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CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
,,
CANCER AND THE CLERGY:
A CURRICULUM GUIDE
A project submitted in partial satisfaction of
the requirements for the degree of Master of
Public Health
by
Linda Arbiter
.../
Jun.e, 1979
'
Copyright
Linda Arbiter
1979
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The project of Linda Arbiter is approved:
California State University, Northridge
ii
___________________,
ACKNOWLEDGHENTS
The author wishes to express appreciation to the
members of her project committee:
Dr. John T. Fodor,
Dr. Michael V. Kline, and Dr. Waleed Alkhateeb.
The
guidance and perceptive suggestions given were invaluable in the organization, selection of content, and
preparation of this manuscript.
A word of dedication is included to my husband,
Ross, and to all o.f my friends who gave encouragement
and support in the development of all phases of the
program.
Special appreciation is acknowledged of Dr.
Krishnamurty for helping me to realize and appreciate
my own potential.
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TABLE OF CONTENTS
Page
i ACKNOHLEDGr-1ENTS
.
. .
.....
iii
vii
ABSTRACT
·Chapter
1.
INTRODUCTION
e
•
•
•
•
•
.•
•
•
1
•
Statement of the Problem.
2
Purpose of the Study . . •
~
.
..
2
Limitations of the Study.
Definition of Terms • .
.
3
•
.
..
3
Curriculum development.
3
Curriculum
•
Instructional
•
4
4P
.. ...
objectives. .
. ... .
.
Concepts
....
~
~
~
Evaluative criteria • .
.
..
....
~
.
JUSTIFICATION .
.
•
•
What is Cancer? . .
7
~
-·
~
-. . .
~
.
. .
. .. .
Psychological Needs of Cancer Patients.
Involvement of the Clergy • • .
.. • .
Cancer Education Programs for Clergy.
3.
METHODOLOGIES .
.
.
• .
• •
.. ..
Developing Points of View .
.
9
10
.
11
• •
12
12
15
15
ORGANIZING THE CURRICULUM GUIDE
iv
6
6
Learning opportunities.
2.
5
.
.
16
:chapter
Page
Planning committee
16
17
Selecting Content
Identification of content areas.
18
Delphi process
19
Structuring Knowledge . .
21
Collecting data.
21
Grouping data
21
Identifying health concepts . . .
22
Formulating Objectives .
.
.
. .
23
Developing Learning Opportunities.
.
24
Organizing Instruction .
.
24
Principles related to the learner.
25
Principles related to the organization of subject matter . . . . . . .
25
• .
. .
.
Developing Criteria for Teacher
Preparation . . . . . • . .
PRETESTING THE CURRICULUM GUIDE.
26
.
.
.
General Considerations
Target population
26
27
. .
.
27
Administrative support
27
Teaching staff
28
Budget .
28
Teaching environment
28
Equipment and materials.
28
Inservice Education
29
Evaluation .
30
.
.
v
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Page
\Chapter
34
Revision and Updating
4.
36
THE; CURRICULUM GUIDE
..
i
CONCEPT 1 .
5.
36
CONCEPT 2 .
36
CONCEPT 3 •
36
CONCEPT 4 .
37
CONCEPT 5 •
38
63
SUMMARY .
Methodologies •
64
Evaluation.
65
67
REFERENCES
APPENDIXES
A.
Pre-Program Questionnaire
B.
Cancer and the Clergy:
Evaluation
~
72
•.
A Curriculum Guide
•
vi
87
I
ABSTRACT
CANCER AND THE CLERGY:
A CURRICULUM GUIDE
by
Linda Arbiter
Master of Public Health
Cancer is a disease process; but it causes more
than physical damage.
Standard cancer therapy usually
results in the destruction of the patient's self-image.
For this reason, guidelines for cancer management must
incorporate more than medicine, surgery, and radiation
therapy.
A separate component of psychosocial support
,must be included in the treatment regimen for all cancer
'patients.
I
The purpose of this study was to develop a curriculum guide for a cancer education program whose target audience was members of the clergy.
Identification
of the lack of psychological care for the cancer patient
as a health problem along with the fact that there are
few health professionals trained in this area provided
'the impetus to develop this curriculum guide.
This
guide was used as a model for the development of cancer
education programs which acquaint members of the clergy
vii
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with the various. problems encountered by the cancer
patient and family members.
A curriculum has been defined as a package of
planned learning experiences developed to influence
knowledge, attitudes, and behavior.
Planning a curricu-
lum involves identifying and arranging these learning
experiences so that effective learning takes place.
The eight-step rationale developed by Fodor and Dalis
served as the rationale for the development of this
cancer education curriculum guide for members of the
clergy.
1 ..
Developing points of view
2.
Selecting content
3.
Structuring knowledge
4.
Formulating goals and objectives
5.
Developing learning opportunities
6.
Organizing instruction
7.
Developing evaluative criteria
8.
Developing criteria. for teacher preparation
A primary concern of this project was the
development of a curriculum guide which when implemented would meet the educati.onal needs of the specified
target population.
The curriculum guide was pretested
, on a group of fifteen ecuminical clergypersons, in
addi.tion to the adv·isory conun.ittee, foi;" their review
and eva.luation.
Each of the evaluators reviewed the
viii
curriculum and provided feedback in the areas of:
1.
Concepts
2.
Content
3.
Objectives
4.
Learning opportunities
The feedback provided by this evaluation committee was used to revise the curriculum guide into its
present version.
ix
Chapter 1
INTRODUCTION
Cancer is a disease process, but it causes more
than physical damage.
Standard cancer therapy usually
results in the destruction of a patient's self-image.
For this reason, guidelines for cancer management must
encompass more than medicine, surgery, and radiation
therapy.
A separate component of psychosocial support
must be included in the treatment regimen for all cancer
patients.
Many influential agencies such as the National
Cancer Institute (NCI) and the American Cancer Society
have recognized this need..
During the last decade, the
'NCI has placed greater emphasis on the development of
training programs which are aimed at familiarizing members
of support groups with the specialized needs and problems
o~
cancer patients and their families,
Training programs
have been developed at the various Comprehensive Cancer
'Centers throughout the United States.
Special courses
~ocusing
on the psychosocial needs
of cancer patients have been incorporated into the training curriculum in schools of social work, nursing,
'physical therapy, and even m.edicine.
1
One group of helping
2
:professionals has been overlooked.
This is the group of
hospital chaplains and community clergypersons.
Members of the clergy have an unusual educational
and experiential background which enables them to help
all people who are going through difficult times, and
especially, those persons diagnosed with cancer.
Unfor-
tunately, these clergy, like many health professionals,
shy away from deep relationships with those who are
struggling for survival against cancer.
reasons for this:
There are several
the clergy are afraid of cancer as a
disease process; they have not faced their own feelings
about cancer and/6r death, and they do not have the
psychosocial skills to effectively counsel the cancer
patient.
This is particularly true when the clergy have
insufficient knowledge of the disease process, the current
1
modes of treatment, and the emotional needs of cancer
• patients.
Statement of the Problem
t..fembers of the clergy have indicated a desire to
, learn more about cancer so as to improve their a.bili ties
to counsel parishioners afflicted with this disease.
At
the time of this writing, no such program exists.
Purpose of the Study
This study was designed to develop a curriculum
guide which could be used as a mpdel :f;or the development
3
of similar cancer education programs for clergypersons
in other cancer research institutions.
Correspondence with the other twenty ComprehenI
sive Cancer Centers and the American Cancer Society
revealed that no individual agency or institution had
developed a formal curriculum guide for cancer education programs which were targeted for members of the
clergy.
However, each of the surveyed agencies indicated
they would be interested in conducting cancer education
programs for clergypersons if some type of guide was
made available.
Limitations of the Study
Because of time constraints, this curriculum guide
was reviewed only once by a panel of clergypersons before
its implementation.
It was intended that the curriculum
guide be field tested two or three times and revised as
needed over a period of two years.
At that time, an
intensive review of the program's evaluations would be
used to revise the curriculum guide into a final
format~
·The revised and updated curriculum guide would then be
distributed to the National Clearinghouse for Cancer
Education Programs.
Definition of Terms
Curriculum development.
Curriculum development
refers to the planning of learning opportunities to effect
4
specific knowledge and behavior changes in students and
the assessment of the extent to which these changes have
taken place (12:14).
Curriculum development is that aspect of teaching
and administration that systematically and continuously
seeks to improve the teaching-learning process (25:9).
It is often asserted that curriculum development
is a continuous process.
The basic concept of curriculum
development implies that there is no one starting point
and that it is a never ending process.
The following significant aspects of curriculum
development have been identified and utilized in the
development of this curriculum guide:
1.
Determination of educational directions.
2.
Choice of experiences comprising the instruc-
tional programs.
3.
Selection of a pattern of curriculum organ-
4.
Determination of principles and procedures
ization.
by which changes in the curriculum can be made, evaluated,
and sustained (13:vii).
Curriculum . . The learning environment is made up
:of persons, resources, and activities which are organized
·to promote intellectual development and desired behavioral
changes within the learner.
A curriculum guide is one
5
means of organizing the learning environment to reach the
desired outcome (11).
A c:urriculum is a means of instruction used by
institutioris to provide opportunities for student learning
·experiences which lead to desired learning outcomes (7:3).
Lavatelli, Moore, and Kaltsounes defined curriculum as a set of learning experiences for students planned
by an institution to attain the aims of education (9:1-2).
The following definition served as the basis for
the development of this curriculum guide:
the total
teaching-learning activities or experiences, organized in
an orderly manner in order to attain desired educational
goals and objectives.
Concepts.
This cancer education program was
designed specifically for members of the clergy.
It con-
sists of three separate modules which together provide an
· indepth understanding of the biological nature of cancer
and the related psychosocial problems which may develop.
Knowledge is not merely an accumulation of
;unrelated information.
By knowing a field of knowledge,
it is possible to interrelate the information and bring
order to it by placing it within idea systems.
system is a concept.
Each idea
A conceptual approach to curriculum
development implies the use of concepts as a means of
indicating the grouping of relationships of basic ideas
drawn from knowledge which has been internalized.
When
6
'concepts are presented as elements of the curriculum which
center on other components, learners are better able to
, internalize the content with meaning rather than merely
memorizing disassociated facts (14:26).
It is essential to identify an effective means of
ordering and structuring content into meaningful concepts.
These concepts serve as focal points for the development
of instructional objectives, learning opportunities, and
evaluative criteria (16:303).
Instructional objectives.
Once a body of knowledge
is structured into concepts, appropriate instructional
objectives can be developed (15:31).
Precisely stated
objectives provide a sound basis for the development of
a curriculum.
Instructional objectives identify specific content
:to be covered by the students, identify specific changes
in behavior sought in the student with respect to the
content, facilitate in the selection of learning oppor• tunities, and indicate what to evaluate in terms of
:knowledge and behavior change.
Evaluative criteria.
Evaluative criteria identify
the specific knowledge and behavioral changes sought in
the student as stated in the instructional objectives.
1
The evaluative criteria aid both the teacher and the
· student by clarifying the terms necessary to meet the
instructional objectives.
7
Learning
opportunitie~.
Learning opportunities
provide an opportunity for the students to practice the
behaviors stated in the instructional objective.
They
should be planned to enable students to acquire concepts
and to effectively utilize the new information.
Fodor
and Dalis provide the following definition for the term,
"learning
opportunities~;
• . . learning opportunities take place
in or out of the classroom situation. They
may be teacher centered as in the lecture, or
they may be student centered involving reading
texts or preparing a paper for a class report.
Learning opportunities may involve both overt
and covert behavior on the part of the learner.
What teachers.do or what they have the students
do to attain instructional objectives are merely
opportunities that are provided. The degree to
which learning opportunities enhance learning
depends on many factors: teacher ability,
quality of learning opportunities, student
maturity level, and past experiences in the
classroom setting {14:52-53).
The type, nature, and purpose of instructional
objectives determine the appropriate learning opportunities.
