
All became interested in the study after learning its
nature, and agreed to work on its committee.
I.
Formulation of the Commi t·tee
This committee, called the Ad Hoc Hospital Needs
Assessment Committee, was formed on Sept_ember 20, 1976.
Its ultimate goal was to develop the means for assessing
the needs of the cancer patients' programs of the mediumsized hosptial.
14
15
II.
Selection of the Hospitals
Eleven hospitals were selected by the committee as
target hospitals to be assessed by the committee according
to their needs.
Basic information about these hospitals
was obtained prior to their selection:
a.
Type of hospital (i.e., propriety, non-profit)
b.
Size of hospital (study only concerned with
medium-sized hospital) .
c.
Number of cancer patients annually
d.
Is there a cancer committee already established?
e.
Is there a Social Service Department?
These findings are as follows:
Members of the Committee divided themselves
according to individual tasks.
Each had an assignment
which was directed towards the completion of the project,
these being:
1.
To secure all available data and material
about the target hospitals.
2.
To compose a letter of introduction to hospital
administrators and to develop an introduction
to the survey.
3.
To "feel out" personal contacts in the hospitals
(essential in order to test ideas and identify
the proper channels of communication) .
4.
To develop a method by which specific
information and feedback from hospital
personnel could be obtained.
CHART 1
Selected Hospitals for the Project
NAME
0~
HOSPITAL
TYPE
ADMINISTRATOR
SOCIAL SERVICE
DEPARTMENT
NO {ContractBirdie McClain)
CANCER
COMM.
Community Hospital
of Huntington Park
Proprietary
Corporation
Curtis 0. Hermann
NO
Fox Hills
Community Hospital
Proprietary
Corporation
Robert Koondel
YES
NO
Hollywood
Community Hospital
Proprietary
Corporation
Richard M. Vogel
NO
NO
Hollywood West
Hospital
Proprietary
Corporation
Edward M. Armstrong
NO
NO
Mission
Hospital
Proprietary
Corporation
Curtis 0. Hermann
NO {Contract}
Morningside
Hospital
Non-Profit
Association
Hayward M. McNeill
YES
(Vivian Robinson)
Southeast Doctors
Hospital
Proprietary
Corporation
Arthur Wardner
YES
(person comes
1 day/week)
NO
NO
(Tissu.e
Conun.
only.)
NO
i-'
0"1
CHART 1 (Continued)
NAME OF HOSPITAL
TYPE
AD:HINISTRATOR
SOCIAL SERVICE
DEPARTHENT
CANCER
COMM.
View Park
Hospital
Non-Profit
Association
Thomas D. Pittman
NO
YES
West Adams
Hospital
Proprietary
Corporation
Marvin Cloyd
YES
NO
Westside
Hospital
Proprietary
Corporation
Arthur Kellerman
YES
(Ned Parker)
NO
Midway
Hospital
Non-Profit
Association
Marvine I. Howard
YES
(Pamela Lazar)
NO
•·
1-'
-.....1
18
..
III.
Development of the Survey Instrument
Initially, exploration into types of surveys was
conducted, in order to ascertain which survey techniques
would best facilitate the acquisition of useful information.
The 'personal interview' was decided upon.
In his
studies on behavior research, Kerlinger expresses that the
personal interview "could be very helpful in learning a
respondent's own estimate of his reasons for doing or
believing something." 11
This particular type of questionnaire is timeconsuming and difficult to compose.
But, according to
current research on interview types, it appeared to provide the most effective vehicle for the desired result.
Upon presentation of all the material gathered, the
Committee themselves agreed that a structural interview
would best suit the Project's purposes.
Each member of
the Committee assisted in the development of the interview
format.
Key questions were discussed or disregarded, as
decisions were reached.
A preliminary questionnaire was
drawn up, and the Ad Hoc Committee, at its second meeting,
reworked the questionnaire until
~t
satisfied all of its
constituents, and a final form was then constructed.
An outline of how initial contact, conducted with
the target hospitals, was also made at this second meeting.
Personal contacts were made at several of the hospitals,
19
and greater input was derived as to how initial contact
could best be made.
IV.
Selection of the Target Hospitals
Between the second and third meetings, three
hospitals were chosen from the original eleven, as the
targets for the pilot study; these being, Westside Hospital, Fox Hills Community Hospital, and View Park Hospital.
A decision was made to contact the hospitals by
telephone.
