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Building personal and social competence through cancer-related issues.

The initial impetus for this teaching technique comes from a young man named Tim, who, while in middle school, was diagnosed with a rare form of cancer known as Ewing's sarcoma. Like many other children and adolescents who are diagnosed, Tim is a cancer survivor. In fact, childhood cancer today is more correctly characterized as a life-threatening chronic illness than a fatal disease. (1) Similar to many children who fight childhood cancer, Tim was faced with a fear of dying, the trauma of treatment, the return to school amidst the worries of social isolation, concern for body image due to physical changes from chemotherapy, and the pressures to perform academically despite frequent medical absences. Upon reflection of his illness experiences and path to recovery, Tim believed that some of his fears, uncertainties, misconceptions, and anxieties could have been ameliorated if, in the course of his school health instruction, prior to becoming ill, students had opportunities to learn about these issues. The purpose of this teaching technique is to make Tim's unique request possible, and to guide such a learning opportunity in a way that is beneficial for all learners. This type of approach involves teaching and learning to enhance interpersonal communication and social support (healthy relationships) around cancer issues in a general health education context.

In a time of competing educational priorities, it is reasonable to question whether or not there is adequate instructional time to address the aims of social support and communication within a context of cancer-related issues. There are at least 3 reasons why such instructional aims are valuable and warrant instructional time. First, the research literature on school reintegration focuses on adaptation of the child with cancer, yet in doing so, also identifies learning needs for parents, teachers, school personnel, and all students. (2) Since it is likely that many individuals will either be affected by cancer or be socially connected to someone who is, such a learning experience is valuable for all learners. The cancer experience has itself shown to be a protective factor for several health risk behaviors. (3) This learning experience is framed to draw upon the strengths and resiliency of all learners. Second, some of most promising interventions with childhood cancer reintegration involve improving social support and communication skills. (4,5) Since the advantage of building personal and social health skills is well-recognized as a health education outcome, (6) applying and practicing communication and social support while gaining cancer knowledge is a realistic and useful way to meet National Health Education Standards (NHES). Third, research evidence around the childhood cancer experience is suggestive of similarities between cancers and other chronic illness or disease. (7,8) It is reasonable that explicit connections throughout the course of instruction could be made to broaden the skills of communication and provision of support to other chronic illnesses or to healthy interactions in general. This teaching technique is intended to demonstrate pedagogy consistent with the characteristics of effective health education curricula that is student-centered, builds personal and social competence, and embeds assessment throughout the learning process. (6)
Figure 1. Group Problem-Solving Role-Play

Problem

Young people who have had treatment for cancer are often worried
about changes in the way they look, such as hair toss and body
image. As a result, they are also worded about being isolated or
left out because of these changes.

Questions for Discussion

1. Visualize yourself in the position of a young person who has
been diagnosed with cancer and has undergone treatment. How would
you feel? What would you be worded about in general? What would you
be worried about going back to school? Share your answers with your
group.

2. What causes changes in appearance such as hair loss?

Supportive Solutions

1. Understanding empathy and respect for others, what could you do
to support and communicate in a healthy way with someone who has
returned to school after being diagnosed with cancer or after
having had cancer treatment?

Role-Play Construction

With your group members, create a role-play scenario that depicts a
realistic situation involving the problem listed above and include
opportunities for the practicing of the healthy and supportive
solution to this problem. Make sure to include healthy
communication from both the point of view of the person with cancer
and the point of view of their peers. Your role-play should involve
some, but not all of your group members so that those group members
not involved can provide feedback on your communications.

   Once your role play has been created and the teacher has checked
   your work. You and your group members should take turns and
   practice communicating in this situation. Those group members who
   are not taking part in the role play should observe and provide
   feedback based on the supportive communication rubric.

Problem

Students in school will have questions about cancer to ask a
student with cancer. For example, questions may include:

What can a person with cancer do?

What are the treatments for cancer?

Is cancer contagious?

Despite these important questions, each person may differ in their
desire to share personal information and the amount to share.

Questions for Discussion

1. Visualize yourself in the position of a peer who has been
diagnosed with cancer, has undergone treatment, and returned to
school. Would you be willing to talk about your diagnosis or
treatment with others? How could you communicate your needs and
wants successfully to your peers? What worries would you have?

2. If you have questions about cancer, like those questions listed
above, and your peer does not feel comfortable sharing information,
where might you be able to look to find answers to those questions?

Supportive Solutions

1. Understanding support, empathy and respect for others, what
kinds of things could you do when communicating with a peer to
determine their needs for sharing information? What verbal and
non-verbal signs and signals from others may indicate to you their
desire to share information? If there is a difference between
questions you need answers and your peers need to share
information, what might be a solution?