The success of a learning opportunity depends on
the teacher's abili.ty to develop and select the appropriate learning opportunity.
The value of learning
opportunities depends on the extent to which the subject
matter has real meaning for the students {13:409) ..
It is important to include a variety of learning
.opportunities for each concept included in the curriculum.
Fodor and Dalis give several reasons for this:
1.
To meet a variety of objectives.
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2.
To meet a variety of student needs and interest.
3.
To stimulate a variety of senses (14:53-55).
Chapter 2
JUSTIFICATION
The purpose of this study was to develop a curriculum guide for a cancer education program which target
audience was ecumenical clergypersons.
Justification for
· the development of this curriculum guide was based on two
points:
(1) extensive correspondence with each of twenty
Comprehensive Cancer Centers, the National Cancer Institute,
and the American Cancer Society revaled that no such curriculum guide for a cancer and the clergy education program had ever been documented; and (2) a survey of hospital chaplains in Southern California indicated a more
than casual interest in the field of oncology and a need
: to learn more about the disease process and the ensuring
psychosocial problems which develop.
Identification of
the psychological care of the cancer patient as a health
problem along with the fact that there are very few
,health professionals trained in this area provided the
basis to develop a curriculum guide_ which could be used
as a model for program development.
This program would
acquaint members of the clergy with the various problems
encountered by the cancer patient and their families.
Review of the literature was lim.i ted to the
following areas in order to justify the need to develop
9
10
a curriculum guide:
A~
What is· cancer?
B..
Psychological needs of cancer patients.
C.
Involvement of' the clergy ..
D.
Cancer education programs for clergy.
What is Cancer?
Cancer is a large group of diseases characterized
by the uncontrolled growth and spread of abnormal cells
(37:15).
If the spread is not controlled, it may result
in death (37:17).
Many cancers can be cured if detected
early and treated _promptly by surgery, x-rays, radioactive
substances, chemicals, and/or hormones (1:27).
The cancer
survival statistics have improved from one-in-five in the
1930's to one-in-three in 1977 (2:14).
There are over
.three million Americans alive today who have a history of
having cancer (3:7).
Approximately one-third of all people
who get cancer this year will be alive at least five years
after treatment.
Approximately 115,000 people with cancer
:will probably die in 1977 who might have been saved by
earlier treatment.
Of every six people who get cancer,
two will be saved and four will die.
But of the four who
will die of cancer, one might have been saved with earlier
diagnosis and prompt treatment.
The other three will die
of cancer which cannot yet be controlled.
This means that
half of those who get cancer should and could be saved
·(3:13).
11
Psychological Needs of
Cancer Patients
Recent advances in treatment techniques have
'increased the number of cancer survivors.
The radical
surgery necessary for prolongation of life, however,
results in severe impairment of function for many
patients.
The improved medical management of cancer
patients makes evident the importance of dealing with
psychological factors in caring for the cancer patient
(4:1).
Surgery, because of its realistic and symbolic
threat to personal safety is frequently anticipated with
dread, even when the projected operation is neither
extensive nor mutilative.
to two major threats:
The cancer patient is exposed
one from the disease itself, and
;the second from extensive surgery or prescribed medical
regimen that often constitutes the only available form
of treatment (4:17).
The psychological reactions of anxiety and
depression are particularly likely to occur when the
'patient is unable to relate to family members and medical
personnel.
If the patient cannot escape surgery and,
:because of mistrust, is unable to gain emotional support
from others; anxiety can increase to the point of total
breakdown (4:18).
The family is the institution in
which primary social interaction takes place.
The kind
12
of emotional response the cancer patient experiences within
the family prior to and following treatment for cancer
becomes an important factor in attempts to restore social
function and self-esteem (4:27}.
Involvement of the Clergy
Effective emotional support for cancer patients
by medical personnel occurs rather infrequently.
Members
of the medical staff do not have the proper training or
the time to deal with the psychological needs of their
patients suffering from cancer.
however, do feel
(29:315-316).
~hat
Members of the clergy,
such a task is within their domain
Members of the clergy have an unusual back-
ground of experience in helping people who are going through
difficult times.
Clergypersons have been trained to listen
and to provide emotional guidance and support.
Unfor-
tunately, members of the clergy lack adequate knowledge of
the disease process and its accompanying emotional components.
Members of the clergy should be more effective in
dealing with "why me?" questions that are so often asked
by cancer patients.
Cancer Education Programs
for Clergy
A cancer education program was conducted by the
American Cancer Society at Madison General Hospital in
Madison, Wisconsin in 1975 (31:4).
It was received
enthusiastically by -t_he clergy participants.
As a result
13
of the program, the clergy reported an increased ability to
counsel parishioners afflicted with cancer and their family
,members.
Following the
program~
an increased number of
congregational clergy members were noted counseling cancer
patients in the hospital setting.
As a result of this
program, hospital and medical staff are able to involve
the clergy in designing the overall care £or the cancer
patient (26:3).
These clergy members are now better pre-
pared to assist the patient and the patient's family
following discharge from the hospital
(31)~
In November, 1976, the Regional Activities Program
of the USC Comprehensive Cancer Center sponsored a one-day
conference entitled, "Cancer and the Clergy."
This con-
ference v1as designed for ecumenical clergypersons.
Con~
tent covered in the program's format was designed to
assist the clergy in ministering to the cancer patient
and his/her family..
attended the program.
by all participants.
Seventy-six community clergy members
A program evaluation was completed
Results of the evaluation indicated
'that there was indeed an interest within the target com-munity of congregational clergy to justify the development of an intensified cancer education program.
The development of a curriculum guide for the
cancer and the Clergy Internship Program provides a
readily available resource manual £or the development
14
and implementation of additiona.l cancer education programs
for community clergy ..
Chapter 3
METHODOLOGIES
Curriculum has been defined as a package of
planned learning experiences developed to influence the
knowledge, attitudes, and behavior of the learners.
Planning a curriculum involves identifying and arranging
these learning experiences so that effective learning takes
place.
'l'he methodologies utilized in the development of
this curriculum guide are described under the headings
of {1) Organizing the Curriculum Guide, and (2) Pretesting the Curriculum Guide.
ORGANIZING THE CURRICULUM GUIDE
The eight-step rationale developed by Fodor and
Dalis served as a rationale for the organizing of this
cancer education curriculum guide:
1.
Developing points of view
2.
Selecting content
3.
Structuring knowledge
4.
Formulating objectives
5.
Developing learning opportunities
6.
Organizing instruction
15
16
7.
Developing an evaluation scheme
8~
Developing criteria for teacher preparation
·This approach to curriculum development emphasizes the
conceptual approach which, as discussed previously,
stresses the importance of designing a program around
the concepts and the behaviors sought in the learners.
Developing Points of View
Directions for the development of a health curriculum and for the planning of health instruction were
provided by studying current points of view concerning
health, education, and the cancer education program.
Points of view affect instructional decisions on what
content should be taught, how this new information should
be taught, and when it should be taught (14:1).
It is
.crucial that the planned health instruction reflect a
point of view which takes into account the many forces
which affect one's health and which integrates physical,
mental, and social dimensions of health (14:3).
Planning committee.
The first step in planning
. the Curriculum Guide for the Cancer and Clergy education
program entailed the selection of a planning committee.
According to Ross's principles of community organization,
'when members of the target community are involved in the
:program's planning phases, errors are often avoided due
to the insight provided by community members.
17
Cooperative planning is an important function in
any health education
progra~~
To be
e~fective,
the com-
munity health education program must be developed by the
functional community using a coopera.ti ve approach.
Members of the community and target group were
included in planning this health education program.
Using
the principles of community organization (5), communication
lines were opened between the professional health care
workers and members of the target population.
committee was organized.
A planning
Community representation in the
planning committee included
staf~
persons from the USC
Cancer Center, staff persons from the American Cancer
Society, twelve clergypersons, two physicians, two social
workers, and two psychologists.
The planning committee selected for this program
· e~fectively influenced the development of the point o~
view maintained throughout this curriculum guide.
Selecting Content
Fodor and Dalis have stated that the selection of
'relevant content for a curriculum necessitates the
zation of a rational process.
utili~
This process involves
selecting content based upon data concerning health
problems, needs, and interest.
From the data obtained,
inferences were made concerning the content of health
instruction (14:13).
18
Identification of content areas.
Several sources
were considered in an attempt to develop a health curriculum which addressed a specific health issue or prob• lem:
1.
The first source considered was the learner
and the target community.
Their current level of knowl-
edge, health interests,. a.nd personal health practices
were reviewed and assessed.
2.
The second source considered was society.
Societal health beliefs are usually reflected in community laws and vital statistics.
The planning committee
'reviewed morbidity and mortality statistics and relevant
legal regulations which pertained to the health problem of
cancer.
3. The third source considered was the experts.
!Experts in the field of oncology and education were consulted as content specialists..
These identified experts
were consulted to obtain their perspective on current
health problems in cancer as they related to the develop:ment of this curriculum.
4.
The fourth source considered in the selection
of content for this-curriculum was textbooks.
Textbooks
provided a general review of health content and a per ....
spective of how cancer relates to other health problems.
(It is important to remember that content in the textbooks
becomes outdated quickly).
19
5.
The review of previously developed curricula
provided an additional review of content important for
inclusion in this curriculum.
Most of the curricula
•reviewed were designed for a specific target community-.care was taken to adapt from other target populations to
the specific target population of this curriculum guide.
The final source considered in the selection of content
for this curriculum was the controversial issues.
The
planning committee decided that controversial issues should
not be included in the health curriculum until a favorable
climate for their inclusion was established; e.g., the
use of laetrile in the treatment of cancer.
The consider-
ation of all of these sources provided some of the basis
for making rational decisions for the selection of the
content which was included in this health curriculum (14).
·Additional data was accumulated by the planning committee
by conducting a Delphi study.
Delphi process.
In an effort to make this cancer
'education curriculum responsive to the needs of the clergy,
a modified Delphi process was used to obtain the perceptions of knowledgeable persons
in~
field and from the target community.
cancer education
The objective of
'this Delphi study was to identify appropriate content
areas for inclusion in the proposed curriculum guide.
The Delphi technique is a group process using
written responses to a series of questionnaires to poll
20
individuals who are difficult to bring together physically.
In the first questionnaire, individuals respond to a broad
'question such as,
11
What topics do you feel should be
i.ncluded in a cancer education curriculum for members of·
the clergy? 1'
Each subsequent questionnaire built upon
responses to preceding ones until a consensus was
approached and sufficient information exchange took place.
Delphi preserves anonymity and, unlike face-to-face meetings, prevents domination by a small group of individuals
(31:389).
The planning committee met to share ideas and
concerns about the selection of the content for the proposed curriculum.
Delphi study.
These i.deas formed the basis of the
Ea.ch committee member had reviewed several
other cancer education curriculum guides.
Appropriate
content from these past curricula was developed into a
list.
Each member of the planning committee added his
.or her own suggestions to the list.
adjourned.
The meeting was
The list was consolidated and mailed to each
member of the committee.
They were asked to assign
scores from one to ten in decreasing order of importance
to the ten most important
items~
The total score for each
,item was obtained by adding the assigned scores; i.e.,
•the maximum score an item could get was 230--23 respondents times ten..
Thirteen content areas were identified
,as the most crucial for inclusion in the ourriculum.
The
21
next task was to identify the order in which these items
would be
presented~
Structuring! Knowledge
i
~.
There was an overwhelming amount of subject
matter for each of the identified topic areas.
The next
problem was to structure the content that had been
selected for inclusion in the curriculum in a meaningful
manner.
A strategy was developed which provided a syste-
matic approach to organizing this selected content.
Collecting data.
The first step was identified
in the preceding section:
needs of the learner
these needs.
~nd
identification of the health
collection of data relevent to
The Delphi process discussed above accom-
plished this.
Grouping data.
The next step was to group the
content into similar categories.
