Quality improvement in radiation therapy: translating printed patient education pamphlets to audiovisual digital resources

Abstract

Objective

Written pamphlets have traditionally been the mainstay of patient education in radiation oncology. This project assesses the efficacy of an illustrated (non-live-action), narrated animated video versus a printed pamphlet in supporting patients with breast cancer undergoing radiation therapy.

Materials and methods

A narrated animation video illustrating radiation therapy education was created. 40 patients recommended for adjuvant breast radiotherapy were recruited, presented with both the pamphlet and video, then surveyed. Cohorts were compared using Mann-Whitney U and Fisher's exact tests, and before-and-after emotional changes using McNemar's test.

Results

Most participants (95%, n = 38) rated the materials “very easy” to review. Comfort with the upcoming CT simulation had a median of 1 [IQR 1–2] in Cohort B versus 2 [IQR 1–2] in Cohort A (p = 0.52). Preparedness for managing skin reactions and confidence in retaining information were similar between cohorts (p = 0.82 and p = 0.36). Almost all found the length appropriate.

After reviewing both resources, 50% (n = 20) preferred the video alone, 18% (n = 7) preferred both, and 33% (n = 13) preferred the pamphlet alone; preference did not differ by viewing order (p = 0.41). Self-reported anxiety decreased significantly from before to after the consultation (30%, n = 12 to 5%, n = 2, p = 0.002), with non-significant increases in relief, calmness, and confidence.

Conclusion

The animated video may support patient comfort and confidence during radiation therapy for breast cancer. However, both pamphlets and videos appear useful for patient education, and combining them could optimize effectiveness.

Highlights

• •Animated video and paper pamphlet for breast radiotherapy were compared.
• •No significant difference between video and pamphlet on any outcome.
• •Patient preference was split between video, pamphlet, and both.
• •Anxiety fell significantly after reviewing the educational materials.
• •A dual-modality approach using both video and pamphlet is supported.

Introduction

Patient-centered care has long been fundamental to healthcare but has not always received the attention it warrants, with patients increasingly participating in decision-making and shaping their overall care experience [1], [2], [3]. A crucial element of this approach is patient education, which equips individuals with the knowledge and resources necessary to navigate their care journey [3]. Research consistently demonstrates that effective patient education can improve satisfaction with treatment, reduce anxiety, and support treatment compliance, particularly in cancer care settings [4], [5], [6], [7], [8]. Consequently, optimizing patient education materials is essential for healthcare institutions.

Patients with cancer often face complex decisions during emotionally challenging and uncertain times, making comprehensive and accessible education vital to their care. Patient education has traditionally relied on written pamphlets providing key information about treatments and procedures. However, while printed education materials have been widely evaluated in radiation oncology, their effectiveness is mixed; recent work highlights that many fall short on readability and health-literacy demands and may not meet the needs of all patients [9]. A recent rapid review likewise found that the format in which radiotherapy information is delivered influences patients' experience and satisfaction, underscoring the value of evaluating alternative educational formats [10]. Patients with lower literacy levels may struggle to comprehend written materials, while others may simply prefer learning through visual or auditory formats [11]. Additionally, certain concepts, such as treatment positioning in radiation therapy, may be more effectively communicated through visual aids. This underscores the need to explore alternative educational methods that cater to a diverse patient population.

Procedural anxiety is common during radiotherapy, particularly at the start of treatment, yet evidence for non-pharmacological strategies to address it remains limited [12]. Advancements in technology have paved the way for the integration of multimedia and audio-visual tools into patient education [8], [11], [13], [14], [15], [16]. A meta-analysis by Gysels and Higginson [11] evaluating video and interactive technologies for cancer patient education found these methods to offer slight but meaningful advantages over traditional formats. These benefits included increased knowledge, higher patient satisfaction, and reduced anxiety [11]. Video resources, in particular, present information in a consistent and comprehensive manner, which can be especially advantageous for patients with limited literacy or educational backgrounds [11].

A common concern regarding video-based education in radiation therapy is the assumption that older patients, who are often the primary demographic for cancer care, may be less comfortable with technology. However, recent trends show a growing adoption of digital tools among older adults, including those undergoing cancer treatment [17] Studies also indicate that video-based education enhances satisfaction and engagement, even in older populations [14]. Notably, Almerdhemah et al. [18] found that older patients and those with poorer reading ability derived greater benefit from video education, suggesting digital formats may aid rather than disadvantage these groups. This highlights the relevance and potential impact of digital resources in improving patient education for patients with cancer.

