Daniel Golden, MD, MHPE

Customizing Patient-Physician Communication

Daniel Golden, MD, MHPE, of Rush University is focused on improving communication between patients with cancer and their physicians by developing personalized discussion guides that explain external beam radiotherapy in an easy-to-digest format. Radiation oncology patient education materials are often written above the recommended seventh to eighth grade reading level, which can make the treatment process difficult to understand and increase anxiety for patients. To reduce barriers to understanding and facilitate conversations between providers and patients, Dr. Golden partnered with Tomoko Ichikawa, MS, at the Illinois Institute of Technology Institute of Design, to create the “Communicating the External Beam Radiotherapy Experience” (CEBRE) discussion guide. The CEBRE discussion guide uses graphic narrative to explain external beam radiotherapy and is written at a sixth grade reading level.

Patients, family members, doctors and other radiation clinic staff provided input on the design of the CEBRE discussion guide. To ensure that any provider can use the CEBRE discussion guide, it can be downloaded free of charge, customized for any clinic and printed on a standard color office printer. The prototype CEBRE discussion guide was intentionally designed to provide a general overview of the radiotherapy process, but patients face unique challenges depending upon the location of the cancer. To further personalize the patient experience, Dr. Golden and Professor Ichikawa developed six additional discussion guides in the CEBRE series that are customized for radiotherapy for breast, central nervous system, digestive system, head and neck, lung, and prostate cancers.

With the ROI Personalized Radiation Therapy award, the team:

• Audited the existing patient education material for the specific disease sites and researched the latest theories of the graphic narrative medium.
• Interviewed patients, family members, physicians, nurses and radiation therapists to understand their needs and perspectives on the radiotherapy process for each of the specific disease sites.
• Used a human-centered design process to construct a storyboard of the patient experience for each disease site.
• Developed and tested prototypes of the site-specific CEBRE discussion guides to refine and finalize them and then make them available online to all clinics.

Download the personalized CEBRE discussion guides that were supported by ROI: 

• CEBRE Breast Cancer Discussion Guide
• CEBRE Central Nervous System Discussion Guide 
• CEBRE Digestive System Discussion Guide 
• CEBRE Head and Neck Discussion Guide 
• CEBRE Lung Cancer Discussion Guide
• CEBRE Prostate Cancer Discussion Guide​

Dr. Golden's team also translated the CEBRE guides into Spanish and is working with partners in Colombia to evaluate and optimize their use.

• CEBRE en Español Breast Cancer Discussion Guide
• CEBRE en Español Central Nervous System Discussion Guide 
• CEBRE en Español Digestive System Discussion Guide 
• CEBRE en Español Head and Neck Discussion Guide 
• CEBRE en Español Lung Cancer Discussion Guide
• CEBRE en Español Prostate Cancer Discussion Guide

Visit the CEBRE and the CEBRE en Español websites for more information about the innovative patient education series.

Publications 

• Spanish Adaptation and Evaluation of Clinical Discussion Guides: Communicating the External Beam Radiotherapy Experience (CEBRE) en Español was published online in the International Journal of Radiation Oncology•Biology•Physics on January 27, 2023. 

Presentations

• Evaluation of a Graphic Narrative Patient Education Tool to Reduce Pre-Treatment Anxiety for Patients Receiving Radiotherapy in a Latin American Hospital was presented at the 2024 ASTRO Annual Meeting. 
• Communicating the External Beam Radiotherapy Experience (CEBRE) Discussion Guides: Real World Implementation and Evaluation was presented at the 2023 ASTRO Annual Meeting.
• Prospective Pilot Study to Measure Baseline Anxiety Prior to Radiotherapy after Standard Education at Consultation was presented at the 2022 ASTRO Annual Meeting.
• Readability of a Radiotherapy Graphic Narrative Patient Education Guide Series in English and Spanish was presented at the 2021 Radiation Oncology Education Collaborative Study Group (ROECSG) Spring Symposium and the Medical Organization for Latino Advancement's 5th Annual Latino Health Symposium.