Each member of the
planning committee was given a set of thirteen index
cards.
On each card was written one of the content items
identified by the Delphi process.
Each committee member
was asked to sort the cards into stacks of similar items.
No limit was set as to the number of stacks possible.
This methodology is often referred to as a miniature
Q-sort.
The Q technique is a sophisticated way of rank
ordering objects and then assigning numerals to subsets
of the objects for statistical purposes.
A comparison
22
of the items that were grouped a.s similar by the committee
members was used to determine the content areas for the
curriculum guide.
Identifying health concepts.
Once the content was
grouped, a "Big Idea" or concept was identified for each
category.
Formulation of health concepts involved inter-
preting the data, identifying relationships among the
data, categorizing the data, synthesizing the data, and
then forming abstractions from the data.
After each com-
mittee member sorted their items into stacks, they were
asked to write one statement describing the items in each
stack.
These abstractions are actually the concepts.
Using this method, a total of five concepts emerged.
These concepts were stated in a non-prescriptive manner
allowing the learner to make his or her own decisions
;which are consistent with the values of society (14).
A brief summary of what has taken place so far
reveals that the planning committee was instrumental in
the selection of the content to be included in the curriculum and in the formulation of
11
Big Ideas" or con-
cepts.
The committee members were not consulted in
: planning the rest of the curriculum guide since they did
not possess skills in the areas of program planning and
curriculum development.
23
Formulating Objectives
The development of several objectives relevant to
each concept allows the learner and instructor to focus
on various aspects of each concept.
Objectives have been defined as short-term,
precise statements of end results that build cumulatively
to a goal (14:40).
Objectives identify the specific
behaviors that are sought with respect to this content.
They provide clues for the instructor and the learner as
to what should be taught, how it should be taught, and
whether or not what is taught is understood by the
learner.
According to the definition of objectives
offered by Fodor and Dalis, well stated objectives
serve as a guide to identifying the specific content to
be studied by the student;
specifying changes,in
·behaviors that are sought in the student with respect
to this content, selecting learning opportunities that
best enable the learner to achieve the desired behavioral
outcomes, identifying what to evaluate in terms of the
health content studied and the behaviors sought in the
learners, and evaluating teacher effectiveness (14).
Each of the thirteen content areas identified in the
Delphi process were developed into instructional objectives for the curriculum guide.
24
Developing Learning Opportunities
Learning opportunities provide a chance for the
learner to .practice the behaviors stated in the objectives.
They were planned to enable the students to
acquire the concepts and to effectively utilize health
information.
Learning opportunities were not limited to
the learning situation.
The instructor's ability to
effectively use a specific learning opportunity was considered.
The selected learning opportunities were varied
as the utilization of several different types of learning
opportunities enables the instructor to meet a variety of
student needs and interests and to stimulate a variety
of senses (14).
Organizing Instruction
Learning is dependent upon both the maturation
· of ·the learner and the accumulation of knowledge that was
acquired (14:83-5).
The members of the clergy had not
received formal education dealing with the medical or
:psychosocial aspects of cancer.
The selection of the
·content for this curriculum guide was based on:
1.
Individual and societal health needs.
2.
Points of view concerning health and educa-
tion as expressed by members of the community.
3.
Clergy needs, interests, and knowledge.
4.
The opinion of experts in the field of
oncology, psychology, and psychosocial rehabilitation._
25
;-·~
·--:-·-
·-·-··---------------------·---------- -------------------- ------------- ------------------ ----------
5.
·-
--- ----•----------- ---------- ------
--- ---------··
A review of cancer-related textbooks and
pamphlets developed to educa.te the clergy.
6..
A review of cancer-related curricula
developed for the clergy.
Conveyance of information based on concepts,
objectives, content, and learning opportunities considered
principles related to the learner and principles related
to the subject matter
(14:93-6)~
Principles related to the learner.
These prin-
ciples include examination of the readiness of the learner,
his/her maturity level, and the health needs and interests
of the learner (14:93).
The curriculum also considered
the geographical extension as it related to the learner
(14:93).
A greater awareness of the surrounding environ-
ment develops as the learner matures.
Learning oppor-
tunities and instructional objectives were designed to
reflect this growth.
The content of this clergy intern-
ship program began with the medical and psychosocial
aspects of cancer and subsequently involved the clergy
in the care of the cancer patient.
Principles related to the organization of subject matter.
These included the logic of the subject
matter, ordering of concepts from simple to complex,
and from concrete to abstract.
This health curriculum
followed a logical sequence developed on the basis of
the learner's geographical extension.
The sequence was
26
.devised whereby the complexity and depth of the material
increased with the introduction of each new concept.
In
this manner the concepts, objectives, content, and learning
opportunities follow a logical sequence (vertical organization) and they were interrelated (horizontal organization) .
Developing Criteria for Teacher
Preparation
A poorly prepared instructor can ruin a program
regardless of the extent of program planning.
The content,
concepts, objectives, and learning opportunities become
irrelevant in the hands of an ineffective instructor.
An
effective instructor is well versed in both the program
content and methods of presentation.
Instructors for the Cancer and the Clergy Internship program were recognized experts in their content area
and highly rated in their ability to convey their assigned
subject matter.
PRETESTING THE CURRICULUM GUIDE
The four areas under consideration while pre.testing this curriculum were:
': t '1.ons,
(1) general considera-
(2) inservice education,
irevision and updating materials.
(3) evaluation, and (4)
These four topics were
an integral part of planning this instructional program.
27
General Considerations
Each of the general considerations for implementing
this health education program are discussed separately
below:
Target
population~
This curriculum was designed
for use with members of the clergy who expressed an
inte~est
or desire to learn about the medical and ther-
apeutic aspects of cancer, the psychosocial implications
of having cancer and skills related to counseling of
cancer patients.
The members of the clergy selected to
pretest this model program were matched with respect to
their pre-program level of knowledge of cancer.
A copy
of the pre-program questionnaire is found in Appendix A.
Administrative
support~
The administrative
support for this program was divided into three units:
a program coordinator, a planning committee (described
in the previous chapter), and the program moderators.
The USC Comprehensive Cancer Center Regional Activities
Program appointed a staff person to provide the overall
coordination of the planning and pretesting of the Cancer
and the Clergy Curriculum Guide.
The planning committee
was facilitative in the selection of content covered and
in the formulation of goals and objectives.
The planning
committee also aided in the selection of program
instructors.
28
Teaching staff.
The pla,nning committee selected
· eleven consultants to instruct the content of the program.
Consultants were selected on the basis of their knowledge
·Of the subject matter, reputation within the community,
·and their ability to teach (as demonstrated in other
cancer education programs).
Budget.
A working budget of $3,000 was allocated
for the Cancer and the Clergy Internship.
Teaching environment.
The pretesting of the
Cancer and the Clergy Curriculum Guide took place
at Hollywood Presbyterian Hospital, Los Angeles.
This
hospital maintains excellent conference facilities.
Each
conference room was equipped with central heating and
cooling.
A chalkboard and projection screen was found in
each room.
Seating arrangements were flexible and varied
'to accommodate program needs.
Adequate lighting was avail-
able from overhead electrical fixtures and direct lighting
filtered in through windows which could be darkened for
viewing audio-visual presentations.
A telephone was
available for emergency calls.
Equipment and materials.
It was the responsi-
bility of the Program Coordinator to arrange for all
materials.
This cancer Education curriculum was designed
for use with four textbooks:
1978 Cancer Facts and
Figures (2), Science and Cancer (38), Psychosocial
,Aspects of Cancer Patient Care;
A Self-Instructional
29
Text (39), and Seeds of Destruction (30).
Suggested
pamphlets and other literature (see Selected Resources
in the Curriculum Guide) were available prior to imple.mentation of the program.
A copy of each textbook and
all supplementary literature was distributed to each
student.
Several 16 rnm films were suggested as learning
opportunities.
advance.
The film projector was reserved in
Arrangements for faculty consultants were made
two months prior to program implementation.
Audio-visual
equipment for their presentations was reserved one month
prior to implementation.
Inservice Education
Inservice education is a means by which health
educators may be kept abreast of current information per'taining to this topic area.
Inservice education also
provides an opportunity for teachers to expand their
repertoire of learning opportunities and to improve their
.teaching competencies.
The planning committee provided on-going inservice
·education to those faculty consultants involved in the
implementation of this health education program.
A two-
hour inservice workshop was conducted by the program
coordinator for the faculty consultants one month prior
to the implementation of the Cancer and the Clergy Internship Program.
30
The purpose of this inservice workshop was to:
1.
Update all factual information relating to the
,suggested content outline in the Curriculum Guide.
i
2.
Provide faculty consultants with a rationale
for developing and implementing a functional health
education program.
3.
Acquaint faculty consultants with goals and
objectives of the program.
4.
Augment available learning opportunities.
5.
Review materials and resources to be used as
instructional aids.
6.
Discuss effective measures of program evalua-
tion.
The program coordinator provided the necessary
:resource materials and officiated as the workshop leader.
Evaluation
Evaluation is helpful in determining the
ne~d
:for and of a health program and in assessing the strengths
i
and weaknesses of such a program.
The program evaluation
iwas used as a guide in revising and updating the currieulum guide for the Cancer and the Clergy program.
Evaluation of the program was a continuous
;process.
Evaluative feedback from one segment of the
program provided insight to other program segments.
How-
; ever, care must be taken not to confuse evaluation with
. measurement.
31
-------- ----
. -----------------------------
-------·- -- ------ - --- __ _._. __________ - ·--- ------ - --- ----- -·
--·-
------·------ -------. --· --.-
--------
It is important to differentiate between evaluation and measurement.
Evaluation involves a comprehensive
study of student achievement followed by impartial interpretation of these facts.
Measurement refers to the
observation that can be expressed quantitively and that
answers the question, "how much?"
Evaluation goes
beyond this to answer the question, "what value?"
(14)
Evaluation of the curriculum guide for the Cancer
and the Clergy Internship Program was a continuous revie·w
and assessment of the instructional program.
The purpose
of evaluation was to provide information by retaining
the effective learning activities and by modifying or
deleting the ineffective learning activities.
Evalua-
tion of the curriculum for the Cancer and the Clergy
Internship Program will provide a basis for improving it.
Of primary concern to this project is the evaluation of the ability of this curriculum to meet the educational needs of the target population.
The curriculum
. guide was pretested on a group of fifteen ecumenical
clergy, in addition to the planning committee, for their
·review and evaluation.
Each of the evaluators reviewed
the curriculum and provided feedback in the following
areas:
1.
Concepts
a.
Are they valid?
b.
Are they based on health needs and
32
interests?
c.
Are they interrelated with other concepts
within the curriculum?
d.
Are they in keeping with modern viewpoints
of health?
e.
Are they in keeping with the needs of the
participants?
2.
Content
a.
Is it factual?
b.
Is content interrelated?
c.
Is content in keeping with modern viewpoints of health?
d.
Is content based on the health needs and
interests of the participants?
3.
Objectives
a.
Ar.e objectives reasonable and worthwhile?
b.
Are objectives based on the health needs
and interests of the participants?
c.
Are objectives interrelated with the rest
of the curriculum?
d.
Are objectives in keeping with the modern
viewpoints in health education?
e.
Do objectives cover a wide range of cognitive skills?
f.
Are objectives stated in terms of content
and behavior?
33
g.
Are evaluative criteria included and
defined for participants?
4.
Learning opportunities
a.
Are learning opportunities based upon the
health needs and interests of the participants?
b.
Are they appropriate to the knowledge and
maturity level of the participants?
c.
Are they interrelated with the rest of
the curriculum?
d.
Are they in keeping
wi~h
modern points of
view in health?
e.
Do they cover a wide range of cognitive
skills?
f.
Do they elicit the specific skills and
behavior that they seek?
g.
Do they allow the participants opportunities to practice behaviors sought?
h.
Program coordinator will maintain anecdotal
records ·of success or failure of learning
opportunities.
i.