Several studies have found that educational videos for patients undergoing breast radiotherapy improve understanding, preparedness, and comfort while reducing anxiety, with the greatest benefit among patients with lower literacy [18], [19], [20], [21]. This pilot study evaluates whether an animated educational video adds value alongside the established printed pamphlet for patients with breast cancer beginning radiotherapy. Specifically, we compare the two formats on ease of review, comfort with the upcoming CT simulation and treatment, preparedness for managing skin reactions, confidence in retaining information, emotional state including anxiety, and patient preference, and ask whether a combined written and video approach is warranted.

Materials and methods

Video and pamphlet education tools

The educational materials were developed through a consultative process involving radiation therapy educators, radiation therapy navigators, a patient partner, and the study's radiation oncologists. The paper pamphlet was adapted from the breast radiotherapy patient-education pamphlet in routine clinical use at our center and was revised iteratively by incorporating patient-partner feedback and clinician review, to improve its comprehensiveness and patient-centeredness in line with current clinical guidelines. The updated pamphlet content was then adapted into an animated educational video with a voiceover narrative, mirroring the pamphlet content to maintain consistency across modalities (Appendix A), and was reviewed by the study's radiation oncologists prior to use.

The video is an illustrated (non-live-action) animation with voiceover narration, running approximately four minutes. It covers the rationale for radiotherapy, the CT simulation appointment, treatment logistics and the daily treatment experience, and the management of skin reactions and other side effects, mirroring the pamphlet content exactly so that format, not content, differed between arms. It was viewed on a tablet on site during the consultation, and participants were given a link to re-watch it at home. Breast cancer was chosen for practical reasons and to limit the scope of this study. The video used in this study can be made available from the authors upon request, and the framework developed may be expanded to encompass educational resources for additional cancer types in future iterations.

Study population

Consecutive eligible patients were approached at their initial radiation oncology consultation. Forty adults aged 18 years and older scheduled to receive adjuvant radiation therapy for breast cancer were enrolled. Exclusion criteria included patients who did not require radiation treatment for breast cancer and those who did not speak English fluently. Disease stage and health literacy were not recorded in this pilot.

Evaluation survey tool

The surveys were developed by the research team (including two radiation oncologists, one radiation therapy educator, one medical student, and one patient partner) to evaluate endpoints relevant to this study, including demographic information, how patients viewed the two resources, patient emotions in relation to the educational resources, and patient preferences. No validated instrument existed for evaluating these specific materials in this context. Where possible, a Likert scale format was used to ease survey administration, and the surveys were administered on paper. Emotional state was captured within Survey 2 as a retrospective self-report, with participants indicating the emotions they experienced both before and after reviewing the educational materials; no separate pre-encounter baseline was collected.

Study recruitment and process

To evaluate the efficacy of the animated video, a pilot study was conducted following ethics approval. Participants were enrolled sequentially into two cohorts by order of enrolment (non-randomised allocation); the sample was not stratified by any patient characteristic. The target of 20 participants per cohort (40 in total) was a pragmatic pilot sample to assess feasibility and generate preliminary estimates rather than a formally powered target. All materials and both surveys were administered within the single initial radiation oncology consultation visit, delivered by a radiation therapy educator. Participants were assigned to one of two cohorts:

• ●Cohort A (n = 20): Participants initially reviewed the traditional paper pamphlet and completed Survey #1 (See Appendix B). They subsequently viewed the animated video and completed Survey #2 (See Appendix C).
• ●Cohort B (n = 20): Participants initially viewed the animated video and completed Survey #1, followed by a review of the paper pamphlet and completion of Survey #2.

To facilitate comparative analysis, Survey #1 responses from Cohort A (post-pamphlet) were compared with those from Cohort B (post-video). Survey #2 responses captured participants' overall impressions and preferences following exposure to both educational modalities.

Data analysis

Categorical variables are summarized as frequencies and percentages, and ordinal Likert responses as medians with interquartile ranges. Because Survey 1 was completed after the first material only, between-cohort comparisons of Survey 1 items (Cohort A = pamphlet, Cohort B = video) were tested with the Mann–Whitney U test. Categorical comparisons between cohorts, including modality preference, used Fisher's exact test, chosen over the chi-squared test given the small expected cell counts. Within-participant changes in reported emotions before versus after reviewing the materials were tested with the exact McNemar's test. A supplementary comparison of Survey 1 outcomes and modality preference between patients aged <65 and ≥ 65 years used the same tests. Two-sided p < 0.05 was considered significant, and analyses were performed in R version 4.5.2. Reporting followed the CONSORT extension for randomised pilot and feasibility trials where applicable, recognising that allocation here was sequential rather than randomised.

