Background: The purpose of this study was to clarify the effects of a facilitator training course focused on teaching beginners facilitator intervention skills. Intervention Method: One-and-a-half-day program combining education, role plays and relaxation. Methods: Participants were 11 participants, and of these 8 gave valid responses to our questionnaire. The scores of the participants on a facilitator intervention skills scale and on a scale of facilitator skills to cope with difficult situations were compared before and after the course, using SPSS16 for windows. In addition, the participants’ impressions before and after the course were analyzed qualitatively and inductively. Results: Seven of the 16 items on the facilitator intervention skills scale and 7 of the 12 items on the facilitator skills to cope with difficult situations improved the participants after the facilitator training. All participants indicated that they could understand the lectures. Their impressions changed from anxiety and enthusiasm to pleasure of learning and discovery of specific problems. Conclusion: The results suggested that the educational method created in this study, with emphasis on role-playing, is useful.
In recent years, increasing interest has been paid, both in Japan and overseas, to the psychosocial burden of cancer patients. Studies have been conducted to investigate the effectiveness of psychosocial interventions for reducing the psychological burden of cancer patients and improving their quality of life (QOL) [
Psychosocial group interventions for cancer patients will certainly be further disseminated in the future, but for this to happen, it is first necessary to create a therapeutic environment for providing group interventions. However, at pre- sent, there is a lack of human resources with the ability to act as facilitators (having the role of smoothly and effectively leading group discussions in group interventions). Facilitators provide interventions while facing difficulties in dealing with participants having problems, anxiety due to a lack of knowledge, and difficulty overcoming the fear of interventions, etc. [
Based on the above background, the purpose of this study was to clarify the effects of a facilitator training course focused on teaching beginners facilitator intervention skills.
This study is expected to serve as a foundation for finding the direction of facilitator education and for the dissemination of group interventions by clarifying the effects of the facilitator training course focused on facilitator intervention skills in group interventions for cancer patients.
Posters and leaflets were distributed at the nursing departments in 29 hospitals near a university and within a university to recruit those who wished to participate in the study. In all, 11 persons applied for participation.
Practice of the educational program of the I Can Cope Program [
Improvements in the program were made to incorporate easy-to-use skills. (
The effects of the program were evaluated along the curriculum as follows.
1) Level of understanding of the lectures
The level of understanding was assessed for each item on a 4-point Likert scale.
2) Changes in attitudes as facilitators
1) Facilitator intervention skills
The scale that we created consisted of 12 items selected using a qualitative study method from the facilitator techniques used in group therapy for cancer patients. Each item was assessed on a 4-point Likert scale, with scores ranging from 0 to 3: e.g., “I have high anxiety” to “I have no anxiety”. A scale of facilita-
Min. | |||
---|---|---|---|
First day | Guidance | 10 | |
Lecture | Purpose and effects of group therapy for cancer patients | 60 | |
Lecture | Facilitators’ role and skills Partnership in the group | 30 | |
Lecture | Communication methods | 15 | |
Lecture | Change of participants in the group | 15 | |
Lecture | How to role-playing | 10 | |
Practice | Role-playing sessions based on facilitators’ difficult-situation scenarios | 70 | |
Practice | Role-playing sessions based on facilitators’ difficult-situation scenarios | 85 | |
Second day | Practice | Role-playing sessions based on facilitators’ difficult-situation scenarios | 85 |
Practice | Role-playing sessions based on facilitators’ difficult-situation scenarios | 85 | |
Practice | Role-playing sessions based on facilitators’ difficult-situation scenarios | 85 | |
Lecture | The relaxation method | 20 | |
Practice | Exercises of the relaxation method | 40 | |
Lecture | How to conduct group therapy | 20 |
tor skills to cope with difficult situations consisting of 12 items of difficult situations was also created by reference to representative difficult cases reported by Morita et al., and the level of anxiety was assessed on a 4-point Likert scale with scores ranging from 0 to 3:e.g., “I have high anxiety” to “I have no anxiety”.
2) Impressions of the group facilitator training course
The participants were encouraged to freely describe their impressions of role- playing exercises, what was good or bad, future problems, etc.
This study was conducted with the approval of the Ethics Committee of the School of Heath Sciences, Faculty of Medicine, Tottori University. Researchers explained the purpose of the study verbally and in writing to the participants.
1) Changes in attitudes as facilitators
Scores on each scale before and after the training course were statistically compared by the Wilcoxon test using SPSS16 for windows. The level of significance was set at p < 0.05.
2) Impressions
I read free descriptions on days 1 and 2 of the training course again and again, classified the descriptions into categories according to their meaning, gave them category names and counted the number of descriptions for each category.