A letter might be put aside, neglected indef-
initely or altogether, or even thrown away.
The telephone
provided a fast, inexpensive method of making contact and
setting up interviews.
In a February, 1977 meeting, discussion as to who
should be contacted at these hospitals was made.
It was
decided that the Hospital Administration, The Division of
Nursing, The Inservice Division and The Division of the
Social Service Department should all be contacted.
Initial findings were to be reported to the
Professional Educational Committee of the American Cancer
Society at the end of the month.
The following weeks were devoted to making telephone
contact with the above mentioned hospitals.
The Admini-
stration of each hospital was spoken with, and informed
· of the project and its connection with the American Cancer
20
~
Society.
The proposal of a program constructed with the
purpose of providing educational and service needs to the
professional staff of the hospital was presented to each
Administrator.
Interest was evidenced and reference to
the Director of Nursing, Inservice Director and Social
Services Department was made.
Appointments for interviews
were set up with each of these Department's Heads.
In
all cases but one (Social Service Department of one hospital), agreement was reached regarding-participation in
the pilot study.
A summary of facts about the American Cancer Society
was cons·truc·ted to be presented to each person interviewed.
Specifically, this was to make each person aware of the
American Cancer Society's Program and Services (see
Appendix A) •
The interviews were designed to probe in an
open ended manner rather than simply
question,;,.and~answer,
as established in the structural interview.
The struc-
tural interview, however, did provide a guide for extracting pertinent informa·tion from the persons interviewed.
This was necessary for evaluation of the needs of the
hospital in ques·tion.
It was also thought beneficial to the desired aim of
the Project for staff physicians to be contacted concerning
the nature of the Project, and to perhaps
tions or suggestions from them.
receive reac-
21
Some twenty doctors in attendance at the American
Cancer Society meeting advised the Ad Hoc Committee meeting that other physicians would be personnaly contacted
by them in regard to the project.
The interviews conducted did, in fact, reveal a
need for further educational programs and patient services.
In recommendation to the American Cancer Society,
the Ad Hoc Committee chose specifically to work with the
three hospitals selected for the pilot study.
The estab-
lishment of necessary programs would be made, and then,
if successful, continued work with the remaining hospitals
would be made.
Although the structural interview, developed by the
Ad Hoc Hospital Needs Assessment Committee is not a
scientific instrument, it was constructed as a guide for
the interviewer to use which would provide specific direction when addressing members of the hospital staff.
The American Cancer Society had absolutely no
perception of the quality of Cancer Care at the three
hospitals chosen for the pilot study.
Basically, knowl-
edge about the kind of cancer care received at these
hospitals was needed.
Also, other questions to be ex-
plored included who was providing the medical treatment?
were referrals being made to other hospitals? was there
ongoing education for the staff who dealt with the cancer
22
patient?
.
These questions and many others had to be
incorporated into the questionnaire so that an assessment
of what was actually being done and what was needed to be
done could be made.
The first question which had to be answered was:
who were the key personnel involved with supporting the
importance of continuing medical education?
This was
basic to the pilot study since it was this person with
whom initial contact would be made.
It-was hoped that
their efforts would then be a positive influence on the
other staff members who would later be approached.
The next question brought up was who was most
interested in developing a program· for Cancer patients?
The people involved in the educational planning for the
hospital were not necessarily the same persons most
interested in seeing a program established there.
The third question was related to the referral
policy at these hospitals.
Do they lack the facilities
essential for radiation therapy?
Are certain surgical
procedures not provided for as a result of deprivation
of funds and facilities?
The American Cancer Society
finds this information extremely important, as transportation can be made for the patient in order for him to
receive cancer therapy, if not a provision of the
hospital.
23
The following three questions were related to the
background of the patient.
If a referral was being made,
was the receiving hospital obtaining only information
about the patient's medical background, or was information concerning the patient's personal needs being transmitted as well?
Did the social worker share in this
aspect of referral policy?
Next, information was needed to ascertain if one
type of cancer patient was being seen more frequently
than another.
If this were the case, the American Cancer
Society would then plan an educational program designed
to fit the needs of this particular type of patient.
Also, specific services would be planned and structured
for this patient.
Examples of services which would be
provided to assist the patient who has suffered an impairment as the result of some kind of cancer included speech
therapy (including esophageal speech given by a professional speech therapist) , rehabilitation for women suffering the loss of one or both breasts to operable cancer,
etc.