Role-Play Construction

With your group members, create a role-play scenario that depicts a
realistic situation involving the problem listed above and include
opportunities for the practicing of the healthy and supportive
solution to this problem. Make sure to include healthy
communication from both the point of view of the person with cancer
and the point of view of his/her peers. Your role-play should
involve some, but not all, of your group members so that those
group members not involved can provide feedback on your
communications.

   Once your role-play has been created and the teacher has checked
   your work. You and your group members should take turns and
   practice communicating in this situation. Those group members who
   are not taking part in the role-play should observe and provide
   feedback based on the supportive communication rubric.

Problem

Young adults who have been diagnosed with cancer need to receive
social support from friends and classmates and often have stress
due to social isolation, yet peers in school are often very
uncertain about what a peer with cancer's strengths are, what they
can and cannot do. This uncertainty may cause classmates to avoid
or exclude those diagnosed with cancer.

Questions for Discussion

1. Visualize yourself in the position of a peer who has been
diagnosed with cancer, has undergone treatment, and returned to
school. In what ways can you communicate with your classmates what
you can and cannot do?

2. Would you be uncertain about the capabilities of a peer who has
returned to school after cancer treatment?. How would you react in
this situation?

3. Is cancer a fatal illness? How might this impact your actions to
support and communicate with others in e healthy way?

Supportive Solutions

1. Understanding support, empathy and respect for others, what
kinds of things could you do to when communicating with a peer to
help them to feel social support? Whet are healthy ways to include
others and find out what students' strengths are?

Role-Play Construction

With your group members, create a role-play scenario that depicts a
realistic situation involving the problem listed above and include
opportunities for the practicing of the healthy and supportive
solution to this problem. Make sure to include healthy
communication from both the point of view of the person with cancer
and the point of view of his/her peers. Your role-play should
involve some, but not all, of your group members so that those
group members not involved can provide feedback on your
communications.

   Once your role-play has been created and the teacher has checked
   your work. You and your group members should take turns and
   practice communicating in this situation. Those group members who
   are not taking part in the role-play should observe and provide
   feedback based on the supportive communication rubric.


OBJECTIVES

1. Learners will demonstrate the ability to apply and utilize skills for effective communication with peers around cancer-related issues (NHES 4.8.1, 4.12.1).

2. Learners will demonstrate negotiation and collaboration skills to enhance health (NHES 4.8.2;4.12.2).

3. Learners will demonstrate an understanding of how social environments affect health through the application of core cancer concepts in real-life simulations (NHES 1.8.3; 1.12.3).

GRADE LEVEL

This teaching technique is appropriate for middle and high school students grades 7 through 12.

LEARNING CONTEXT AND PRIOR KNOWLEDGE

The learning tasks identified here take place within a larger set of learning experiences designed to enhance cancer knowledge, communication skills, and healthy supportive relationships. Prior to the ensuing learning tasks, student engagement has been prompted by examining photographs and stories around student experiences with cancer. In addition, learners have had the opportunity to personalize broad cancer information, self-assess their ability to communicate with peers, and adopt some individual learning goals. At the point where this teaching technique begins, in the flow of instruction, only broad and basic information about cancer has emerged from preliminary discussions. This teaching technique assumes that learners have already been exposed to communication skills and their steps. It is also assumed that students have had some prior experience with role-play activities. Within this larger context, the teacher should be sensitive to the children within the classroom that may be dealing with cancer-related issues in some way.

LEARNING TASKS

Small-Group Discussion

Learners are broken up into a series of groups and each group assigned 1 of the 3 "Group Problem Solving Role-Play" tasks (Figure 1). The Group Problem-Solving Role-Play tasks combine problem-based learning (9) with the use of role-plays, which means that students will construct, model, and practice a role-play that is a solution/response to the problem posed. In their small groups, the learners should be given time to discuss the problem scenario and the accompanying discussion questions. The questions for discussion are meant to prompt personalization and student engagement.

Role-Play Construction

The role-play learning task involves learners in groups coming up with role-play scenarios that model healthy and supportive communication as solutions to the problem scenario. The purpose of posing the problem is to situate the learners into the real-life context in which cancer information is used, allowing this situation to drive the need for health information. The problem scenarios are constructed in such a way that the learners cannot create an appropriate response without accessing, acquiring, and uncovering accurate cancer knowledge. Teaching strategies involve making resources available to learners (books, articles, computer, other people, etc), pointing learners in the right direction for information and posing guiding questions to lead and shape their responses. In addition, direct instruction to present key information may emerge in a "just in time" moment when learners understand a need for such information relevant to their problem-solving tasks. This strategy promotes knowledge construction that is accessible for future use in relevant contexts. (10) As preliminary work, the teacher should review the problem scenarios, anticipate the likely need for student information, and identify sources of that information to support student inquiry that are relative to the age and developmental level of the learners.