Participants will provide feedback
regarding f and g above.
The feedback provided by this evaluation committee
was used to revise the curriculum guide into a final version.
The evaluation forms and results are included ·in
34
---------
,Appendix B.
-------~------~--------
------
··-------~~
A few objectives were deleted and two new
objectives were added to the curriculum.
These changes
were made after careful review of the evaluations com.pleted by the group selected to pretest the curriculum.
Revision and Updating
Revision of the curriculum based on the program
evaluation and the development of new information was an
important function of the planning committee.
All facets
of the Cancer and the Clergy Education Curriculum must be
updated and revised as necessary.
in defining the term
11
as necessary.
A difficulty arises
11
The curriculum
should be revised when changes occur in the following
areas:
1.
Points of view concerning health education
a.
When community attitudes about cancer
change.
b.
When recognized experts no longer express
a need for this type of program.
2.
Basis in selection of health content
a.
When individual or societal needs and
interests change.
b.
When information becomes outdated by
current research.
3.
Learning opportunities
a.
When selected learning opportunities no
longer elicit behavior sought.
35
.----------·---·--- -----------------------------
b.
----------------·---~----·-·
------~----------·--
----·---
--
-·
---·------~-·---·
------·-------·-
------·-·
When learning opportunities no longer
motivate student's interests.
c.
When learning opportunities are not
ef'fectively used by teachers.
The Cancer and the Clergy Curriculum evaluation
is a tool designed to assess changes as outlined above.
Participation in an evaluation of the Inservice Workshop
by members of the conununity provides necessary feedback
on changes in the community's point of view, needs, and
interests.
A student evaluation of the Cancer and the
Clergy Internship provided feedback on the students•
points of view, needsr and
interests~
The curriculum must be based on current information.
This is essential if the faculty members are to
provide accurate information to the students as the students cannot build the desired health practices from outdated
information~
It was the task of the planning com-
'mittee to keep abreast of the latest developments in
•cancer research and to relay this information to the
faculty members via Inse'rvice sessions and special meet.,...
ings to update the information in the Curriculum Guide.
'The revised version of the Curriculum Guide follows.
--- -·-
--~
---------- --- ---·-----··-·--· ·-----
~
--------- -- -------- _,_
-
-·--------·-------------~----
·------------·
··-
---- -------------·------,
Chapter 4
THE CURRICULUM GUIDE
CONCEPT 1:
Objective 1:
Cancer Control is a problem for society.
Following
instructio~
students will
describe in writing the impact of cancer
as a disease of society.
CONCEPT 2:
Cancer cells are like normal cells in that
they grow and travel throughout the body.
Ojbective 1:
Following instruction/
the students will
compare and contrast the development of
the normal cell and the development of a
malignant or cancerous cell.
Objective 2:
Following instruction, the students will
explain how cancer spreads through the
bodye
Objective 3:
Following instruction, students will cite
the difference between a sarcoma, a
carcinoma, and a diffuse tumor.
CONCEPT 3:
Cancer is a group of diseases, some of
which can be prevented, treated, or cured.
Objective 1:
Following instruction, the students will
state that cancer is a group of diseases.
Objective 2:
Following instruction, the students will
36
37
integrate the results of epidemiological
studies into a realistic plan to prevent
two types of cancer.
Objective 3:
Following instruction, students will
list four accepted cancer treatment
modalities.
CONCEPT 4:
Rehabilitation of the cancer patient
includes psychosocial rehabilitation,
physical rehabilitation, and vocational
rehabilitation.
Objective 1:
-Following instruction, the students will
be able to compare and contrast the
psychosocial adjustments made by cancer
patients during the period of prediagnosis, diagnosis, and rehabilitation.
Objective 2:
Following instruction, students will
discuss orally the importance of
adequate physical rehabilitation for
the cancer patient following treatment.
Objective 3:
Following instruction, students illustrate in writing examples of the positive effects of vocational rehabilitation.
38
CONCEPT 5:
Understanding the patients' and one's own
psychological fra.me of reference is necessary to facilitate effective counseling.
Objective 1:
Following instruction, students will
summarize their own feelings about
CC1ncer.
Objective 2:
Following instruction, the students
will list the emotions that are most
often displayed by cancer patients trying to cope with the diagnosis of cancer.
Objective 3:
Following instruction, each student will
apply the dynamics of counseling discussed during instruction to dealing
with four of the emotions displayed by
cancer patients coping with the diagnosis of cancer and its anticipated prognosis.
-----------·----........------------------· ---::--··--------------- --·---·-.------------------·
I
----------,
I
i
!CONCEPT:
I
Cancer Control is a problem for society.
I
(INSTRUC'I1IONAL OBJECTIVE:
I
Following instruction,
students will describe in writing
the impact of cancer as a disease on society.
I
I
i
!EVALUATIVE. CRITERIA:
I
.[
I
I
I
The student will include the following items in a description
of the impact of cancer:
1. cancer is a chronic disease
2. one in four people aliv~ today will develop cancer
3. early detection effects the rate of cure and/or possible
eradication of certain types of cancer
I
j
1
·~
I
I
I
I
I
I
:
I
I
I
I
I.
ii.
I
.
1
CONTENT OUTLINE
Cancer is a chron~c
disease
A. Second most common
cause of death in
the U.S.
B. One in four people
alive today \vill
de1 relop cancer
C. F our of every six
pee )p.ie who have
car leer could be
cured.
D. The economic costs
to society are
great.
~-~------·- ...
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
1.
Compute how many of the students
are likely to develop cancer.
1978 Cancer Facts and
Fi9ures, ACS 1978.
2.
Have students discuss the significance of the chart "Cancer
Around the Horld". This chart
compares the incidence of cancer
and other major diseases.
One Out of Every Six,
27 minutes ACS
3.
Divide into small groups and
discuss how the cost of cancer
is borne by society as a whole.
4.
Show ACS film "One Out of Every
Six".
(6553).
"Screening of Cancer by
Nurses", Cancer
Nursing, February,
1978.
:
I
I
- ···-· -·-· -···---·- ---·
i
----------~
w
1.0
II
CONTENT-OUTLINE
increased taxes! 5.
to supporb research, medicare, medicaid
E. Many efforts are
being made to control the incidence
of cancer
I 6.
1. early detection
mechanisms.
1.
l---~--------------------·
RESOURCES
SUGGESTED LEARNING OPPORTUNITIES
Have students attend a panel
discussion involving a representative from a major medical
insurance company, a vocational
rehabilitation counselor, and
an oncology social worker.
Have a speaker discuss methods
of cancer prevention and cancer
screening and detection mechanisms.
---------------------·----------
-----1--
__ _)
ol:>o
0
---------------
CONCEPT:
Cancer cells are like normal cells in that they grow and travel
throughout the body.
INSTRUCTIONAL OBJECTIVE:
EVALUATIVE CRITERIA:
I.
.
l.
I
CONTENT OUTLINE
Cel~u~ar
Structure
A. Component$ of a
cell
l. normal cell
2. malignant cell
B. Growth and development
1. normal cell
2. malignant cell
C. Describe how a
normal cell becomes malig~ant
1. changes ln
size, shape &
L________ _
Following instruction,
the students will compare and
contrast the development of the normal cell and the development of a malignant or cancerous cell.
In an essay, the student gives at least two ways in which the
development of a cancer cell differs from the development of
a normal cell in terms of:
1.
2.
3.
4.
I.
j
rate of growth
temperature
use of nutrients
Blood supply
SUGGESTED LEARNING
OPPORTUNIT~ES
1. Read chapter 1-3 in Science and
Cancer.
2. Show the film "What is Cancer",
by the American Cancer Society
(this film explains the basics
of cellular biology and discusses
how a normal cell undergoes
changes to become a malignant
cell).
3. Recruit a cancer research biologist to discuss "What is
Cancer".
REi SOURCES
Shimkin, :r.~ichCl,el B., M.D
S.cience gnq Cancer.,
U.S. bept. bf He~lth,
Education & Welfare,
1973.
Ame~ican
Cancer Society,
A Cancer Source Book
for Nurses, American
Cancer Society, Inc.
1975.
Smith, Elizabeth A.,
Ph.D., Psychosocial
··-·---- ..
---- ---- ---------------- --------------------------------
j
~
1-'
RESOURCES
SUGGES'J.'BD J..~EARNING OPPORTUNITIES
CONTENT OUTLINE
I
~------------+------·~------------~~------------+
nuclear patterns
a. DNA
b.
RNA
4. Divide into small groups to
discuss the difference between
normal cells and cancer cells.
c. Chromosomes
d. Virus
2.Time sequence
a. length of time
varies with
type of
neoplasm
Aspects of Cancer
Pat1ent Care: A Self~
Instructional Text.
The University of Texas
Health Science Center I
at Houston, 1975.
"What is Cancer", ACS
film #3404.00 21
minutes, color, 1962.
~augh,
Thomas H.
L. Marx, Seeds
Jea~
and
of
I
Destruction, Plenum
I
Press, New York, 1975. I
I
I
L___________ -----------------------·------• ------------·-----·-·--·--------------------------------
~·
J
If:>,
t-v
~-----·-···
-···-·· --·-------·-··-.--
------------------------------------------------·--·--·--------------------·-------------------·--··
I
.CONCEPT:
1
i
Cancer cells are like normal cells in that they grow and travel throughout
the body.
I
I
Following instruction the students will explain how cancer
spreads through the body.
I
The students will write a p~ragraph which discusses how cancer
cells spread and travel through the body in terms of the
lymphatic system and the circulatory system.
I
I
INS'l'RUCTIONAL OBJECTIVE:
EVALUATIVE CRITERIA:
l
I
I
i
I.
+-------------------------~------------------------------------~~----------------------~
CON'I'Et-lT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
J
II
II.
fi·
Anatomy
1.
A. Circulatory Systen
B. Lymphatic Syst~m
Read chapter 1 of Psychosocial
Aspects of Cancer: A SelfInstrt1ct;Lanal Text.
Spread of Cancer
Cells
A. Via direct extension
B. Via regional ex. tension
C. Separation from
primary cancer
D. Via circulatory
system
Recruit cancer pathologist to
discuss how cancer spreads in
the body.
2.
3•
Diagram on a chart of the human
body the five ways that cancer
can spread through the body.
--·---- -- ··---···- -- - . - ... - ·- ·-··---- -- --------
Smith, Elizabeth, Ph.D.,
The Psychosocial
Aspects of Cancer
P~tient C~re: A SelfInstructional Text.
Ame1rican Cancer Society,
A Cancer Sourcebook
for Nurses, ACS, 1975.
Clinical Oncology for
Medical Students and
Physicians, Philip
Rubin, M.D., (ed.) ACS
1974.
--· ----- ---··
-------
_______ I
(
.::..
w
!
--CONTE~;- OUTLINE
. . ···-·
-
--
--
-
.
--
.. ·-·- --·
- .... -- --
.. ·-·--··
····-·-·-
- --
.
-----
SUGGESTED LEARNING OPPORTUNITIES
--------
RESOURCES
i
E. Via lymphatic
system
I
I
I
I
I
I
I
------------------------·--·-··------------
.
------------------- --
.1::>
""'
----------------------------·---------·--·-----·--
~-----
!
I CONCEPT:
Cancer cells are like normal cells in that they grow and travel throughout
the body.
INSTRUCTIONAL OBJECTIVE:
Following instruction, students will cite the difference
between a sarcoma, a carcinoma, and a diffuse tumor.
i
EVALUATIVE CRITERIA;
i
I
CONTENT OUTLINE
The students will list the tissue of origin for each of the
two major types of cancer: sarcoma-connective tissue;
carcinoma-epithelial tissue.
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
iI
I I. There are many dif-
Ii
i
!
I
I
I
I
I
1. The instructor provides the stu- Manu~l for Staging of
ferent types of
Cancer 1977, American
dents with a list of 25 cancers cancer, these cancers
the students categorize them by
Joint Committee for
can be categorized
tissue of origin.