Results

Forty patients participated (20 per cohort; allocation detailed in Methods). Results are presented in Table 1, Table 2, Table 3.

Table 1.

Comparison of Educational Methods: Survey 1 Results for Cohort A and B.

		Cohort A (N = 20)		Cohort B (N = 20)
		Frequency	%	Frequency	%	p
Age Range	<65 years	11	55	9	45
	>65 years	9	45	11	55
How easy is it to review this material	1 (very easy)	19	95	19	95	1.00
	2 (somewhat easy)	1	5	1	5
	3 (neutral)	0	0	0	0
	4 (somewhat hard)	0	0	0	0
	5 (very hard)	0	0	0	0
		Median 1 [IQR 1–1]		Median 1 [IQR 1–1]
How comfortable are you with the upcoming CT simulation scan and treatment	1 (very comfortable)	8	40	12	60	0.52
	2 (somewhat comfortable)	10	50	4	20
	3 (neutral)	2	10	2	10
	4 (somewhat uncomfortable)	0	0	2	10
	5 (very uncomfortable)	0	0	0	0
		Median 2 [IQR 1–2]		Median 1 [IQR 1–2]
How prepared do you feel about managing the potential skin reaction	1 (very prepared)	8	40	9	45	0.82
	2 (somewhat prepared)	11	55	7	35
	3 (neutral)	0	0	2	10
	4 (somewhat unprepared)	1	5	1	5
	5 (very unprepared)	0	0	1	5
		Median 2 [IQR 1–2]		Median 2 [IQR 1–3]
How confident are you that you will remember the information provided here	1 (very confident)	5	25	9	45	0.36
	2 (somewhat confident)	14	70	9	45
	3 (neutral)	1	5	1	5
	4 (somewhat unsure)	0	0	0	0
	5 (very unsure)	0	0	1	5
		Median 2 [IQR 1–2]		Median 2 [IQR 1–2]
What do you think about the length and amount of information provided here	1 (prefer shorter and briefer)	0	0	0	0	0.34
	2 (just right)	19	95	20	100
	3 (prefer longer and more details)	1	5	0	0

Survey 1 was completed after the first material only (Cohort A = pamphlet, Cohort B = video). Between-cohort comparison: Mann–Whitney U; age band: Fisher's exact.

Table 2.

Patient Preference of Educational Methods: Survey 2 Results for Cohort A and B.

		Cohort A (N = 20)		Cohort B (N = 20)
		Frequency	%	Frequency	%	p
Have you searched the internet about breast radiation side effects before coming here	1 (Yes)	10	50	11	55	1.00
	2 (No)	10	50	9	45
What emotions were you experiencing prior to viewing the education material	Nervous	5	25	4	20
	Anxious	6	30	6	30
	Confused	0	0	1	5
	Fearful	0	0	0	0
	Neutral	5	25	4	20
	Relieved	2	10	1	5
	Calm	6	30	8	40
	Confident	5	25	2	10
	Other⁎	2	10	3	15
What emotions were you experiencing after viewing the education material	Nervous	1	5	2	10
	Anxious	1	5	1	5
	Confused	0	0	0	0
	Fearful	0	0	0	0
	Neutral	6	30	5	25
	Relieved	6	30	4	20
	Calm	9	45	9	45
	Confident	5	25	4	20
	Other⁎⁎	1	5	0	0
Which education material do you prefer	1 (Paper pamphlet)	8	40	5	25	0.41
	2 (Video and video link)	10	50	10	50
	Both⁎⁎⁎	2	10	5	25

^⁎Prior ‘Other’: curious (2, Cohort A), sad (1, B), scared (1, B), unknown (1, B).

^⁎⁎After ‘Other’: entertained (1, Cohort A).

^⁎⁎⁎‘Both’ was not a printed survey option; written in by participants.

Table 3.

Change in reported emotions before vs. after reviewing the education materials (N = 40).