Role-Play Practice and Feedback

After the necessary information has been acquired and role-plays constructed, the next step is for learners to practice their role-plays within their groups. As some of the learners within each group are performing the role-play, the other group members who are not practicing are observing and providing feedback based on the Healthy and Supportive Communication Rubric (Figure 2). It is an essential strategy that learners within groups have appropriate time to practice and provide each other feedback. In addition, learners should be instructed to take on different roles throughout this process and the teacher should ensure that this occurs. Prior to engaging in this portion of the role-play task, the teacher, with the help of a few students, should model the process of giving feedback and the types of feedback that are acceptable. Since each group has a different role-play problem, after adequate time has been given within groups to practice and provide feedback, students/ observers will rotate to a different group to observe the model, provide feedback, and practice the new scenario and response.

ASSESSMENT STRATEGIES

The Healthy and Supportive Communication Rubric (Figure 2) is a tool through which one may assess student learning relative to the objectives reported and to NHES 4. Throughout this teaching technique, this tool is used by learners as a formative strategy to assess their own learning and, give and receive feedback from peers. Formative assessment in this teaching technique is deeply embedded within the learning task, and is meant to be part of the instructional dialogue and not merely a mid-lesson checkpoint. The processes of self and peer assessment, coupled with skills practice, are important strategies and should be given appropriate time. This tool may also be used in either a formative or a summative context by the teacher, to assess student learning, give feedback, and measure students' mastery of learning standards. In order to assess learner growth and development over time, follow-up assessment tasks such as personal journal entries, written letters to someone who is dealing with cancer, reflection papers, etc., are warranted. Such follow-up assessment tasks should be consistent with the interests, needs, and developmental abilities of the learners.

CONCLUSION

Childhood cancer is no longer considered a fatal disease, but rather a life-threatening chronic illness. (1) Experiences with cancer, like other life-threatening illnesses, are often shared between the schools, parents, school personnel, and students/peers. Such shared experiences framed in positive ways that promote learner strengths and resiliency provide a real-life context in which the skills of healthy communication, support, and collaboration may be fostered. The purpose of this teaching technique is to use the context of cancer-related issues to foster supportive and healthy communication and build personal and social competence. Special attention should be given to the use of guiding questions that prompt the personalization of information, the explicit opportunities for practicing skills and receiving feedback, the use of assessment strategies that are deeply embedded throughout the learning task, and encouragement of creative expression. It is advisable for teachers to make explicit connections between healthy communication and support around cancer issues and other types of illness, disease, or in a general positive healthy climate. From the perspective of teaching and learning practice, the congruence between the identified objectives, learning tasks, and assessment tools and strategies identified in this teaching technique provide a defensible position from which to suggest that NHES of learning can be met and mastered in meaningful ways.

Accepted on September 30, 2008

REFERENCES

(1.) Katz ER, Varni JW, Rubenstein AB, Hubert N. Teacher, parent, and child evaluative ratings of a school intervention for children with newly diagnosed cancer. Child Health Care. 1992;21(2): 69-75.

(2.) Prevatt FF, Heifer RW, Lowe PA. A review of school reintegration programs for children with cancer. J Sch Psychol. 2000;38: 447-467.

(3.) Verrill JR, Schafer J, Vannatta K, Noll RB. (2000). Aggression, anti-social behavior, and substance abuse in survivors of pediatric cancer: possible protective effects of cancer and its treatment. J Pediatr Psychol. 2000;5:493-502.

(4.) Varni JW, Katz ER, Colegrove R, Dolgin M. The impact of social skills training on the adjustment of children with newly diagnosed cancer. J Pediatr Psychol. 1993;18:751-767.

(5.) Vance YH, Eiser C. The school experience of the child with cancer. Child Care Health Dev. 2002;28:5-19.

(6.) Joint Committee on National Heath Education Standards. National Health Education Standards: Achieving Excellence. 2nd ed. Atlanta, Ga: American Cancer Society; 2007.

(7.) Kliebenstein MA, Broome ME. School re-entry for the child with chronic illness: parent and school personnel perceptions. Pediatr Nurs. 2000;26:579-582.

(8.) Rynard DW, Chambers A, Klinck AM, Gray JD. School support programs for chronically ill children: evaluating the adjustment of children with cancer at school. Child Health Care. 1998; 27: 31-46.

