The Bare Essentials: Exploring Modesty Concerns to Enhance Radiation Therapy Practice and Patient Care

Modesty affects patient experience of health care and health outcomes. Radiation therapy often requires body exposure. Little is known about modesty and patient unease during radiation therapy across diverse populations and treatment sites. This study examined current practice and patient perceptions regarding modesty and associated unease during radiation therapy to the thorax and pelvis areas.

A 38-question survey was distributed to patients undergoing thoracic or pelvic radiation therapy across 4 centers. Item response theory analyzed the psychometric properties of unease. A structural equation model identified factors associated with unease. Summative content analysis of free-text responses was conducted.

A total of 312 participants responded: 76% were female, 69% received thoracic radiation therapy, 43% were foreign-born, and 65% spoke a language other than English. Ten percent of participants indicated they were never informed about the need to undress, and 26% received written information regarding the need to undress. This survey was reliable for patients with average or above levels of unease (item response theory theta values > -0.3). 67.5% of the variance of unease in the treatment room was explained by unease in the waiting room, gender of treating staff, and baseline levels of modesty unease (P < .001). Staff kindness and professionalism were connected to patient ease in the treatment room. Functionality of treatment garments and waiting spaces were also themes connected to patient ease (f = 41% and 46%, respectively).

Patient modesty can affect unease in radiation therapy waiting and treatment rooms. This is the first study to demonstrate this in both a multicultural population and across different anatomic treatment sites. Simply worded questionnaires can distinguish responders with higher than average unease. Personalisable treatment garment and waiting space options are recommended. Patient education materials can be improved by clearly outlining the requirement for patients to undress during treatment delivery.