	Before		After
Emotion	Frequency	%	Frequency	%	p
Anxious	12	30	5		0.002
Nervous	9	23	3	8	0.070
Relieved	3	8	10	25	0.065
Calm	14	35	18	45	0.22
Confidence	7	18	9	23	0.63
Neutral	9	23	11	28	0.73
Confused	1	3	0	0	1.00
Fearful	0	0	0	0

Demographic characteristics

Half of participants were younger than 65 and half were 65 or older, with balanced distribution between cohorts (Cohort A: 55% (n = 11) <65; p = 0.75; Table 1).

Comparison of educational methods

Nearly all participants described the materials as “very easy” to review (95%, n = 38; median 1 [IQR 1–1]; p = 1.00; Table 1).

Comfort with the upcoming CT simulation and treatment was similar between formats (median 2 [IQR 1–2] after the pamphlet vs. 1 [IQR 1–2] after the video; p = 0.52; Table 1).

Preparedness for managing skin reactions did not differ between formats (median 2 [IQR 1–2] for both; p = 0.82; Table 1).

Confidence in retaining the information was likewise comparable between formats (median 2 [IQR 1–2] for both; p = 0.36; Table 1).

Nearly all participants agreed the length of the educational materials was appropriate (Cohort A: 95%, n = 19; Cohort B: 100%, n = 20); one participant in Cohort A preferred more detail (p = 0.34).

In a supplementary comparison by age, patients aged <65 and ≥ 65 years did not differ on any Survey 1 outcome (all p ≥ 0.34) or on modality preference (video alone preferred by 10 of 20 in each group; p = 1.00; Supplementary Table S1). Self-reported anxiety declined in both age bands, from 5 to 2 in younger patients (exact McNemar p = 0.25) and from 7 to 0 in older patients (p = 0.02). Rather than being disadvantaged by the animated format, older patients rated it as usable as younger patients did and showed a clear reduction in reported anxiety.

Patient preference of educational methods

Patient preferences for educational modalities were evaluated following their review of both resources, with findings delineated by cohort in Table 2. Combined results across both cohorts are reported in the text below.

About half of participants in each cohort reported searching the internet about breast radiation side effects beforehand (Cohort A 50%, Cohort B 55%; p = 1.00; Table 2).

Before reviewing the materials, patients in both cohorts reported a mix of positive and negative emotions, most commonly anxiety and calmness; afterward, reports shifted toward more positive states, with relief and calmness most frequent and fewer reports of anxiety and nervousness (Table 2; write-in responses are footnoted).

Modality preference did not differ by viewing order (Table 2; p = 0.41).

p-values (Fisher's exact) shown for categorical items. Survey 2 followed BOTH materials, so cohort differences reflect order of exposure, not modality. Before-vs-after change in emotions is tested in Table 3.

A total of 52% of participants indicated that they had searched the internet for information regarding breast radiation side effects prior to their initial consultation, while 48% reported not engaging in such searches.

When asked about their preferred educational modality, 50% (n = 20) favored the video alone, 18% (n = 7) preferred both the video and paper pamphlet, and 33% (n = 13) preferred the paper pamphlet alone. Emotions before and after were both recorded retrospectively in Survey 2, after participants had reviewed both materials and completed the consultation. Pooled across cohorts, anxiety decreased significantly (30% to 5%; n = 12 to 2; exact McNemar p = 0.002), consistent in both cohorts (6 → 1 each); positive emotions rose without reaching significance. Because this before/after report was retrospective and had no pre-encounter baseline or control group, it reflects improvement in emotional state over the consultation rather than an effect attributable to the materials specifically.

Discussion

Existing literature evaluating the role of video resources in radiation oncology patient education consistently reports positive outcomes, including high levels of patient satisfaction [4], [14]. The findings of our study align with these results, as participants indicated that the animated video provided was easy to understand and of appropriate length. Participants reported comfort regarding their upcoming treatment, with no statistically significant difference between the video and pamphlet on any rated outcome (all p ≥ 0.52).

Prior research highlights that educational technologies, compared to traditional methods, are associated with enhanced knowledge acquisition [11], [13], [19]. Our findings report similar levels of confidence in retaining information in both the video and paper pamphlet groups. Rather than testing patients' knowledge during an already stressful period, future work could assess radiation therapists' perceptions of patient preparedness at simulation and during treatment, and whether educational format supports patient coping across the treatment trajectory rather than only at the point of consultation.