The sixth and seventh questions were related
directly to the educational activity presently being conducted in the pilot study hospitals.
Questions were asked about the kind of education,
and depth of education provided for cancer patients, in
24
.
order for provisions of education to be made according
to what was lacking in these hospital programs.
The hospital's perception of its own needs for
tumor patients was the basis for the next question.
It
was asked in order to obtain information about the services provided by the hospital for its tumor patients.
Following up on this, questions 8, 8A and 8B make
reference to_the educational needs of the staff physicians
of these hospitals.
Is there a continuing education pro-
gram for the physicians related to the cancer patient?
If so, what kind of program has been established?
Do
they need a. supplementary program?
In view of the new, mandatory ruling applying for
re-licensing that nurses must submit evidence of 30 hours
of approved continuing education program study, question
nine asks if nurses would be interested in a program related to cancer care - one, of course, accredited for
their license renewal.
The tenth question asked if the hospital provided
a medical library, and if indeed it does, have the nurses
access ·to it?
If .they did not, the American Cancer Soci-
ety would provide access to a library specifically containing cancer-related materials.
The next two questions made reference to the type
and amount of contact the hospital had with the American
25
Cancer
Society~
by the Soc ie·ty?
Are ·they aware of the services provided
If so, are there any services provided
by the Society which they would like to have instituted
or provided to their hospital?
The final ques·tion was intended to open comment
and suggestion.
With these thirteen questions, findings about
cancer patient care, and educational programs directed
toward more efficient cancer patient care can be derived
and ideas subsequently brought about for improvement in
these hosptials and can be provided by the American Cancer
Society.
CHAPTER III
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
SUMMARY
The American Cancer Society's Professional
Education programs, while currently providing members of
all fields of the medical profession with information and
training in the detection, treatment and rehabilitation
of cancer, still are continually searching for more programs and newer educational methods.
In the large;
metropoLitan hospitals, accredited programs exist which
are surveyed for approval by the American Cancer Society.
Because these hospitals have a great annual cancer-patient
load, their programs, techniques and equipment are everchanging and redeveloping.
This particular study con-
cerned itself exclusively with the medium-sized community
hospital, whose cancer patient load annually is betv1een 30
and 120.
In order to ascertain the specific educational
needs of the medium-sized hospital, an Ad Hoc Needs Assessment Committee was formed and three of ten mediumsized hospitals were selected as the target groups for
the project.
The Assessment Committee was responsible
for securing all available data about the target hospital,
and for composing a letter of introduction to each
26
27
hospital's administration.
The goal of the committee
was included within the form letter and from this, an
interview with each hospital was established.
The Ad Hoc
Needs Assessment Committee also formulated a structural
interview which was used essentially as a guide for the
interviewer, providing him with a specific direction when
addressing members of the hospital staff.
Of the three
hospitals interviewed, each expressed great interest in a
continuing educational program, the establishment of which,
ultimately, was the goal of the Ad Hoc Needs Assessment
Committee.
Though the Project's end was thwarted, its
·efforts did. receive a favorable reaction from each hospital, and enough material was gathered to draw conclusions and make recommendations.
In all of the cases studied and interviewed,
interest seemed to lie with the patient himself, rather
than with his particular disease.
This suggests that no
real focus of interest is limited.to the disease of cancer.
Scientific aspects of the disease were virtually
ignored, while sociological and physiological reactions
were greatly
emph~sized,
in all cases.
All three hos-
pitals studied stressed a desire to provide for the patient's social, personal and emotional needs.
This would
indicate the desire for a general continuing education
28
program, rather than one specifically designed with the
cancer patient in mind.
The selection of Westside Hospital, Fox Hills
Community Hospital and View Park Hospital was done on the
basis of their cancer-patient load and current educational
programs.
Of the original ten hospitals chosen for study,
these three seemed the most ideal for the specific needs
of this project.
Their location, size, needs and goals
were in direct accordance with the desires and aims of
this study.
Interviews were received at these three hospitals
by the Administrator, Directors of Nursing and Social
Service, and by personnel of the Inservice Department.
Summaries of the project's goals were given to each director, in order that they be made aware of the American
Cancer Society's Programs and Services.
The structural
interview established by the Ad Hoc Committee was then
used for the extraction of all pertinent information.
In dealing with the Director of Nursing at
Westside Hospital, it was learned that a program
emphasiz~
ing treatment for·gastro-intestinal cancer would be most
beneficial, since their cancer treatment is concentrated
on the patient suffering from gastro-intestinal tract
cancer.
