Table 3.

Summary of included studies

Author and year	Type	Target cancer diagnosis	Category	No. of patients	No. of RTs	RT training	Results
Halkett et al.19 (2013)	RCT	Breast	PIE	122	10	2 mandatory workshops: (1) Preparing patients for radiation therapy (2) Eliciting and responding to emotional cues	At pre‐planning time point, significant results for intervention versus control: anxiety reduced by 0.15 points, knowledge (planning) increased by 3.5 points, knowledge (treatment) increased by 5.3 points, radiation therapy‐related concerns reduced by 0.9 points.
Dong et al.15 (2014)	Cross‐sectional	Mixed	PIE	56	10	N/A	RTs scored high on ‘MPCC information’ (explaining radiation therapy procedures, skin care, side effects) RTs scored low on ‘MPCC feelings’ (inquiring about patient feelings/fears/anxieties, understanding of radiation therapy) Post‐consultation decrease in STAI scores (range): baseline 10.98 (6–24), post‐consultation 9.6 (6–17)
Braeken et al.20 (2011)	RCT	Mixed	SNA	568	7	1‐h session – use and interpretation of SIPP conducted by the researcher and 2 social workers	SIPP feasible and valued by most patients and some RTs Patient perspectives: 67.5% agreed discussing SIPP with RTs was important; 47.4% rated discussions as pleasant; usefulness of discussing physical, psychosocial and sexual issues with RTs were 56%, 39.3% and 9.3% respectively. RT 7‐month versus 13‐month FU SIPP usefulness for ‘quality of consult’ – 33.3%, 16.7% and 50.1% versus 66.7%, 0%, 33.3% negative, moderate and positive respectively RTs were negative towards changing communication styles, SIPP usefulness in referring patients to psychosocial care and feasibility of discussing psychosocial issues RTs reported increased patient communication and knowledge of patient issues through screening processes RT motivation positively correlated with ‘usefulness’ of screening processes
Clover et al.4 (2011) and Oultram et al.12 (2012)	Cohort	Head & neck or Brain	SNA	105	35	N/A	At CT‐Sim: RTs identified 27% of patient self‐reported cases of anxiety and 90% of non‐anxious cases, provided verbal reassurance alone to three patients and three patients had their mask removed At Fraction 1: RTs identified 50% of patient self‐reported cases of anxiety and 57% of non‐anxious cases; provided verbal reassurance alone to three patients, three patients had their mask removed (one refused further treatment), one patient received verbal reassurance and mask removal (two of these patients were unable to complete treatment that day). Authors concluded that patients may have under‐rated anxiety, while RTs may have over‐rated anxiety
Halkett et al.17 (2012)	Pre–post feasibility	Breast	PIE	13	4	2 mandatory workshops: (1) Preparing patients for radiotherapy (2) Eliciting and responding to emotional cues	HADS scores decreased from baseline to T1 and T2: Baseline mean = 13.6 (SD = 8.03, range = 2–22); T1 mean = 6.4 (SD = 4.9, range = 2–19); T2 mean = 7.0 (SD = 7.5, range = 0–20) Mean scores for ‘concerns about radiotherapy’ dropped from baseline T1, mean = 4.4 (SD = 2.45), to T2 (post‐planning intervention), mean = 2.50 (SD = 1.64) respectively ‘Knowledge of radiotherapy’ scores increased from T1 to T2 and T3 Patients reported the intervention was beneficial in preparing for treatment RTs were positive about delivering intervention and the perceived benefit to patients The intervention was feasible and acceptable Time, staffing and space were identified as barriers in delivering intervention. Time and staffing issues were remedied
Mitchell and Symonds21 (2012)	Cohort	Mixed	SNA	379	30	Optional 1‐h session in use of screening tool. Communications training also available. Less than 25% of clinicians attended	RTs report screening ‘useful’, ‘not useful’ or ‘unsure’ in 43%, 21.5% and 35.4% of assessments respectively Significant positive correlation between RTs rating screening as ‘useful’ and rating any of the following: the ‘screening tool as practical’, the ‘RT having low confidence’ or ‘assessing a patient with high anxiety’ Favourable perception of screening was significantly correlated with both completion of screening tool training and improved detection of psychological issues RTs reported increased patient communication and knowledge of patient psychological issues using screening
Canil et al.16 (2012)	Cross‐sectional	Mixed	PIE	24	N/A	N/A	Anxiety STAI‐S pre‐ and post‐test median scores were 2.00 and 1.46 respectively (P < 0.001). No change = 1 patient, increased anxiety = 3 patients Self‐efficacy CBI‐B pre‐ and post‐test median scores were 6.96 and 7.82 respectively (P < 0.001). No change = 3 patients 16 of 23 attendees reported reduced concerns Many reported reduced feelings of isolation
Miller18 (2008)	Cross‐sectional	Mixed	PIE	50	N/A	N/A	Post‐intervention, patients reported: feeling more confident and less anxious about treatment; meeting other patients helped decrease feelings of isolation; reassurance was gained through staff openness and friendliness Components rated most valuable were demonstration of the treatment machine 66% and informal one‐on‐one chat 34% with RT staff
Halkett and Kristjanson3 (2007)	Qualitative interview	Breast	PP	34	N/A	N/A	Patients perceive RTs as not only technical professionals but also information and supportive care givers Main theme: the importance of the patient achieving emotional comfort Emotional comfort is achieved by forming relationships with RTs and gaining information. Achieving emotional comfort can decrease anxiety and enables the patient to feel more relaxed, a sense of belonging and confident in the treatment and RTs skills Developing a relationship with the same RTs daily was perceived to reduce anxiety, improve continuity of information and treatment accuracy
Egestad13, 14 (2013)	Qualitative interview	Head & neck	PP	12	N/A	N/A	Main themes: emotional vulnerability, need to be treated as a unique person Sub‐themes: to be understood, emotional support, to feel safe, to form relationships, politeness and communication Patients valued effective communication, being treated as an individual, care/empathy and acknowledgement RTs who initiated relationships, spent time with patients and provided information helped decrease patient vulnerability, anxiety and loneliness Familiar RTs who provide information and build a relationship with the patient can reduce patients’ loneliness, existential anxiety and uncertainty Perceived RT incompetence can increase patient insecurities and anxiety

N/A, not applicable; NK, not known; SNA, screening and needs assessment; PIE, patient information/education; PP, patient perspectives; MPCC, measure of patient centre communication; STAI, State‐Trait Anxiety Inventory; ASR, authentic self‐representation; SIPP, Screening Inventory of Psychosocial Problems; FU, follow‐up; CT‐Sim, computed tomography simulation.