Cancer Staging, 1977.
into three categories
A. Sarcomas
2. Recruit a pathologist to lecture Guidelines for Cancer
1. tissue of
Cqre, American College
on the topic using slides and
origin-connector-Burgeons Commission
anatomical diagrams to indicate
ive tissue
differences in cellular structure
on Cancer, 1976.
2. method of
of various tissues ~f origin.
metastasis
3. specific types 3. Read Manual for Staging of
of sarcomas
Cancer 19 7 7.
B. Carcinomas
L_______________ .
I
I
~
V1
-·----1
CONTENT OUTLINE
i
I
I'
I
I
I
I
I
SUGGESTF.D LEARNING OPPORTUNITIES
.......,~...........-
I
c.
RESOURCES
---------+----------r
1. tissue of
origin-epithelial tissue
2. method of
metastasis
3. specific types
of carcinomas
a. colon-rectal
cancer
b. breast cance
c. skin cancer
Diffuse tumors
1. Leukemia
i
I
L
·-------
---------
---------------- 1--
J
~
0"1
,-----------------.
1
CONCEPT:
I
I
--------------------·---
Cancer is a group of diseases some of which can be prevented, treated
and cured.
i INSTRUCTIONAL
OBJECTIVE:
EVALUATIVE CRITERIA:
Following instruction, the students will state that
cancer is a group of diseases.
Students will list four different types of cancer in terms of:
1. tissue of origin
2. rate of growth
3. method of spread
CONTENT OUTLINE
SUGGESTEP LEARNING OPPORTUNITIES
RESOURCES
I
I I. Cancer is a group of
I
I
J.
I
I
I
I
I
1.
diseases with ~irnilar
characteristics
A. longer cell life
than normal cells 2.
B. failure to main~
tain boundaries
c. cancer cells
resemble immature
·cells under the
3.
microscope.
D. cancer cells are
capable of metastasis and growtH
Have students list common
characteristics of malignant
cells.
:I
Richards, Victor, Cancer
~he Wayward Cell,
i
Uni~er~ity"of C~liforn~a
Press, Berkeley, 1972.
Have students divide into
smaller groups to discuss the
similarities and differences of
four different types of cancer.
i
American Cancer Society,
A Cancer Sourcebook
for Nurses, ACS 1975.
Have the students match lists
of types of cancers with their
associated body part.
L___________ .
~
-....]
--·-
-- ---·
----
··- ·---
------- ----- -··
---
.
---
-
-- -
·-
.
--
CONTENT OUTLINE
- ---- --- -
-----
-··
---
--·
....
-
---- ..... --
-
--- -----· ----
- ___ ______
_.
- -----
....
..
-
--
-,
RESOURCES
SUGGESTED LEARNING OPPORTUNITIES
in distant parts
of the body
-----·
---
I. The distinguishing
characteristics between types of cancer
include:
A. site of tumor
B. severity of illnes
c. cause
D. occurrence in
different age
groups and sexes.
i
iI
l_ _________________________________ .
------------~----------------------
----------------------
..
--
~
cc
~--------------------------------------------,------------------------------------
1
CONCEPT:
j
Cancer is a group of diseases some of which can be prevented, treated,
or cured.
!
i INSTRUCTIOHAL
Following instruction, the students will integrate the
results of epidemiological studies into a realistic plan
to prevent two types of cancer.
OBJECTIVE:
i
I
I\ EVALUATIVE
l
CRITERIA:
-i
Students will design a program aimed at preventing lung and
skin cancer which includes the results of epidemiological
studies.
I
CONT~NT
QUTLINF.
SUGGESTEO
-I
I I.
~I.
i
Prevention is one
1.
way to avert something - in this case ,12.
cancer
Some cancers can be
prevented
A. Lung Cancer
1. stop smoking
B. Skin Cancer
1. decrease exposure to the
sun
I
L ---------------- --- ----- ---
___
,,
_______
3.
4.
5.
--~
LEA~NXNG
11
OPPORTUNITIES
RESOTJRCJ.;:S
1
I
(#2376) ISense in, the Sun, 14
minutes, ACS (2331,
Spanish, 2331.19)
Show ACS film, "Sense in the Sun"
(#2331)
Signals, 13 minutes,
ACS ( 2 376)
Show ACS film "The Time to Stop
is Now" (#2369)
The Time to Stop is Now
ACS (236 9)
Have students list those cancers
which are preventable and describ
1978 Cancer Fact&-and
how they can be prevented.
Figures, ACS 1978.
Have students site studies which
show a positive association be-
-----·
Show ACS film,
,.
Signals",
. --- ....
---~-
...
- -··· -------- - -· -·---.-----
.---------------------------------·---
,f::.
I..C
~
___,__ ·- -
-
··-
-
"""
CONTENT-OUTLINE
-
""
--
-
--··- --
.
-
--·
"
-
-·
·-
-- ---·-
- ---
---
- -···- ---·------
-
--
.
--
-,
RESOURCES
SUGGF.STBD LEARNING OPPORTUNITIES
-·
tween smoking and lung cancer
and between sun exposure and skin
cancer.
6. Recruit a person conducting
cancer research to lecture to the
students.
I
I
I
I
I
I
I
I
I
II
I
I
I
I
I
I
l
----
---
-----------
~
---------------- ------------
·-----
------'
U1
0
,-----··--··-----·----------------------------------·---------·-·-·-·--·--------·-------·
~
I
t
I
j
1
CONCEPT:
Cancer is a group of diseases some of which can be prevented, treated,
or cured.
I
I
j
INSTRUCTIONAL OBJECTIVE:
·
EVALUATIVE CRITERIA:
Following instruction, . s~udents will list four accep·ted
cancer treatment modal1 t1es.
____ _
Students will list four accepted cancer treatment modalities,
site one type of cancer each modality is most effective in
treating, and state whether this is curative or palliative
treatment.
CONTENT OUTLINE
I. Chemotherapy
11.
A. The use of
specific chemica
agents to kill
12.
cancer cells
B. Effective in
control of micrometastasis from 13.
solid tumors,
i.e. breast
cancer, and in
controlling the
spread of diffusE
tumors, i.e.
leukemia.
SUGGESTED LEARNING OPPORTUNITIES
Show ACS film "Traitor Within"
(2324)
Have the students describe how
each modality destroys cancer
cells.
Have students divide into smaller
groups and match types of cancers
with various treatment modalities
and determine if this is palliative or curative treatment.
RESOURCES
Kagan, Robert A., Radiation Therapy: x-Man~al for Patients
and Their Families,
not published.
Breeding, Mary Ann and
Myron Wollin, "Working Safely Around
.
Implanted Radiation
I
Sources", Nursing 76,
Intermed Commun1cation•
PA 1976.
Ln
I-'
CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
Ivan Scoy-Mosher, Michae 1,
Chemotherapy: A Manual I
for Patients and Their
~~~~------~--~~~-Families, not publishel
II. Radiation Therapy
A. The use of radioactive materials
to kill cancer
cells
B. Effective in
shrinking the sizE
of tumors prior
to surgery or in
killing radiosensitive tumors
not accessible to
surgery, i.e.
Hilm' s tumor.
II. Surgery
A. Surgical removal
of cancer cells
B. Effective in the
treatment of skin
cancer, early
breast cancer,
and cancer of the
bones.
Irrununotherapy
A. Stimulation of
the hosts immune
system to kill
.tumor cells.
B. Still in the
research stages
--- ·--·-·--·-· -----·-··-----------·
RESOURCES
1
I
I
I
I
I
-----------------------------------------··
U1
N
RESOURCES
SUGGESTED LEARNING OPPORTUNITIES
CONTENT OUTLINE
C. Successful in the
treatment of' malignant melanoma.
I
I
·I
I
I
I
II
I
i
I
I
I
!
L..
I
-----------------------------------------------
-
I
----------,--- J
Ul
w
CONCEPT:
Rehabilitation of the cancer patient includes psychosocial rehabilitation,
physical rehabilitation and vocational rehabilitation.
INSTRUCTIONAL OBJECTIVE:
1.
2.
3.
;EVALUATIVE CRITERIA:
I
1.
'
2.
3.
C.-
Following instruction, the students will be able to
compare and contrast the psychosocial adjustments made
by cancer patients during the period of prediagnosis,
diagnosis, and rehabilitation.
Following instruction, students will discuss orally the
importance of adequate physical rehabilitation for the
cancer patient following treatment.
Following instruction, students illustrate in writing
examples of the positive effects of vocational rehabilitation
Students \.Vill identify in writing tv.To variables characteristic of each stage of psychological adjustment following
the diagnosis of cancer.
Adequate physical rehabilitation is discussed in terms of
self-worth, physical well-being and quality of life.
The positive effects of vocational rehabilitation are discussed by comparing two case histories in terms of ease of
reentry into work force, return to prior position, length
of time out of work. -
U1
,:::..
CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
i·
d. . . . .
jr.
·
Psychosocial Adjust1.
ment during
A. Prediagnosis
1. Where to go
for help
2.
2. How to choose
a physician
3. Dealing with
internal
3.
emotions
a. stress
b. anxiety
c. fantasies
B. Diagnosis
1. Communicating
to loved ones
2. Maintaining
day to day
activities
3. Mobilizing
resources to
make decisions 4.
re; personal
and professional life.
C. Rehabilitation
1. Returning to
the work force
2. Concerns of
s.
reentry to
social life.
---····-----~----
RESOURCES
I
,. . . . . . . ~,.
Read Psychosocial Aspects of
Cancer Patient Care: A Self":l
Instructional Text.
--Read A Comprehensive Approach
to Rehabilitation of the Cancer
Patient.
Smith, Elizab~th,
I
Psychological Aspects·
of Cancer Patient Care_
McGraw-Hill, 1976.
II
i
1
Smith, Elizabeth. A
Comprehensive Approach!
to Rehabilitation of ·
the Cancer Patient.
McGraw-Hill, 1976.
1
Students divide into groups of
four, read a case history of
a cancer patient.
a. identify characteristics of American Cancer Society,
each stage of diagnosis
Speakers Bureau.
b. outline areas of possible
psychosocial intervention.
c. discuss the value of vocational rehabilitation in
terms of self-worth, quality
of life and physical wellbeing.
Recruit a Social vJorker who
specializes in working with
Oncology patients to discuss
the need of the cancer patient
for psychosocial, physical and
vocational rehabilitation.
I
Ask a cancer patient to share
some of their rehabilitation
experiences with the students.
---
______
Ii
_)
l.il
Ul
CONTENT OUTLINE
SUGGESTBD LEARNING OPPORTUNITIES
....._---------+-·-··-.·---·--II. Role identi:t.y and
other adjustments
as they relate to:
A. Male as head of
household
B. Female as head
of household
c.
RESOURCES
l
I
I
I
~Vife
D. Child
III. The Psychosocial
Adjustment Period
IV.
I
·I
!
I
1
Social Needs
A. System intervention or how
to ask who for
what
B. Building a
support system
1. family
2. work
3 commun1ty
.
c. Clergy intervention
1. the art of
active
.
l-~---·· . . -
llsten1ng__ _
I
__j
U1
0"1
---------·----------------------~----
~--·--·--·---------
1
Understanding the patients' and one's own psychological frame of reference
is necessary to facilitate effective counselling.
I
CONCEPT:
I\
INSTRUCTIONAL OBJECTIVE:
I
I
I
EVALUATIVE CRITERIA:
-Students' summaries should include discussion of cancer:
a
disease entity; the diagnosis of cancer in themselves or a
significant other; their feelings about death.
CONTENT OUTJ,INF.
I
II
I
I. Dealing with Role
1.
Expectations
A. The clergy's expectation of themselves.
B. The cancer patientls'
expectations of
themse 1 ve s.
C. The clergy's expectation of the
cancer patient
D. The cancer patientis'
expectation of thE
clergy.
i
L------···-···
Following instruction, students will summarize their own
feelings about cancer.