A key focus of this study was the emotional impact of educational resources. Literature suggests that video and interactive technologies can alleviate anxiety and fear among patients with cancer [8], [11], [19], [22]. Consistent with these findings, our study observed a statistically significant reduction in anxiety (p = 0.002) following engagement with the educational materials, with a similar non-significant trend for nervousness. This is consistent with Almerdhemah et al. [18] and Moussa et al. [21], who reported reduced anxiety following video-based radiotherapy education; however, as Forbes et al. [12] note in their systematic review, the evidence base for education in reducing procedural anxiety remains limited and mixed, warranting cautious interpretation. This was accompanied by an increase in positive emotional states, including relief, calmness, and confidence, underscoring the potential psychological benefits of patient education tools.

Other studies had previously assessed the use of patient education videos for patients with breast cancer undergoing radiation therapy [19], [20].

The longstanding debate regarding the relative efficacy of paper-based versus video-based educational materials in radiation therapy lacks a definitive resolution. For instance, a recent study by Lee et al. suggests no statistically significant differences in the effectiveness of different educational modalities in reducing patients' anxiety, including video, paper, or chatbot [23]. Similarly, Almerdhemah et al. [18] concluded that the benefit of educational materials may be independent of the specific media used, consistent with our finding that patient preference was genuinely split, with half of patients preferring the video, a third the pamphlet, and the remainder both, indicating a clear role for both formats rather than the superiority of either. Numerous studies emphasise the value of both modalities, suggesting that each serves a distinct yet complementary role in enhancing patient understanding. Research on educational aids indicates that audiovisual resources can sustain attention, while written materials reinforce learning and serve as reference points [24], [25].

In our study population, participants had diverse preferences, consistent with Moussa et al. [21], whose participants valued the video as a complement to rather than a replacement for existing materials. Alongside those who favored the video alone, a substantial group preferred the pamphlet alone or both formats, indicating that printed materials remain a relevant and effective tool. As McPherson et al. [16] note, patients with cancer are a heterogeneous population with diverse learning needs: videos offer an engaging audiovisual experience that can be revisited at home, while paper materials provide a tangible reference. Offering patients the choice of either or both may best accommodate individual preferences and optimize the educational experience.

Limitations

This study has several limitations. As a small pilot, it was not powered to exclude clinically meaningful differences; non-significant results indicate no difference detected rather than proven equivalence. Emotions were reported retrospectively within a single survey rather than measured at a true pre-encounter baseline, introducing recall bias, and the consultation and interaction with the radiation therapy educator occurred alongside the materials and may have contributed to the observed emotional change. The surveys were non-validated instruments developed for this study, and disease stage and health literacy were not recorded. As Forbes et al. [12] highlight, studies that do not screen for elevated baseline anxiety may underestimate intervention effects; the absence of a control group and baseline anxiety screening similarly limits causal interpretation of the observed emotional changes. As a single-centre study relying on survey data, confounding variables or subtle nuances may not have been fully captured. Nonetheless, this research provides valuable preliminary insights into the potential benefits of audiovisual educational resources.

Future directions

This pilot supports a definitive study. Because allocation here was sequential and the sample small, a future trial should randomise patients and recruit across multiple sites; to detect a moderate between-format effect (Cohen's d ≈ 0.5) at 80% power and two-sided α = 0.05 would require roughly 64 patients per arm (about 128 in total). Two questions merit particular attention. First, whether animation specifically, versus live-action or other video formats, confers benefit was not tested here and could be isolated in a head-to-head comparison using established frameworks for evaluating the components of digital educational resources. Second, whether educational format supports patient coping beyond the consultation, assessed with validated instruments and, ideally, a baseline emotional measure or no-education control.

Conclusion

This study aimed to evaluate the effectiveness of animated educational videos in comparison to traditional paper pamphlets for patients with breast cancer undergoing radiation therapy. By administering two surveys, we were able to assess the relative impact of each modality and gain insight into patient preferences regarding educational materials.

The findings suggest that the educational resources used in this project may support patient comfort and confidence in preparing for radiation therapy, and that both paper pamphlets and animation videos contribute positively to patient education, particularly by significantly reducing anxiety, with trends toward greater relief and calmness. Based on these outcomes, a dual-modality approach incorporating both video and pamphlet resources appears to offer the most comprehensive and effective educational experience for patients.

The insights derived from this study will inform ongoing refinement of patient education materials and provide valuable feedback for future quality improvement initiatives. By integrating evidence-based educational tools that align with patient preferences and effectively convey critical information, this project has the potential to transform patient education.