Attributes of the participants
There were 11 participants, and of these, the responses of 8 were investigated. The remaining three participants were excluded because they failed to attend the entire one-and-a-half-day training course. Participants in their 20s (n = 3) and 30s (n = 3) were the most common. Nursing practice was the most common occupation (n = 4), followed by nursing students (n = 3). Two participants had previous experience of participating in support groups and 3 had experience of participating in patient groups, but none had previously attended a facilitator training course (
All 8 participants answered that they understood all the lectures (purpose and effects of group therapy for cancer patients, significance of group experience for cancer patients, communication methods, roles and techniques of facilitators, relaxation method, and how to conduct group therapy) (
1) Facilitation ability
n | ||
---|---|---|
Age | 20s 30s 40s 50s | 3 3 1 1 |
Job category | Nurse Graduate student University student | 4 1 3 |
School register | Vocational school Junior college University Graduate school | 1 2 4 1 |
Previous experience of participating in support groups | Yes No | 2 6 |
Experience of participating in patient groups | Yes No | 3 5 |
Yes No | 0 8 |
Yes | No | |
---|---|---|
Purpose and effects of group therapy for cancer patients | 8 | 0 |
Meaning of group experience for cancer patients | 8 | 0 |
Communication methods | 8 | 0 |
Roles and techniques of facilitators | 8 | 0 |
Relaxation method | 8 | 0 |
How to conduct group therapy | 8 | 0 |
Analysis of the participants’ facilitation ability before and after the training course revealed that the score on the facilitator intervention skills scale (total score) and that on the facilitator skills to cope with anxious situations (total score) significantly improved after the training (p < 0.05) (
In addition, the individual scores for the following items concerning facilitator intervention skills improved significantly: “consider time and distribution of speaking time among individuals”, “express participants’ feelings in place of them”, “encourage participants to reflect on themselves”, “show oneself as standing face to face with participants”, “participants want to interact with other participants”, “participants play the role of facilitator in place of the facilitator”, and “the facilitator and sub-facilitator cooperate with each other”. Furthermore, the individual scores on the following question items concerning facilitators’ ability to cope with difficult situations also improved significantly: “when some participants do not speak at all”, “when silence lasts long”, “when some participants express dissatisfaction with how to proceed with the group”, “when participants often grumble and complain about medical staff”, “when participants develop recurrence or metastasis (disease progression)”, and “when there is a
Before Mean ± SD | After Mean ± SD | ||
---|---|---|---|
Total | The facilitator intervention skill (16 items) | 18.25 ± 7.85 | 26.62 ± 0.53* |
1 | Consider time and distribution of speaking time among individuals | 1.25 ± 0.46 | 1.50 ± 0.74 |
2 | When the discussion deviates from the theme, return the discussion to the theme of the day | 1.12 ± 0.64 | 1.37 ± 0.88 |
3 | Accept participants’ feelings and give them correct knowledge | 1.12 ± 0.83 | 1.25 ± 0.53 |
4 | Sympathize participants’ feelings in place of them | 1.25 ± 0.70 | 1.50 ± 0.51 |
5 | Express participants’ feelings in place of them | 0.87 ± 0.99 | 1.37 ± 0.92* |
6 | Able to play the role of (sub-)facilitator | 0.37 ± 0.51 | 1.00 ± 0.74 |
7 | Encourage participants to reflect on themselves | 0.62 ± 0.74 | 1.37 ± 0.75* |
8 | Protect participants mental and physical condition | 1.37 ± 0.51 | 2.00 ± 0.51 |
9 | Strengthen mutual support among participants | 0.87 ± 0.83 | 1.62 ± 0.51 |
10 | Show oneself as standing face to face with participants | 0.87 ± 0.83 | 1.62 ± 0.74* |
11 | Presence with participants to accept their feelings | 1.50 ± 0.53 | 2.00 ± 0.75 |
12 | Participants do not want to know other participants’ experiences | 1.50 ± 0.92 | 1.75 ± 0.88 |
13 | Participants want to interact with other participants | 1.37 ± 0.74 | 2.37 ± 0.74* |
14 | Participants play the role of facilitator in place of the facilitator | 1.00 ± 0.75 | 2.00 ± 0.75* |
15 | There is humor in discussion | 1.37 ± 0.74 | 1.62 ± 0.51 |
16 | The facilitator and sub-facilitator cooperate with each other | 1.75 ± 0.70 | 2.25 ± 0.88* |
Total | The facilitator skills to cope with anxious situation (12 items) | 10.62 ± 6.27 | 17.62 ± 6.52* |
1 | When some participants talk very long | 0.75 ± 0.88 | 1.62 ± 0.74 |
2 | When some participants do not speak at all | 0.75 ± 0.70 | 1.62 ± 0.51* |
3 | When some participants express strong feelings | 0.75 ± 0.70 | 1.12 ± 0.83 |
4 | When silence lasts long | 0.87 ± 0.64 | 1.87 ± 0.64* |
5 | When some participants express dissatisfaction with how to proceed with the group | 0.62 ± 0.74 | 1.37 ± 0.74* |
6 | When participants often grumble and complain about medical staff | 1.12 ± 0.35 | 1.75 ± 0.46* |
7 | When participants develop recurrence or metastasis (disease progression) | 0.50 ± 0.53 | 1.12 ± 0.83* |
8 | When there is a conflict or difference of opinions among participants | 0.75 ± 0.70 | 1.75 ± 0.46* |
9 | When participants talk about the fear of death | 1.37 ± 0.74 | 1.37 ± 0.74 |
10 | When participants ask about disease or the most up-to-date treatment | 1.37 ± 0.74 | 1.37 ± 0.74 |
11 | When the discussion does not go deepe | 1.00 ± 0.53 | 1.37 ± 0.51 |
12 | When many participants are absent | 0.75 ± 0.70 | 1.25 ± 1.03 |
*p < 0.05.