29
The Director of Nursing at Fox Hill·s Hospital,
was however, especially interested in a general educational program regarding cancer, rather than simply one
type of cancer.
Here, an expression of interest was in
the emotional and social aspects of the patient, as well
as the patient's medical treatment.
View Park Hospital also exhibited an interest in
a program related to moral and emotional support for their
terminal cancer patients.
The importance of an accredited program for
nurses in regard to license renewal was considered essential by all three hospitals.
Both Fox Hills Community
Hospital and View Park Hospital hoped that such programs
could be instituted within the hospitals themselves.
It
was a primary concern of these two hospitals that any
such programs for accreditation be in proximity to the
hospital, in order that all nurses working with them
would be better motivated to attend.
Fox Hills Community Hospital's Social Service
Department evidenced concern as to the special emotional
problems that occur in many cancer patients.
Their edu-
cational interests were oriented toward the treatment of
the emotional support for the cancer patient.
View P'ark Hospital desired an education program
that enlightens all phases of cancer for the family and
the nurse.
30
-
In none of these three cases did physical aspects
of the disease of cancer surface as the most important
goal of the nurse in her education of terminal disease.
CONCLUSIONS
Based on the findings of this Project, it has
been concluded that hospital personnel interviewed desired
a program stressing the social aspects of the disease
rather than the physiological process of cancer.
Accord-
ing to this Project, the most important goals for the
educational needs of these hospitals were based primarily
on four of these social aspects:
1.
crisis intervention
2.
death and dying
3.
the relationship between the terminal patient
and his/her family
4.
moral support by the hospital staff to the dying
patient.
According to the findings of this Project, the
emphasis on the emotional aspect of this disease can be
greatly reduced by well trained personnel who have a solid
comprehension of the terminal patient's emotional, spiritual and physical suffering before death.
The cancer pa-
tient is immobilized both emotionally and physically, and
he experiences basic non-verbal emotions that need to be
expressed.
Therefore, it is vital for the patient to
31
feel confident that someone understands the stage of
fears and stress he is going through.
Thus, helping the patient to clarify his problems
and offering him relevant suggestions is the primary role
of crisis intervention.
Being able to recognize how
hard it is for the patient to do this is essential in
giving support and understanding.
The category of moral
support by the hospital staff to the dying patient can
only be effective when it is coupled with reality.
The second aspect in dealing with a terminal
patient is the support and relationship of the personnel
on a daily basis until the ultimate consequence of death.
Under no circumstances should the patient be reminded of
his burden which he has become as a result of his disease.
At the present time, the situation is such that
a dying person is pretty much segregated from the living
people around him.
He is put in a separate room all by
himself with minimal contact with the staff who fears
getting emotionally involved with the experience of a
dying person.
The staff involved with the patient on a
daily basis should be trained to communicate with the
terminally ill patient and understand the various types
of physical, psychological, social and spiritual pains
•
that the patient is experiencing.
32
The third category of inter-relationships between
the family and the terminally ill patient is also of utmost importance.
The patient's concerns evolving around
fright, anxiety, anger, and depression should be dealt
with most proper understanding and caring, since his
circums.tances make him acutely aware of the reactions of
his friends and family.
Through proper education of the staff and more
awareness of the family about the patient's situation,
more effective methods of coping, support and understanding can be developed for understanding the emotional,
physical, spiritual and social conflicts of a terminal
patient.
RECOMMENDATIONS
With these findings, a recommendation which can
be made to the American Cancer Society would be for them
to further capitalize on their Public Education Programs;
specifically, to ensue that cancer education in its every
aspect reaches youth and adults through effective mass
media communications.
Professional Education Programs
must continue to supplement the learning process by
motivating members of the medical profession to learn and
use the latest and best cancer detection, diagnostic and
management techniques.
Due to the findings of this study,
33
-·
emphasis should be placed on inclusive programs cojoined
with Heart Associated, Arthritis Agencies, and other
medical organizations devoted to the exploration of concepts and exchange of knowledge because the medical staff
is mostly interested in the emotional, psychological,
physical, spiritual and social changes that take place
in all terminally ill patients.
In this way, practical
help and emotional support from all types of-disease and
illness can be learned, and perhaps new and more effective methods of dealing with cancer patients can be
discovered.
This is, after all, the ultimate goal.
FOOTNOTES
•.