(9.) Barrows HS. How to design a problem-based curriculum for the preclinical years. New York, NY: Springer Publishing Co.; 1985.

(10.) Edelson DC. Learning-for-use: a framework for integrating content and process learning in the design of inquiry activities. J Res Sci Teach. 2001;38:355-385.

OWEN M. DONOVAN, MSE

Associate in School Health Education, (odonovan@mail.nysed.gov), New York State Education Department, 89 Washington Ave, Albany, NY 12210.

Address correspondence to: Owen M. Donovan, Associate in School Health Education, (odonovan@mail.nysed.gov), New York State Education Department, 89 Washington Ave, Albany, NY 12210.

Acknowledgments: Tim Doak--for the drive and inspiration for this project. This project was made possible with support from the Make-a-Wish Foundation of Northeastern New York.
Figure 2. Healthy and Supportive Communication Rubric

                          4                          3

Supportive       Demonstrates empathy,      Expresses ideas and
Communication    care, respect through      opinions in a way that
                 understanding and          is sensitive to the
Applies and      acknowledging the          perspective or feelings
utilizes         perspective of others.     of others.
skills for
communicating    Connects feelings to       Overcomes barriers and
effectively      content.                   manages conflict in
with family,                                healthy ways.
peers, and       Demonstrates strategies
others           to prevent manage
                 conflict in healthy
NHES 4.8.1;      ways.
4.12.1

NHES 4.8.3

Active           Clearly expresses          Gives the speaker full
Listening        interest in what the       attention.
                 other person is saying.
NHES 4.8.1;                                 Periodically summarizes
4.12.1           Consistently summarizes    discussion and asks
                 what has been said and     clarifying questions.
NHES 4.8.2;      asks clarifying
4.12.2           questions.

Clear Message    Uses direct and specific   Uses simple and succinct
                 language.                  language.
NHES 4.8.1.;
4.12.1

Body Language    Body language matches      Body language helps
                 what is being said and     clarify the message
NHES 4.8.1.;     contributes positively     being sent.
4.12.1           to the conversation.

Core Cancer      Demonstrates a clear       Actively demonstrates an
Concepts         understanding of core      understanding of cancer
                 cancer concepts that are   concepts.
NHES 1.8.3;      appropriately applied
1.12.3
                 within the skill
* Cancer is      demonstration.
  not
  contagious
* Individuals
  differ
  in their
  willingness
  to discuss
  their
  illness

* Cancer
  survivors
  can lead
  healthy
  productive
lives
* Self-
  assessment
  strategies
  are helpful
  in catching
  cancer
  early enough
  to treat and
  recover with
  appropriate
  medical
  attention.

                           2                         1

Supportive       Expresses ideas or        Expresses ideas and
Communication    opinions without          opinions in a way that
                 considering the           is insensitive to
Applies and      perspective or            others and limits
utilizes         feelings of others.       others opportunities to
skills for                                 opportunities
communicating    Recognizes real-life
effectively      situations that could     Identifies real-life
with family,     lead to conflict and      situations.
peers, and       attempts to overcome
others           barriers.

NHES 4.8.1;
4.12.1

NHES 4.8.3

Active           Pays attention only       Appears preoccupied;
Listening        sporadically but          attention is infrequent.
                 acknowledges what is
NHES 4.8.1;      said.                     Gives no cues to indicate
4.12.1                                     involvement in listening.
                 Refines the ability to
NHES 4.8.2;      actively listen and
4.12.2           respond to others.

Clear Message    Uses language that        Uses language that
                 confuses the other        causes a communication
NHES 4.8.1.;     person.                   breakdown.
4.12.1

Body Language    Body language confuses    Body language disrupts
                 the message sends a       the conversation by
NHES 4.8.1.;     message different from    creating a barrier.
4.12.1           the spoken words.

Core Cancer      Recalls cancer concepts   Skill demonstration
Concepts         within the context of     reveals an inaccurate or
                 the situation enacted.    uninformed use of cancer
NHES 1.8.3;                                knowledge.
1.12.3

* Cancer is
  not
  contagious
* Individuals
  differ
  in their
  willingness
  to discuss
  their
  illness

* Cancer
  survivors
  can lead
  healthy
  productive
lives
* Self-
  assessment
  strategies
  are helpful
  in catching
  cancer
  early enough
  to treat and
  recover with
  appropriate
  medical
  attention.
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Title Annotation:Teaching Technique
Author:Donovan, Owen M.
Publication:Journal of School Health
Geographic Code:1USA
Date:Mar 1, 2009
Words:3422
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