conflict or difference of opinions among participants”.
2) Changes in free descriptions
Based on analysis of the free descriptions, the participants’ descriptions on day 1 were categorized as follows: “anxiety about facilitator communication”, “acquisition of role-play learning skills”, “understanding of the advantages of role- play learning”, “learning from the lecturer’s demonstration of facilitation,” and “others”. The participants’ descriptions on day 2 were categorized as follows: “repeated role-playing increases learning”, “discovery of specific facilitator strategies”, “discovery of problems towards the implementation of facilitation”, “use in clinical nursing, etc.”, and “others” (
The schedule and other information about this course were disseminated to 29 hospitals, inviting attendance, but the actual number of attendees was only 11. This is probably attributable to the long duration of the course (lecture for one and a half days) and the different design of the course (role-playing on many scenes). Of the 11 participants, 3 were able to attend the course only on one of the two days. Therefore, the number of the study subject was only 8. A high percentage of the participants were unwilling to participate in the role-playing, and it would appear that people tend to avoid participating in training courses that involve much role-playing.
Category | Number of descriptions | Example of a description | |
---|---|---|---|
Day 1 | Anxiety about facilitator communication | 9 | I worried about evaluation by others and appearance and I thought I had to do it well, which made me passive at first. I tried to do it without the fear of failure, and I learned a lot. |
Day 1 | Understanding of the procedures of role-play learning | 7 | I was able to have a satisfying time. It was good that I could actually watch and learn how the lecturer brought up a subject in the role playing at the end of the course. |
Day 1 | Understanding of the advantages of role-play learning | 10 | The situation and casting were real, and I was able to think as if I was actually facing difficulties. |
Day 1 | Learning from lecturer’s demonstration of facilitation | 3 | I was able to have a satisfying time. It was good that I could actually watch and learn how the lecturer Chujo brought up a subject in the role playing at the end of the course. |
Day 1 | Others | 4 | I felt that both the lectures and role playing were beneficial for obtaining a deeper understanding of facilitator intervention skills. |
Day 2 | Repeated role-playing increases learning | 3 | We were able to have active discussions in the group on day 2, and this was good for me because I could feel that I learned spontaneously. In addition, I could ask the lecturer about what I did not understand and coping methods, and repeated role-plays of the same situation led me to think. |
Day 2 | Discovery of specific facilitator strategies | 11 | t is important how to let participants know the theme and how to create an atmosphere. It is necessary for facilitators to understand the theme and purpose of the session, and cooperation of the facilitator and sub-facilitator is required. It is important to stay with the patients and think with them. |
Day 2 | Discovery of problems towards the implementation of facilitation | 7 | Through the facilitator experience, I found future problems such as whether I would successfully stay with the patient from the patient’s point of view, eye movements, how to speak and the tone of voice. |
Day 2 | Use in clinical nursing, etc. | 2 | I would like to utilize what I learnt in the group work for two days in my daily nursing practice. |
Day 2 | Others | 4 | I became sleepy during the last lecture, because we practiced relaxation before the last lecture. It would have been better to perform the relaxation exercise after the lecture. Thank you very much. |
There have been many reports on the need for lectures on the objectives and significance of group therapy, and the contents of the lectures in this study also covered these items. In the past, explanation about intervention focused on cases where intervention was difficult [
Significant improvement was seen not only in the total score on anxiety when facing difficult scenes by facilitators, but also in the scores on various other items of the scales used. This outcome was similar to that reported by Morita [
To the free-answer question asked on the first day, many participants described “anxiety about facilitator communication”. Although the participants initially have expressed difficulty in role-playing, repeated role-playing has the advantage of allowing the participants to learn, through comparison, the availability of various ways of dealing with difficulties and the presence of various rationales on the bases of which to choose the appropriate method of handling [
Chujo, M. (2017) Creation of a Training Course Program for Cancer-Patient Group Facilitators and Its Effects. Open Journal of Nursing, 7, 268- 276. https://doi.org/10.4236/ojn.2017.72022