SUGGESTED LEARNING OPPORTUNITIES
Divide stuqents into sm~~l
groups to discuss:
a. the first time each person
encountered death
b. the first time each person
knew someone with cancer
c. what it would mean if they
were diagnosed as having
cancer
d. what they would like to have
someone else do for them if
they had cancer
e. how the students feel about
talking to someone who has
cancer.
RESOUJ:\CES
Rogers, Carl. On
a Pe:r:-son.
Bower and Bower.
ing Yourself.
~ecominJ
Assert-,I
.i
01
.,;.J
..
iI
I
-· ·-
.
--·----··
·--
-----
CONTENT OUTLINE
---
---······--
---··· - ··---··
-
---- ·····-
.
- ··--
-
--
-- .. -
...
-·- ·- --
-·
--- --·
.,
-·-
·SUGGESTF.D LEARNING OPPORTUNITIES
RESOURCES
j
2. Recruit a psychologist experienced in working with cancer
patients to discuss the role
expectation encountered in
counselling cancer patients and
their families.
3. Invite a cancer· patient to
discuss with the students "How
the Clergy Could Have Helped
Them Through a Difficult Time"
I
I
I
I
i
I
-----
··----------------
·--- -·-------·-··
------ -
U'l
co
- - - - - - ·------------·
r--------------------1
I
l CONCEPT:
I
Understanding the patients' and one's own psychological frame of reference
is necessary to facilitate effective counselling.
INSTRUCTIONAL OBJECTIVE:
EVALUATIVE CRITERIA:
Following instruction, the students will list the emotions
that are most often displayed by cancer patients trying:
to cope with the diagnosis of cancer.
Each student will list the seven most common emotions displayed
by cancer patients during the course of treatment.
'
I
I
I
f
~~---C-O_N_T_E._N_T_O_U_T_L_l_N_E.____~,---S-U-G-GE-. S-T-_.E_O__L_E_A-RN_I_N_G-~-O-P._P_O_R-TU_N_!_T-.I-_E-S--~~-------R-E-SO_U_R_C-·~-·~--------_1
I. Dealing with
A.
B.
C.
D.
E.
F.
G.
Anger
Sadness
Grief
Alienation
Anxiety
Acceptance
Denial
Emotion~
1.
2.
3.
Recruit a psychologist fa~niliar Kubler-Ross, Elizabeth
with the emotional probl.ems
Death, the Final
con~on to cancer patients to
Stage of Growth. New
identify the seven emotions
Jersey: Prentice Hall,
most commonly elicited by cancer
1975.
patients.
Shn~idman, Edward.
Have the group of students
Death and Dying.
divide into seven groups. Each
group will describe a set of
circumstances surrounding the
display of one of the seven
emotions.
Each student will write a
I
I
-~---··-·~"··--··--····~~-~-------------'
Ul
1..0
---------
-··-····---------
RESOURCES
SUGGESTED LEARNING OPPORTUNITIES
CONTENT.OUTLINE
i
I
behavioral example for each
emotion.
i
I
I
4.
I
L__------·-·
-----------
Given a behavioral description,
each student will be able to
identify the corresponding
emotion.
- ·-·1 - ·.
____ __)
m
0
,---------·--------
CONCEPT:
-------------------------------------~----------·-·----------------------------
·----------,
Understanding the patients and one's own psychological frame of reference
is necessary to facilitate effective counselling.
INSTRUCTIONAL OB,JECTIVE:
EVALUATIVE CRITERIA:
Following instruction, each student will apply the
dynamics of counselling discussed during instruction to
dealing with f·our of the emotions displayed by cancer
patients coping with the diagnosis of cancer and its
anticipated prognosis.
Students will view a·videotape counselling session of a
cancer patient and a psychologist and will give examples of:
1. establishing a relationship
2.
facilitation of patient's expression of fear
3. using feedback
CONTENT OUTLINE
I. Dealing with the
I 1.
dynamics of the
Counselling process
A. Establishing a
relationship
I 2.
B. Facilitating the
patient to expresE
their concerns anc
feelings.
l 3.
C. Perceiving the
patients predominant orientation
to the situation.
D. Establishing goals
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
Recruit a psychologist to discus
the dynamics of the counselling
process.
Have the students role play
both the part of the counsellor
and the cancer patient.
Videotape these roleplaying
scenes. At the conclusion,
the videotapes should be reviewed by the students. Each
student will identify the
dynamics of the counselling
_ _ _j
0'\
1-'
l
I
SUGGESTED LEARNING OPPORTUNITIES
CONTENT OUTLINE
RESOURCES
r
E. Use of prayer
F. Responding to
time element
G. Using feedback
process and the emotion displayed by the patient.
4. Each student will note which
dynamics are effective with the
various emotions.
5. Students will reveiw case histories of cancer patients to
identify counselling used with
the various emotions.
L-----------------
·---·---,---
"'tv
Chapter 5
SUMMARY
The purpose of this study was to develop a curriculum guide for a cancer education program whose target
audience was members of the clergy.
Justification for this
study came from the need expressed by numerous community
clergy members to include psychosocial support programs
as part of the treatment regimen for cancer patients.
Identification of the psychological care of the cancer
patient as a health problem and the fact that there were
few health professionals trained in this area of psychological support provided the perspective for the development of this curriculum guide.
It is hoped that this
curriculum guide will serve as a model for the development
of additional cancer education programs for allied health
professionals.
A curriculum has been defined as a package of
planned learning experiences developed to influence
knowledge, attitudes, and behavior.
Planning this cur-
.riculum involved identifying and arranging learning
,experiences so that effective learning took place.
The
eight-step rationale developed by Fodor and Dalis served
as the model for the development of this cancer education
!
1
curriculum guide:
63
64
1.
Developing points of view
2.
Selecting content
3.
Structuring knowledge
4.
Formulating goals and objectives
5.
Developing learning opportunities
6.
Organizing instruction
7.
Developing evaluative criteria
8.
Developing criteria for teacher preparation
Methodologies
The Delphi technique was successfully used in the
planning of this curriculum guide.
It was instrumental in
obtaining the quality and quantity of information
sary to construct a comprehensive learning guide.
neces~
Utiliza~
tion of the Delphi technique enabled this author to work
:with more then twenty health professionals to gather and
organize the identified content material which was
. included in the curriculum
guide~
By using the Delphi
:technique, this planning process was accomplished in less
'than six months.
It is the author's feeling, based on past program
planning experience, that had a standard planning
com~
•mittee process been used,. it would have taken more than
a year to compile, organize, and structure the content
included in this curriculum
guide~
The standard committee process usually involves
conducting planning sessions on a monthly basis.
These
65
meetings continue until the program is planned.
The
reason this method takes so long to accomplish the goals
of progrrua planning is that group dynamics interfere
with the planning process.
The Delphi technique eliminates
interference due to group dynamics.
Evaluation
Of primary concern to this project was the
evaluation of the ability of this curriculum to meet the
educational needs of the clergypersons.
The curriculum
guide was pretested on a group of fifteen ecumenical
priests and the advisory committee for their review and
evaluation.
Each of the evaluators reviewed the cur-
riculum and provided feedback in the areas of:
1.
Concepts
2.
Content
3.
Objectives
4.
Learning opportunities
;The feedback was used to revise the curriculum guide into
i its present version.
Since the inception of this project, the Cancer
and the Clergy program has been implemented four times.
Each time the curriculum was evaluated by the program
participants.
And each time several revisions were
recommended by the program participants.
These changes
do not necessarily indicate flaws in the program but
rather changing needs in the target population.
Needs
66
•do change with the passage of time.
Anyone involved in
·the development of a curriculum guide should keep this
'in mind.
'rhis author contends that recommendations for
ichanges in curriculum components should not be viewed as
·negative feedback.
These changes should be viewed as
changes in the point of view of the target population
(discussed in Chapter 3) and treated as justification for
frequent revising and updating of the curriculum guide.
In conclusion, the author hopes that this curriculum guide will serve as a model for the development
of additional cancer education programs for allied health
professionals.
---
--------··--·-------------~--·----------·-
------~----------~··----------·
----.
REFERENCES
1.
American Cancer Society. A Cancer Sourcebook for
Nurses.
New York: American Cancer Society, Inc.
1975.
2.
American Cancer Society. 1978 Cancer Facts and
Figures. New York: American Cancer Society, Inc.
1977.
3.
American Cancer Society. 1977 Cancer Facts and
Figures. New York: American Cancer Society, Inc.
1976.
4.
American Cancer Society. The Psychological Impact
of Cancer. New York: The American Cancer
Society, Inc. 1974.
5.
Baker, Lynn S., Charles G. Roland, Geralds.
Gilchrist.
You and Leukemia. Minnesota:
Mayo Comprehensive Cancer Center.
1976.
6.
Breeding, Mary Ann and Myron Wollin.
"Working
Safely Around Implanted Radiation Sources"
Nursing 76. Pennsylvania: Intermed Communication.
1976.
7.
Clark, R. Lee. Rehabilitation of the Cancer Patient.
Chicago:
Year Book I>fedical Publishers. 1970.
8.
Cox, Barbara G., David T. Carr, Robert E. Lee.
Living with Cancer. Minnesota: Mayo Comprehensive Cancer Center. 1977.
9.
Crosby, Muriel. Curriculum Development for Elementary Schools in·a Changing Society.
Boston:
D.C. Health and Co. 1974.
·10.
Cullen, J. (ed.) Cancer: The Behavioral Dimensions.
A National Cancer Institute Monograph. New
York:
Raven Press. 1976.
li.
Cyrs, Thomas E. Jr., and Rita Lowenthal.
"A
Model of Curriculum Design Using a Systems
Approach." Audio-Visual Instruction.
15:16-18.
January 1970.
67
68
r-----·· - - - - - - - - - - - - - - -
1
--------------------
------------~
---~------------
-----~--------,
12.
Dalis, Gus and Ben Strasser. "Teaching Strategies for
Value Awareness and Decision Making in Health
Education." Unpublished Guides. Health Sciences
Department. California State University,
Northridge. 1976.
13.
Eisman, Seymour. "An Approach for Student Involvement
in Health Education Classes." The Journal of
·School Health.
39:408-411. June 1969.
14.
Fodor, John T., and GusT. Dalis. Health Instruction:
Theory and Application. Philadelphia: Lea and
Febiger. 1974.
15.
Fodor, John T. and Waleed A. Alkhateeb. Solving
School-Community Health Problems. Northridge:
Department of Health Sciences, California State
University, Northridge. 1976.
16.
Fodor, John T. "A Conceptual Approach to Curriculum
Development in Venereal Disease Education."
The Journal of School Health. 43:303-306.
May 1973.
17.
Fodor, John T., and Russell J. Purcey. Health
Teaching--A Challenge. Northridge: Department
of Health Sciences. San Fernando Valley State
College. 1967.
18.
Glaser, Barney G., and Anselem L. Strauss. Awareness of Dying. Chicago: Aldine Publishing Co.
1965.
19.
Hinton, John.
1967.
!20.
!
21.
Dying.
England:
Penquinn Books.
Kagan, A. Robert. Radiation Therapy: A Manual for
Patients and Their Families. Southern California
Permanente Medical Group. Unpublished. 1977.
Kaufman, Roger A. "A System Approach to Education:
Derivation and Deviation." Audio-Visual Communication Review. 16:415-425. Winter 1968.
69
'22.
Kavanaugh, Robert A. Facing Death.
Penquinn Books. 1972 •
Los Angeles:
. 23.
Keith, Robert L., Howard C. Shane, Harvey L.C.
Coates, and Kenneth Devine. Looking Forward:
A Guidebook for the Laryngectornmee. Minnesota:
Mayo Comprehensive Cancer Center. 1977.
24.
Keleman, Stanley.
Random House.
25.
Koopman, Robert H. Curriculum Development. New
York: The Cadre for Applied Research in
Education, Inc.