1
The American Cancer Society, 1978 Cancer Facts &
Figures, New York, New York, 1977, p. 3.
4
5
Ibid., p. 22.
Ibid • , p . 7 •
6 James E. Dezitt, "Does Continuing Medical
Education by Peer Review Really Work," C.M.A. Journal,
May 1973, Vol. 108, pp. 1279-1281.
7 C. B. Hazlett, Ph.D., J. E. Bachynski, M.D.,
J. Embleton, Alta Edmonton, "Evaluation of On-Campus
Continuing Medical Education Programs in Alberta,"
C.M.E. Journal, May 19, 1973, Vol. 18, pp. 1282-1287.
8
Edward R. Schlesinger, M.D., M.P.H., Willa Dean
Lowery, M.D., Dolores B. Glaser, R~N., Margaret D.
Milliones, M.A., and Sati Mazumdar, Ph.D., "A Controlled
Test of the Use of Registered Nurses for Prenatal Care,"
Health Services Reports, May 1973, Vbl. 88, No. S.
9
Edward N. Brandt, M.D., J?h.D., "A Preference of
Family Physicians for Subject Matter in Continuing
Education Programs," Journal of Medical Education, Vol. 50,
April 1975, pp. 395-398.
10
Arthur M. Sutherland, M.D., and Charles E.
Orbach, Ph.D., "Depressive Reactions Associated with
Surgery for Cancer," The Psychological Impact of Cancer,
from the Department of Rehabilitation and Psychiatry,
Memorial Center for Cancer and Allied Diseases, New York,
New York, March 7, 1953, p. 18.
Fred ~- Kerlinger, Foundations of Behavioral
Research. New York: Holt, Rinehart & Winston, 1973,
pp. 410-423.
11
34
BIBLIOGRAPHY
35
36
'·
The American Cancer Society. A Fa•ctbook for the Medical
and Related Professions, Professional Education
Publication, 1975.
The American Cancer Society. 1978 Cancer Facts & Figures.
New York, New York, 1977, pp. 3-22.
Aydelott, Myrtle Kitchell, Ph.D.
Nursing Services. New York:
Nursing, 1968.
Survey of Hospital
National League for
Brandt, Edward N., Jr., M.D., Ph.D.
"Preferences of
Family Physicians for Subject.Matter in Continuing
Education Programs," Journa~ of Medical Education,
Volume 50, April 1975.
The Commission on Cancer. Cancer Program Manual.
American College of Surgeons.~
Publication of this
manual was supported in part by a grant from the
American Cancer Society, 1974~
Devitt, James E., H.D., C.M., M.S .• C., F.R.C.S. (EDIN),
F.R.C.S. (C).
"Does Continuing Medical Education
by Peer Review Really Work?'~ C.M.A. Journal,
Volume 108, May 19, 1973.
Dubin, Samuel, and Leros H. Marlow.
The Determination
and Measurement of Supervisory Training Needs of
Hospital Personnel, A Survey o£ Pennsylvania
Hospitals.
Pennsylvania State University, University
Par~Continuing Education, Eric Accession Number
ED 034138, 1965.
Hazlett, C. B., Ph.D., J. E. Bachynski, M.D., J. Embleton,
"Evaluation of On-Campus Medical
and Alta Edmonton.
Education Programs in Alberta,n C.M.E. Journal,
Volume 18, May 19, 1973.
Hunt, Howard Allan.
Registered Nurse Education and the
Registered Nurse Job Market. · California University
at Berkeley, INS. of Industri.:al Relations, Eric
Accession Number ED 101064, September, 1974.
Kerlinger, Fred N.
Foundations of Behavioral Research.
New York: Holt, Rinehart &·Winston, 1973.
37
Londoner, Carroli. A Diagnostic Procedural Model for
Identifying Real Educational Needs. Eric Accession
Number ED 037675, 1967.
Markel, William M., M.D.
"The Ostomy Program of the
American Cancer Society," Cancer, Supplement,
Volume 34, September, 1974.
Oppenheim, A. N.
Measurement.
Questionnaire Design and Attitude
New York: Basic Books, Inc., 1966.
Proceedings of the National Conference on Cancer Nursing
sponsored by American Cancer Society, Inc., Palmer
House, Chicago, Illinois. Held in cooperation with
American Nurses Association, September 10 and 11,
1973.
Robertson, William 0., and Charles W. Dohner. ·A Study of
Continuing Medical Education fo):" the Purpose of Establishing a Demonstration Center for Continuing Education in the Pacific Northwest, Final Report.