CRediT authorship contribution statement

Iris Guo: Writing – original draft, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Sandra Wong: Writing – review & editing, Writing – original draft, Validation, Software, Resources, Methodology, Formal analysis, Data curation. Julia Campbell: Project administration, Methodology. Angela Lin: Validation, Supervision. Siavash Atrchian: Validation, Supervision.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A. Breast Radiation Therapy Information (Pamphlet and Video)

You are starting your radiation treatment soon and you probably have some questions. Let's review some of them in this video.

Your breast tumour has been removed by surgery. Radiation therapy is a very effective treatment to kill any potential cancer cells that may remain in the breast and prevent cancer recurrences. It works by directing high-energy radiation beam to the treated area. Your radiation can vary from one week to a few weeks.

To start the radiation planning process, you will first have a planning scan, which is called a CT simulation scan. This is done to measure and map out the area needing treatment. The radiation therapist will put marks on your skin with a pen for accurate alignment during treatment. Usually, you will have small tattoos done because the pen marks will wash off.

The time between your scan and first treatment day will vary, typically 2–3 weeks. This allows your treatment team to plan your treatment that is tailored to your case and anatomy. Treatment usually takes about 15 to 30 min, but the machine is only on for a few minutes. Plan to be at the center for about an hour each time. During the treatment, the radiation therapists will not be in the room with you. But they will be watching you closely on a video camera. There is an intercom so you can talk with them at all times. You won't feel anything while the machine is turned on, but you may hear a beeping noise. The radiation therapists can interrupt the treatment if you need help. You will be scheduled a “review appointment” once a week during treatment. On these days, you will see a nurse and a doctor, so plan to be at the cancer centre a little longer. If you need extra support, please talk to your radiation therapists who can help you right away. You will receive treatments on weekdays. We are not open on weekends or holidays. Your appointment times may vary, but it is important you do not miss any appointments.

Normal tissues in the treatment area will get affected by radiation. Reaction in the normal tissues may cause side effects. Some people have fatigue, which is a feeling of extreme tiredness. You may want to rest and sleep more than usual and adjust your routine according to your energy level. Skin reaction in the breast is possible. The skin in the treated area may become warm, dry or itchy. It may become pink, red, darker or tanned looking. The timing of skin reaction can be different for each person. Some patients do not have a skin reaction until after their treatment is finished. Skin reaction usually goes away in a few weeks. You will want to keep your skin moisturized to prevent dryness. Once you start your radiation treatment, use water-based moisturizer multiple times a day. You can wear loose, comfortable clothing, bra or no bra depending on how you feel. It is okay to swim as long as your skin is not broken or irritated. It is best to shower right away after swimming to wash off the chlorine. You should avoid extreme hot or cold (e.g. Heating pads, saunas, hot tubs, or ice packs). Do not rub, scratch or massage the treated skin.

Hope you found this video helpful. Please stay connected with your healthcare team.

Appendix B. Survey 1

What is your age range?

<65 years of age ≥ 65 years of age.

How easy is it to review this material?

1 (very easy) 2 (somewhat easy) 3 (neutral) 4 (somewhat hard) 5 (very hard)

How comfortable are you with the upcoming CT simulation scan and treatment?

1 (very comfortable) 2 (somewhat comfortable) 3 (neutral) 4 (somewhat uncomfortable) 5 (very uncomfortable)

How prepared do you feel about managing the potential skin reaction?

1 (very prepared) 2 (somewhat prepared) 3 (neutral) 4 (somewhat unprepared) 5 (very unprepared)

How confident are you that you will remember the information provided here?

1 (very confident) 2 (somewhat confident) 3 (neutral) 4 (somewhat unsure) 5 (very unsure)

What do you think about the length and amount of information provided here?

1 (prefer shorter and briefer) 2 (just right) 3 (prefer longer and more details)

Appendix C. Survey 2

Have you searched the internet about breast radiation side effects before coming here?

1 Yes 2 No

What emotions were you experiencing prior to viewing the education material?

Nervous Anxious Confused Fearful Neutral Relieved Calm Confident.

Other_______________.

What emotions were you experiencing after viewing the education material?

Nervous Anxious Confused Fearful Neutral Relieved Calm Confident.

Other_______________.

If you can choose, which education material do you prefer? You can take the paper pamphlet home, and you will be given a video link to watch at home.

1 Paper pamphlet 2 Video and video link

Appendix D. Supplementary data

Supplementary material