1966.
26.
Krug, Edward. Curriculum Planning.
Horpel and Brothers Publishing.
27.
Kubler-Ross, Elizabeth. Death: The Final Stage
of Growth. New Jersey: Prentice-Hall. 1975.
28.
Lavatelli, Celia, Walter Moore, and Theodore
Kalastousis. Elementary School Curriculum.
New York: Holt, Rinehart and Winston, Inc.
1972.
29.
Levine, Sol and Norman A. Scoth (eds.)
The Dying
Patient. New York: The Russell Sage Foundation.
1970.
30.
Maugh, Thomas H. and Jean L. Marx. Seeds of
Destruction. New York: Plenum Press.
1975e
31.
Mays, Lowell H.
"A Cancer Residency for Clergy."
Bulletin of the American Protestant Hospital
Association. Special Edition of Pastoral Care.
March 1977.
32.
National Cancer Program Report to the Director.
1975. u.s. Department of Health, Education,
and Welfare. Public Health Service. National
Institute of Health. DHEW Publication No.
(NIH) 77-472.
Living Your Dying.
1974.
New York:
New York:
1950.
70
,-
---~-----~-------~·-----------------------------.--------------------~---------------·---~----·-----~
33.
Nichols, Audrey, and Howard Nichols. Developing a
Curriculum-A Practice. London: George Allen
and Unwin LTD. 1973.
.34.
Parad, Howard J. (ed.)
Cris·es Intervention: Selected Readings. New Yurk: Family ServJ...ce
Association.
1965.
I
35.
Rammers, H.S., N.L. Gage, Francis J. Remmel.
Measurement and Evaluation. New York: Harper
and Row Publishers. 1965.
36.
Richards, Victor. Cancer the Wayward Cell. Berkeley:
University of California Press. 1972.
37.
Rubin, Philip. (ed.)
Clinical Onco.logy for Medical
Students and Physicians. New York: American
Cancer Society, Inc. 1974.
38.
Shimkin, Michael B.
Scienc:e and Cancer. DHEW
Publication No. (NIH) 16-568. U.S. Department
of Health, Education and Welfare. 1975.
39.
Smith, Elizabeth A. Psychosocial Aspects of Cancer
Patient Care. New York: McGraw-Hill. 1975.
40.
Smith, Elizabeth. A Comprehensive Approach to Rehabilitation of the Cancer Patient. New York:
McGraw-Hill. 1976.
4le
Smith, Othanel, William Stanley and Harbor Schores.
Fundamentals of Curriculum Development. New
York: World Book Co. 1950.
:42.
Toynbee, Arnold. Man's Concern with Death.
York: McGraw-Hill·Book Co. 1968.
:43.
Van Scoy-Mosher, Michael. Chemotherapy: A Manual
for Patients and Their Families. Unpublished.
1977.
44.
Weisman, Avery D. On Dying and Denying.
Behavioral Publication.
1972.
New
New York:
.--- ·----- ---------
------~·---
._ ___________ - - - ---·-- - -·----------- -- -·- --·-- --- --- - - - - - - - - - - - - - - --· ---- -· -- ----- ---
APPENDIXES
71
~--------
-.- - - - - - · - - - - - 1
APPENDIX A
PRE-PROGRAM QUESTIONNAIRE
72
73
CANCER AND THE CLERGY INTERNSHIP
PARTICIPANT PROFILE
Personal Data:
Name:__________________~--------------
Add~=-----------------------------
-------
Phone:
·-----
Denomination:
Marital Status:
Age:______
Number of Children:
Sex:__________
Educational Background:
Highest Attained Degree:
Major:
Other non-rei igious work experience:_________________________________
How long have you been a congregational or parish clergy? ------------------In what other states have you serVed as a congregational clergy? --------------
Why did you go into the clergy?------------------------------
Porticipant Profile : Page 2
74
Congregational Data:
l.
Number of fomilies in congregation:
-----
2. Average onnuol income of fomilies in your congregation:
(a) under $8,000
0;1) S,Q00-13,000
(d) 20,000-30,000
(e) over 30,000
(c) t3,00G-20,000
J·. · Does your church/synagogue provide social progn:ms far ·its members?
no
Type af social function
Ii yes, fill out the following:
Haw often is
it offered?
How many
members attend?
. 1.
2.
3.
4.
s.
6.
7.
8.
9.
10.
4. Does your church/synagogue provide heol!li-related education progriuns
for its members?
_ _ yes
no
If yes, fill out the following:
,
..
Participc:nt Profile : Page 3
75
Description of educational programs:
How often is
it offered?
Title of Educ:otionol Program
5.
How many
members attend?
What percentage of your churc:h/synogogue members ·interact with eoc:h otner
outside of the ·rei igious setting?
%
Cou~ling
h
I
Experience Data:
Hove you attended any· counseling- or skill building prc:grom:s?
__yes
nc
if yes, (a) What tapic:s were covered?
(b) How long was the program?
_ _ one day
ser.~ester
_ _ other, please specify
weekend
(c:) Whet was the psyc:hologiccrl or theologiccl frame of reference?
2.
A£ o member of the clergy, hew muc:h time do you spend counseling each week?
I of hours
3. How many ~patients hove you counsel•d?
:;:;_
..
:~
·-:~
Participant Profile
Page 4
76
4. For eoch.concer patient ycu have c:ounseled, please fill in the following
information:
1st
2nri
PATIENTS
3rd
4th
5th
6th
-n~.mber
of counseling sessions
-ag~ of the patient
-sex af the patient
-type of cancer (usa revene side}
-did you work with the patient's doctor
-did you work with the family_
-did you work with the hospital c:lergy
-did you work with the patients
ccmmunity referral services
-did you feel prepared for the
e:o:perience
-was it a positive or negative
e:o:perienc:e for you
5.
Hov many members of your congregation vould you estimate to be in need of
counseling as a direct result of cancer in themselves or in their facily:
I
#
I
I
1
I
of
of
of
of
of
of
women
men
family memben coring for cancer patients
children
--aged (Senior citizens)
extended care foci! ity residents
6. With additional skill, ·would you spend more time assisting ycur :embers who
ore cancer patients?
yes__
no
7 • Do you feel that the cancer patients or their families in your congregation have
appropriate expectations of you in your role· as a clergymen?
yes__
8.
no
My major frustrations as a member of the c:lergy working wHh a cancer patient,
in order of priorities, are:
a. ---------------------------------------------------b.
c.
d.
--~---------- .... a.~-
77
PARTICIPANT QUESTIONNAIRE: MEDICAL
Please circle the correct response(s):
1.
Cancer ce!ls·break away from malignant tumor and spread through the bloodstream
and lymphatic system to other parts of the body. This is called:
a. chemotherapy
b." metastasis
c. clustering
d. none of the above
2.
Cancer is a group of diseases. Some of the different subgroups include: carcinoma,
melanoma, sarcoma, lymphoma. What is the major difference between these
subgroups:
a. age of the cancer at time of diagnosis
b. type of tissue the cancer originated in
c. the type of therapy effective in treating cancer
3.
For women, the most common major site of cancer is:
a. uterus
b. breast
c. pancreas
d. lung
4.
For men, the most common major site of cancer is:
a. colon-rectum
b. prostate
c. lung
d. pancreas
.5.
·The three types of treatment
mos~
often used to treat cancer are:
a. chemotherapy, surgery, radiation therapy
b. surg:ry, penicillin, biopsy
c. vitamins, chemotherapy, dietary regulation
d. surgery, vitamins, epidemiology
6.
Survival rates could be increased to
with earlier diagnosis and prompt
treatment.
---
a. 33%
b • .50%
c. 66%
d. 7.5%
(
. 78
7.
Possible causes of cancer include:
a.
b.
c.
d.
e.
8.
exposure to sunlight
cigarene smoke
a blow to a part of the body
exposure to aniline dyes
all of the above
Which phrase(s) most closely describe(s) "cancer'':
a. a disease which ocC:urs only in humans
b. a normal biologic process
c. uncontrolled multiplication of cells
d. does not impede the functioning of tissue, bone, or muscle
e. a contagious disease ·
Please circle T if the following statements are true, F if they are falso.
!1.
All tumors are cancer.
T
F
T
F
10.
Radiotherapy uses x-rays, radium, and ionizing
destroy cancer cells.
11.
Radiosensitive tumors cannot be destroyed by radiation therapy.
T
F
l:Z.
Surgery is the best method of treatment for disseminated disease.
T
F
13.
The only effective way to destroy cancer is to remove it surgically
from the body.
T
F
14.
"Staging of cancer" refers to measuring the extent of spread of
the cancer.
T
F
1,.
Chemotherapy is only effective if the cancer is localized in one area.
T
F
16.
Chemotherapy is a term l.ised to describe the use of viral agents for
the treatment of cancer.
T
F
17.
Approximately one of
T
F
18.
Cigarrene smoking causes 8096 of lung cancer.
T
F
1!1.
Cancer is responsible for more deaths in children aged 1-14 than
any other disease.
T
F
20.
Leukemia accounts for one half of cancer-related deaths among
children.
T
F
21.
The five year survival rate for children with leukemia is '096.
T
F
22.
Certain diets have been proven to cure cancer.
T
F
radiation to
three persons who have cancer can be cured.
~-
-~--~:.:- ~..:_~·-·
_: : ..-_:_:, ___ --
79
23 •.. The major factors to be considered in the patient's adjustment of the diagnosis of
cancer are: .
-
a. vocational, religious, and aesthetic
b. social, aesthetic, and physical strength
c. personal (physical &. psychological), vocational, and social
d. mental alertness, social, aesthetic
24.
The most common barrier(s) to effective communication with cancer patients is {are);
a. ph-ysical (the patient is physically prevented from communicating)
b.' semantics (persons interpret the words differently)
c. emotional (patient uses defense mechanisms such as deniel, avordance,
repression)
d. negative attitudes &. hearing loss
2,.
Communication with the cancer patient:
a. is only verbal
b. is only nonverbal
c. may be both verbal &. nonvvrbal
d. is more nonverbal than verbal
iz:~
PARTICII'ANT QUESTIONNAIRI!r PSYCIIOSOCII\L
•1•
Please prlorlllze rhe lollowln& roles In ordor ol slanlllconce with
belnsthe moot
lonporlanl and"'" beln&lheleutlonporlanl,
1.
lleellho mosl lmporlanl role lhe ci••&Y can oller lo the concer pallenllll
2.
l.
lleel tlwll lhe type ol role mO.I cleru are most ellecllve In ollerln& II tlwot oh
lleelthe type ol role llwlve moot allen lwld the OWOfllfiltr lo lulllll lor
'·
I feel I ant contrlbutln& moll when I can be ol tervlce at ••
-
Please check lhe moot appropriate re1ponse lor the lollowlna UJtemenh
],
Compared wllh • phy;lclon, llcel that lhe service tlwol the cleriJ oilers to ·
a cancer patient 111
(al less alsnlllcant
(bl <!JU4IIr olanlllc.nl
(cl more slanlllcanl
)!
!·
'
~i
!:
Ploose chedc the most approprlale bo• lor each question or Olalemenl belowr
6.
I am confident thai I can work dlecllvelr wllh the cancer p;rllenll
7.
I orn conlldenl !hall can work ellecllvelr wllh the cancer pallenl's lomllrr
a.
I am conlldentthal I can work eflecllvelr wllh lhe cancer pallenl'a phrslciiRI
'·
I am coolldenl lholl can work ellecllvelr wllh lhe cancer pallenl'l cornmunltr relerrol
aervlce11
10,
I am conlldenlllwltl con work ellecllvelr wllh • woman •• a concer pallenll
II,
12,
I arn confident !hall can 01ork ellecllvelr wllh • man •• a concer pal Ienir
-·-\-1
I
I
I
I
1--1
I
I
1--t·-
1--+
I
I
I
1-
'-•-!---1
I
I
I am conlldenl thai I c.n work ellecllvelr wllh a child 11 a concer potlenlr
IJ.