Washington University, Seattle, School of Medicine,
Eric Accession Number ED 052323, 1970.
Schlesinger, Edward R., M.D., M.P.H., Willa Dean Lowry,
M.D., Dolores B. Glaser, R.N., Margaret D. Milliones,
M.A., and Sati Mazumdar, Ph.D.
"A Controlled Test of
the Use of Registered Nurses for Prenatal Care,"
Health Services Reports, Volume 88, No. S, May, 1973.
Starfield, Barbara, M.D., M.P.H., David Rabin, M.D.,
M.P.H., Mark Glickstein, M.D., Marie McCormick,
Anthony Jackson, and Stuart Broske.
"Medical
Resources and Medical Educatiqn: A Student Survey
of Physicians," Journal of Medical Education, Volume
46, May, 1971.
"Summary of Recommendations for Early Detection,"
Cancer, Supplement, Volume 33, June, 1974.
Trow, Martin E. D.. Teachers and Students, Aspects of
American Higher Educa·tion. Carneigie Commission on
Higher Education, Berkeley, California, Eric
Accession Number ED 109975, 1975.
APPENDICES
38
APPENDIX A
THE AMERICAN CANCER SOCIETY
39
40
The American Cancer Society is one of the largest
and oldest voluntary health agencies in the United States.
It was organized in 1913, in New York city by a group of
physicians and five laymen.
The society and its programs
are under the control of volunteer boards and committees
at the national, division and unit levels.
The·Central
Los Angeles Unit is one of the forty-four in California.
Volunteers of American Cancer Society and the
professional staff employed by them are committed to one
goal:
the ultimate control of cancer which at the present
rates, strikes one in four Americans.
The physicians are
a major part of the American Cancer Society.
Their ex-
perience, suggestion and guidance is responsible for the
formulation of the society's professional policies and
programs.
The role of the volunteer physicians in Arneri-
can Cancer Society is cri~ical to the existence of the
society.
The programs and policies of the organization
is based on their professional experience.
Fifteen thousand physicians participate in
activities to educate the public through mass media about
the lates·t findings on cancer.
They make the public aware
of services available to them through the organization. 1
1
The American Cancer Society, A Factbook for the
Medical and Related Professions# 1975, pp. 1-10.
41
The function of the organization is to fight cancer on
three fronts:
1.
research, 2.
education, 3.
service.
RESEARCH
The goals of American Cancer Society research
are to find the causes of cancer, its prevention, its
cures and the alleviation of patient suffering.
Some $25 million is granted annually to more than
one hunderd United States institutions which have had projects approved.
At least twenty five percent of all unre-
stricted funds contributed to the society are spent on
the society's national research program.
Twice a year, about 150 of the nation's leading
scientists gather in New York to evaluate which of the
personal projects and institutional grants are worthy of
financial support.
The society's national research fund
program trains and invites promising young investigators.
It provides for investigation of new ideas in universities
and research institutes.
It provides teaching programs
in hosptials throughout the country.
MEDICAL LIBRARY
The society has a sizable medical library
containing books, articles and other materials related
to oncology.
It also maintains an extensive reference
and bibliographic service of current literature for
physicians and researchers.
42
EDUCATION
The aim of the society's professional education
program is to make sure that the members of the medical
and allied professions in every conununity are convinced
of the importance of all the American Cancer Society's
programs.
Members are to actively support the programs
and carry out the best possible cancer detection and
management techniques.
Emphasis is placed on planning
local education activities.
All of the society's divisions and many of the
local units have professional education conunittees composed of physicians, dentists, nurses and other health
professionals.
The society provides specially developed
cancer orientation films, literature, newsletters, publications and seminars.
PUBLIC EDUCATION
The goal of American Cancl'=r Socie·ty' s public
education is to help save lives by providing information
about early cancer detection and to stress its importance.
The national society promotes its approved
public education programs by providing speakers, materials
and exhibits to meetings of national organizations.
produces material for television and radio programs.
American Cancer Society aims to reach the public with
It
43
education programs where they work, meet, live and
study.
Stop Smoking Program
The Stop Smoking Program developed by the
California Division, is a four week course that holds
sessions twice a week in order to help stop smoking.
The
smoker is advised to become aware of his problems and behavior, and to concentrate on solutions rather than escape
through smoking.
Breast Self Examination Program
The program is designed to motivate women to
practice monthly breast self examination.
