To Ring or Not To Ring

Abstract

Purpose/Aim

At the end of a course of cancer treatment (chemotherapy, radiotherapy or other) patients are sometimes given the option to ring a bell to celebrate treatment completion. This is widely done across cancer centers in Canada. The act of ringing a bell is generally intended to give patients a sense of closure, but despite best intentions there are many patient concerns that have begun to reach the scarce literature. Patient opinion pieces have described the bell ringing as divisive, reminding them of their own never-ending journey. Additionally, prospective studies have found increased distress in patient groups who rang the bell versus those who did not. The aim of this project was to find and implement a more private and inclusive means of celebrating the end of a course of radiation treatment.

Methods/Process

To start, cancer centers across Canada, Australia and the UK were surveyed to discover what methods of celebration were being used globally in addition to any feedback they had received from patients regarding the bell. All non-bell related options for celebration were gathered with support from the Cancer Patient and Family Engagement platform. From this a patient survey was created for our institution. Patients were surveyed for their opinions and given alternative options to choose from for future use. This survey was then re-opened to increase sample size.

Results or Benefits/Challenges

The benefit of finding a new way to celebrate the completion of a course of radiation treatment is to allow patients a more private means of celebrating that does not impact other patients. The current primary concern with bell ringing is that it can be heard by other patients in the clinic, leading to negative reactions. The challenge of this project will be the implementation process, it may require additional hospital resources and space which is already strained.

Conclusions/Impact

Of the 65 cancer centers polled, 46% used bell ringing, of those, 57% stated they had received some form of negative feedback from patients. After re-opening the survey, 17/56 patients surveyed were given the option to ring a bell at the end of their treatment. 24% chose not to ring, and 20% of those polled did not want to watch or hear others ring a bell. There were many poignant remarks from patients, for example one person stated, “I don't feel the need to see others celebrate - and I know if there comes a time when I will never finish, then I wouldn't want to see that”. When given four alternative options to the bell, most patients voted for an art installation, or a signed card by the treatment team. The results of this project highlight the need to re-examine the bell as an appropriate method of celebration for patients receiving cancer treatment. Our institution has removed the bell and are working towards mounting an art installation for our patient population. We have also shared these results to departments across our provincial cancer care program, who have started taking corrective action. In future, we will conduct follow up surveys or patient focus groups to assess the impact.