I am conUdet11 that I can work dlectlvelr with an adolescent at a cancer patlenh
I'·
U.
I am coolldenl I hall can work ellecllvelr wllh an old person •• a cancer pallmll
I om confident. I hall can be&ln a counselln&selllon ellecllvelr brr
(a) Ollabllohln& lrUIII
lbl laciUlalln&lhe p;rllent 10 npreu their CCNICerns and leelln&"
(cl percelvln& lhe pallonlo' pred<Nnlnml orlenlallon Ia their slluaiiCNISI
(d} 1.-cllllollna the pallenls to eMpress lhelr tapeclollonl ol the clerar•
lei establhhln& aoalo lor lhe COlfiSOIInaoeuloru
(I) uoln& pro yen
:,.
I
00
0
;'1
1·'·:
.Olu1~;.t-l.W:-co'·
(1 '·~~~~,,
'r~
y
t.''
l)iuticipant Que5tionnaire
!
l'as> Z
:I
l
i.i,,
,.
16.
I am coollden& thai I c111 ~a CO<lll.. llns """loo ellecllvtl1 b11
·I
(a) summarlzln&
.j
(b)
'I
li,,
~I
I;j
(c)
respond! nato a Uone element
u.ins mutual leeclb;icll
(d) usln& pra~er
17.
lam confident 1t...1ln a counsellnC sesolool can deal
ellectlvel~
wllh the CIIICer
patlenh' leelincs oh
!I
(a) anaer
(b) sadness
!!
n
•·
(c) ariel
(d) allenatloo
(e) an•lel~
(I)
accepaance
I&) deuial
i:
;;
11.
I ilm confident IMI I can deal
wl~h
phrslcal contact •• 1 me••.s ol
cancer patienla
''·
20.
21,
I am coolldenl !ball can deal wllh a patient lalkln& about
I om conlldenl that I can deal wilh a pollent•o deolho
lam conlldenl In euabllshln& role npoclaiiOIIS lorr
d~lnsr
raau~ance
lor the
-
-
-
(a) lhe cancer patient's e•pectulon ql lhe cler&r •• • counselor•
l·
(b)
,,
(c) the cancer patient's e'll:peCialions lor
'
·t
t~
·t ~
~~
.~<~:
(d)
1he der&J'01 expectations ol lhe cancer patlcnla
m~
lhem~elvcsa
own upecialloos ol my,.ll as a cler IY'
1- -
r-
R
00
....
__
_.:..:
~.-
-~~:=:-. -...::::.;~_:.._:.;.
____...,_ --- -- ·-·--·--~-- - .. -··· >.-.--
.. :.'"
sz
CANCER AND THE CLERGY INTERNSHIP PROGRAM
FUTURE WINDOW
This exercise is designed to help us individualize the content of the Cancer and the
Clergy Internship Program to better meet ~ needs. This exercise is called "futuN
windowing". It is designed to help you examine: (o) what you hope will happen
and what you expect will happen; (b) what you hope will happen but do not expect
will happen; (c:)WiiQt you ho!ffi will not happen, bUt whOt you expect will hOppen
~i (d) what you hope wTI not hc:~ppen Clnd do not expect to hCppen. These
hOpeiand expectations ON relc:~ted to your participation in ttle Cancer and the Clergy
Internship Program.
INSTRUCTIONS FOR USING THE FUTURE WINDOW:
Please review the progn:m schedule we hC!Ve sent you, then fill in the cells on the
"future window• as described below:
Cell 1
Will you please think of as mc:~ny things os you can that you want to
hove happen and believe will happen during the Cancer and the Clergy
Internship Program. As you think of things·, jot them down in Cell 1.
. Cell 2
Will you please think of as many things os you can that you want to
hove happen but do not believe will happen during the Cancer and the
Clergy Internship Program. /u you think of them, jot them down in
Cell 2.
Cell 3
Will you please think of CIS many things CIS you con that you do not
wont to happen but that you believe may happen anyway during the
Cancer and the Clergy Internship Program. As you think of things,
jot them down in Cell 3.
Cell 4
Please think of as many things as you can That you do not want to
happen and do not believe will happen during the Cancer and the
Clergy lnte~rom. /u you think of these things, jot them
down in Cell 4.
~-,·~!:··~··'f·'?'·.
~~:-:~:.-:;,•;:.:_~-;.;:
83
FUTURE WINDOW
Expect will happen
Expect will not happen
.
Hope
will
1appen
-
Cell 1
Cell 2
Cell3
Cell4
Hope
wil I
not
happen
-.
. 'tf'.:.\•.f<f~
........,
. ·.~ •
84
PARTICIPANT QUESTIONNAIRE: MEDICAL
Please circle the correct response(s):
1.
Cancer cells break away from malignant tumor and spread through the bloodstream
and lymphatic system to other parts of the body. This is called:
a. chemotherapy
b. metastasis
c. clustering
d. none of the above
2.
Cancer is a group of diseases. Some of the dlfferent subgroups include: carcinoma,
melanoma, sarcoma, lymphoma. What is the major difference between these
subgroups:
a. age of the cancer at time of dlagnosis
b. type of tissue the cancer originated in
c. the type of therapy effective in treating cancer
3.
For women, the most common major site of cancer is:
a. uterus
b. breast
c. pancreas
d. lung
4.
For men, the most common major site of cancer is:
a. colon-rectum
b. prostate
c. lung
d. pancreas
5.
The three types of treatment most often used to treat cancer are:
a.
b.
c.
d.
6.
chemotherapy, surgery, radiation therapy
surgery, penicillin, biopsy
·vitamins, chemotherapy, dletary regulation
surgery, vitamins, epidemiology
Survival rates could be increased to
with earlier diagnosis and prompt
treatment.
---
a. 33%
b • .5096
c. 6696
d. 7.5%
~
.
85
7.
Possible causes of cancer include:
a. exposure to sunlight
b. cigarette smoke
c. a blow to a part of the body
d. exposure to aniline dyes
e. all of the above
s.
Which phrase(s) most closely describe(s) "cancer":
a. a disease which occurs only in humans
b. a normal biologic process
c. uncontrolled multiplication of cells
d. does not impede the functioning of tissue, bone, or muscle
e. a contagious disease
Please circleT if the following statements are true, F if they are falso.
9.
.
'
All tumors are cancer.
T
F
T
F
10.
Radiotherapy uses x-rays, radium, and ionizing
destroy cancer cells.
11.
Radiosensitive tumors cannot be destroyed by radiation therapy.
T
F
12.
Surgery is the best method of treatment for disseminated disease.
T
F
13.
The only effective way to destroy cancer is to remove it surgically
from the body.
T
F
14.
"Staging of cancer" refers to measuring the extent of spread of
the cancer.
T
F
1.5.
Chemotherapy is only effective if the cancer is localized in one area.
T
F
16.
Chemotherapy is a term used to describe the use of viral agents for
the treatment of cancer.
T
F
17.
Approximately one of
T
F
-{8.
Cigarrette smoking causes 8096 of lung cancer.
T
F
19.
Cancer is responsible for more deaths in children aged 1-14 than
any other disease.
T
F
20.
. Leukemia accounts for one half of cancer-related deaths among
children.
T
F
radiation to
three persons who have cancer can be cured.
21.
The five year survival rate for children with leukemia is 50%.
T
F
22.
Certain dlets have been proven to cure cancer.
T
F
86
23... The major factors to be considered in the patient's adjustment of the diagnosis of
cancer are:
a. vocational, religious, and aesthetic
b. social, aesthetic, and physical strength
c. personal (physical &: psychological), vocational, and social
d. mental alertness, social, aesthetic
•
24.
The most common barrier{s) to effective communication with cancer patients is (are):
a. physical (the patient is physically prevented from communicating)
b. semantics (persons interpret the words differently)
c. emotional (patient uses defense mechanisms such as deniel, avordance,
repression)
d. negative attitudes &: hearing loss
25.
Communication with the cancer patient:
a. is only verbal
b. is only nonverbal
c. may be both verbal &: nonvarbal
d. is more nonverbal than verbal
•
APPENDIX B
CANCER AND THE CLERGY: A CURRICULUM GUIDE
EVALUATION
87
-------------,_:::,:-_,_________ ,-=-----"'-··-··-~---'----·--------
~-
-·~----·-
\.ANI...cK ANU IHt: I..Lt:KI.;;Y INH:l<N!iHIP
88
PROGRAM EVALUATION
The purpose of this program evaluation is to assess which arecs of the program should
be changed the next time we offer the Cc:nc:er end the Clergy Internship.
Pleose rate the fallowing parts of the program on usefulness end quality, bc:sed on
a 1 -. 5 point scale
S"' the most positive scare
usefulni!SS to you
quality of prese\tations/mctericl
medical lectures
psychcsacial lec:tures
religious lectures
skill building exercises •
panel discussions
group disc:ussicns
reoding materials
Plecse rate the following parts of the program an c;uc:ntity of materials and difficulty of materia
based an a 1 - 5 point scale
.5-taa much matef"ia[
:.=too difficult
qucntity of materials
difficulty of materials
medical lectures
psychosocial lec:tures
religious lec:tures
skill building exercises
panel disc:ussi ans
group discussions
reading materials
Please rate the program moderators on a 1 - 5 scale, 5 =the most positive score:
Lowell Irwin, M.D.
Sherrie Bartell, Ph.D.
Ray Harris, Chaplain
What should be changed the next time the program is offered?
What did you like most about the pmgram?
Whet did you like le<>St about the program?
Overall, how did the program meet your expec:taticns on a 1 - 5 scale, 5=the most positive seer
f~0
29
89
RESPONSES TO TEE
CANCER AND TEE cLERGY IN'IERNSHIP
PROGRAM EVALUATION
What should be changed the next time the ptogtam is offeted?
a)
Considet having a co11111unity pastoe present the topic - "Clergy and
Cancer Treat:ment" rather than full-time hospital chaplain.
b)
Deal some with hov to stop cancer from happening - prevention of
cancer.
c)
Expand subjects covered in this program.
d)
Better planning and coordination of the panelists in the panel
discussion
e)
Additional related religious material, also a counterpart to
Heifitz which will balance the presentation.
f)
Perhaps more skill-building
g)
More of the same
h)
Even more time to specific skill-building.
from re-videotape {vhich ve never sav).
i)
No response
j)
More didactic material
k)
No response
1)
Include Tumor Board presentation, more medical presentations,
simplified. More use of board, bibliographies. Video tape of
good counseling.
m)
All parts are very good
n)
No response
I could have benefited
;;::'
·•
90
-2What did you like most about the program?
a)
Exchange
b)
Information about cancer effects on life of patient
c)
Group discussions
d)
The presentation of the Children's Hospital Program
e)
Children's Hospital presentation
f)
Thoroughness of coverage
g)
All
h)
The seriousness of purpose, respect for our intelligence, and
effective organization.
i)
Exposure to experts in the field & to other programs - team
approaches, community resources, etc.
j)
The fellowship, sharing, the delight of knowing that we shared
so many feelings and concerns.
k)
Lecture and group
1)
Presentation by Steve Bowles, more use of him would be helpful
n)
Small group - richness of different denominations
91
-3What did you like least about the program?
b)
Time spent in Children's Hospital (only because I do not work with
children in my hospital.)
Extended sessions on counseling skills, loosely structural
c)
Panel discussions
d)
A couple of the panel discussions which needed more planning
e)
Panel
f)
The specifically religious dimension
g)
Religious lectures
h)
No response
i)
The input from the chaplains was not always helpful---! wonder if
having a Catholic sister involved in pastoral care as part of an
oncology team might be a good addition to this part of the program.
j)
Dr. Heifetz, also some of the tiresome group discussions.
k)
No response
1)
Not enough breaks.
m)
Not long enough
n)
I liked everything
a)
Attention span thus affected.