Sessions are
held in a comfortable and relaxed setting where the participating members of the group are given information
about the facts of breast cancer.
They are encouraged
to perform breast self examination every month.
The con-
cept of this program is to promote the idea of being
responsible for one's body and health.
SERVICE
The service program is an expression of concern
and interest of the American Cancer Society in the problems of cancer patients and their families.
The essence
of the society's program is giving emotional support and
a variety of direct services to the cancer patient and
44
the family.
It helps them with the stresses that are
often concurrent with the diagnosis of cancer.
Counseling
Professional counseling by a trained medical
social worker is available to help the patient to resolve
many of the emotional, economic and physical problems
imposed by cancer.
Loan and Gift Service
This service provides necessary and useful items
for cancer patients such as dressings, bed jaakets, supplies and equipment.
Transportation Service
Transportation is provided as necessary for
cancer patients to and from the physician's office,
hospital or clinic for diagnosis or treatment.
Speech Therapy
Speech therapy, including esophageal speech, by a
professional speech therapist is available for laryngectomees or any patient whose speech is impaired as a
result of cancer.
REHABILITATION PROGRAM
This program also includes retaining
laryngectomees to their former work, or helping them
45
to obtain training and employment in a suitable
vocation.
Mastectomy Rehabilitation Program
"Reach to recovery" is concerned with the
rehabilitation of a woman who has had one or both breasts
removed because of cancer.
This program helps the new
patient to adjust by meeting with other women who have
had the same problems.
A gift kit containing a temporary
breast form and other helpful material is given to the
patient who is visited by a specially trained American
Cancer Society volunteer worker.
Ostomy Rehabilitation Program
Volunteers of American Cancer Society working
along with volunteers of other various ostomy groups
throughout the country, mobilize to provide psychological
reassurance for patients with astomeses.
Gift kits are
given to these patients with informative materials on
st9ma care.
PUBLIC INFORMATION
The primary function of the public information .
is to disseminate information of the society's program
activity to the public through broadcast and print media.
APPENDIX B
THE AMERICAN COLLEGE OF SURGEONS
46
47
The commission is composed of a representative
.cross section of the surgical community from the college
itself, and representation from.all disciplines and major
agencies interested in the cancer patient and in problems
related to this disease.
For the past forty three years
the American College of Surgeons has promoted the establishment of special hospitals based on programs designed
for improved quality of care for patients with cancer.
The American College of Surgeons was founded in
May 1913 for the purpose of developing methods for advancing the quality of care for all patients requiring
surgical methods of treatment.
The deep concern about
cancer was developed further in the same year.
organization is composed of four committees.
1.
Committee on Education.
This
1
This committee develops
postgraduate courses in cancer.
Special hospital
programs are necessary to care for cancer patients,
apart from other patients, since the nature of the
disease varies significantly from other diseases
as follows: ·
A.
There are approximately 650,000 cancer patients
annually, of which half of them die.
1
Cancer is
A Factbook about the American College of
Surgeons. Commission on Cancer, American College of Surgeons, 1974, pp. 5-18. Publication of this manual was
supported in part by a grant from the American Cancer
·Society.
48
the second major killer in the United States,
therefore, it is a major concern of the American
College of Surgeons and is considered separately
from other disease.
B.
The knowledge about the cause of cancer and its
cure is limited.
Thus, limiting prevention pro-
. grams.
c.
The treatmentofcancer depends on many unkown as
well as known variables.
It is-necessary for a
cancer patient to have follow up examinations
even after treatment, for the chances of recurrence of the disease is quite high compared to
other diseases.
D.
Special consultation programs are available for
patients to accept their new situations.
The abovementioned factors and others make the
necessity of organized hospital cancer program obvious.
Improvement of complete care of patients and acquiring
new knm¥1edge of cancer are the two important tasks undertaken by American College of Surgeons.
2.
Commi-ttee on Patient Care and Research.
This committee
is responsible for developing criteria for patient
care related to diagnosis, treatment, rehabilitation
and follow up.
49
3.
Cowmittee
on~
Approval.
for direction of all
This committee is responsible
aspect~
of the hospital survey
program including establishing criteria for approval.
4.
Committee on Field Liaison.
The primary goal of this
committee is to serve as consultant in promoting the
development of new hospital cancer program and to
assist as needed in improvement of existing programs.
Criteria for approval of institutional cancer program.
Institutions are surveyed only on a voluntary
basis upon invitation from the institutions.
The basic
requirements are as follows:
1.
Only hospitals which are accredited by the joint
commission on Accreditation of Hospitals will be
surveyed for approval.
The hospital will be re-
surveyed when accreditation is restored.
2.
Multidisciplinary membership to the Cancer
Committee should include representatives from all
medical specialties involved in care of cancer
patients.
Responsibilities of the Cancer
Con~it-
tee, cover the entire care which include diag.nosis, treatment, rehabilitation,. follow up and
end results reporting.
In order to carry out its
I
assigned responsibilities the Cancer Committee
has to meet on regular and frequent intervals.
50
The frequency of the meetings depend on the size
of the hospital, but
ings.
mo~t
require monthly meet-
The meetings are for policy decisions and
patient care evaluations.
3.
A functioning cancer registry provides an annual
report for distribution to the staff.
The report
should show what is happening in the areas of cancer in that institution and possibly in the community.
Special site studies from available data
should be reported throughout the year.
Another
function of the registry is to follow up the
patients.
4.
Multidisciplinary educational cancer conferences
at a minimum of monthly intervals are a basic
requirement for approval of the cancer program.
The conferences are
pri~arily
for continuing edu-
cation of the professional staff and other community physicians.
The Cancer Committee also does
consultation services for specific problem cases.
5.
The Cancer Committee should have· a small group
that is on call for consultation.
6.
The necessary documents of patient care
evaluations must be avilable for the surveyor
upon his request.
These records should also
include the criteria for different anatomical
51
sites, minutes of meetings for patient care
evaluation and results of evaluation in accordance
with observation of the criteria.
The members of the commission on cancer proceed
investigation as follows:
1.
They develop a format to be used for evaluation
and composing diagnosis, treatment, rehabilitation
and follow-up of cancer patients.
2.
Review the patients' records treated in the
institution to find out if the established
criteria has been adopted.
Procedure for obtaining survey of cancer program.
Since the survey program is on a voluntary basis,
institutions are visited only on written request.
Requests are accepted of those institutions that have
conformed to the criteria for a minimum of two years and
have fulfilled the prerequisitions for membership.
The
report o_f survey of a cancer program is reviewed by several groups before a final decision.
An approval status
is made by the board of Regents of the American College
of Surgeons.
If the program meets all requirements,
an approval for three years is given.
,.
APPENDIX C
A SAMPLE OF THE STRUCTURAL INTERVIEW WHICH
WAS USED TO OBTAIN DATA AND INFORl'1ATION
FROM THE THREE HOSPITALS CHOSEN
FOR THE PILOT S'.rUDY
52
53
STRUCTURAL INTERVIEW
1.
Who are the key personnel who have
an interest in or are actively
involved with supporting continuing medical education?
2.
What individual in the hospital
is most interested in developing
a program for cancer patients?
3.
After the diagnosis and treatment
plan has been outlined, where are
cancer patients referred for treatment which is not available at your
hospital?
(If patients are never
referred, go to number 5)
4.
Who provides the receiving
hospital with information regarding these referred patients?
(If
information is not provided, go to
number 5)
4-A.
What kinds of information do you
share about such a patient with
the receiving hospital?
4-B.
What forms are used in the
transmittal of this patient?
5.
Do you see one particular type
of cancer patient more frequently
than others?
6.
What kind of medical review do
you have regarding the care of
tumor patients?
7.
Do you have in-service
education related to the
problems of tumor patients?
I
7-A.
If so, what kind?
(Medical review
refers to the
discussion of
the patient in
a group)
54
7-B.
What additional needs do you
have for in-service education
related to tumor patients which,
for one reasons or another, are
not or cannot be met at this
time?
8.
Do you have continuing education
programs related to tumor patients?
8-A.
If so, what kind?
8-B.
What additional needs do you have
for this type of program?
9.
Would your staff members,
especially nurses, be interested.
in a program given for credit to
up-date their licenses?
10.
Is there a medical library in your
hospital? Who functions as the
librarian? Does the nursing staff
have access to this library?
11.
What contact have you had with the
American Cancer Society? Do you
know what services are provided by
the American Cancer Society? May
we have a representative come and
discuss these services with you?
12.
(If you have had contact with the
American Cancer Society) what services which are not provided by the
American Cancer Society now would
you like to see provided in the
future?
13.
Are there any additional comments
and/or suggestions that you would
like to make?