Patient education

The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. Results Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any

Medical and nursing staff in oncology for older cancer patients are confronted with a range of problems including co-morbidity, poly-pharmacy, cognitive impairments, emotional problems, functional limitations, sensory impairment and a lack of social support. Comprehensive geriatric assessment identifies many of the existing problems and can be used to estimate life expectancy and tolerance of treatment. However, health care providers have to interpret and apply the medical and nursing information and must deal with specific problems and care needs throughout the continuum of cancer care. Imperfect interdisciplinary communication, cooperation and patient-provider communication may further complicate the care actually delivered. A clinical care pathway aims to improve continuity, increase multidisciplinary tuning and deliver appropriate patient education, treatment and care for vulnerable older cancer patients. This paper gives an overview of common problems in older cancer patients and addresses communication barriers through the development of clinical care pathways in geriatric oncology.

for acute myocardial infarction (AMI) demonstrate the potential to limit infarct size and decrease mortality by coronary reperfusion and arrhythmia control. The effectiveness of these treatments is dependent on time and access to acute medical care. Coronary reperfusion requires early administration of thrombolytic agents or angioplasty. 1-3 Defibrillation and other methods to control cardiac arrhythmias require trained personnel and equipment in an appropriate clinical setting. 4,5 Although the need for timely receipt of these therapeutic strategies is well recognized, rapid access to emergency medical care re-).

Objective Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. Design A prospective longitudinal 12-week pilot study. Setting A university hospital HD unit and patients' homes. Participants A convenience sample of nine older ([55 years) patients undergoing HD.

Conclusion: Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure.

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Education and coaching that focuses on both somatic and psychosocial aspects, is an essential part of the treatment of patients with atopic dermatitis. These interventions are important to reinforce self-management of the patient. Education and coaching by nurses, via outpatient visits or eHealth, seems to be effective and cost-saving.

Aim.-This study focused on issues in the education of type 2 diabetes patients in primary care on Reunion Island which, in a medical context, is broadly similar to metropolitan France, but with a much greater prevalence of diabetes. The aim was to assess the perceptions, training, reported practices and needs of health care providers in the field of patient education in advance of the initiation of a health care management network for diabetic patients. Methods.-A total of 74 physicians and 63 nurses completed a detailed questionnaire comprising 52 items divided into six parts: professional activity, initial and postgraduate training, educational practices, objectives of patient education, perceived barriers and prospects for optimization. Results.-Educational activities for patients are almost nonexistent. Information and explanations given during a face-to-face encounter with the physician or nurse that combine technical and caring approaches are the main reasons reported for patient education. The obstacles reported by professionals that need to be overcome are limited available time, patient passivity and inadequate staff training. Practitioners and nurses are poorly taught as regards patient education and self-management of chronic diseases. The suggested improvements include professional acknowledgement, more convenient and available tools and improved postgraduate training. Conclusion.-Patient education in primary care is still mostly an illusion, with many gaps that hinder education for both patients and professionals. The training of health professionals needs to meet the challenge of chronic diseases by integrating aspects from the fields of education and the social sciences.

Objectives.-To develop recommendations for the information and education of patients with rheumatoid arthritis (RA) seen in everyday practice, using evidence from the literature, supplemented with expert opinion when needed. Methods.-A scientific committee developed eight questions using the Delphi consensus procedure. A task force reviewed the literature for answers to these questions, using the PubMed Medline database (1980-2004) and the 2002-2004 databases of the annual meetings held by the French Society for Rheumatology (SFR), the European League Against Rheumatism (EULAR), and the American College of Rheumatology (ACR); the indexing terms for the search were rheumatoid, arthritis, patient, education, information, knowledge, general practitioner, family doctor, and continuing medical education. Only articles in French or English were included. A panel of rheumatologists used the evidence thus compiled to develop recommendations for each question; gaps in evidence were filled by calling on the panelists' expert opinion. For each recommendation, the level of evidence and extent of agreement among panelists were specified. Results.-There were four general questions about the objectives, supports, and mode of delivery (group or one-on-one) of patient information and education, as well as on evaluating knowledge, and four specific questions on program content. The search identified 1235 articles; 144 were selected on the title and 118 of those on the abstract. Three abstracts presented at meetings were also kept. The evidence from the literature was presented to the panelists during interactive workshops. The panelists then developed eight recommendations, all of which were grade D because no published studies specifically addressed everyday clinical practice. Agreement among panelists ranged across recommendations from 85.7% to 100%. Conclusion.-Recommendations about educating and informing patients with RA in everyday practice were developed. They should increase practice uniformity and ultimately optimize the management of patients with RA.

A study to determine the effect of an educational intervention on the prevalence of safety seat usage in a population of low income mothers was conducted in six randomly selected outpatient care centers in Maricopa County for a period of 1 year. These six centers were subjected to either a control or intervention treatment. Outpatient care centers which were assigned to the intervention treatment received a planned, educational intervention employing coercive, incentive, education and reinforcement approaches. The data indicated that the application of a health education intervention employing a combination of approaches significantly decreased the safety seat non-usage rate from 74.9% to 62.3%, while the rate in the control group remained stable. It was also found that continued health education beyond the 6-month period would not affect the safety seat usage rate significantly. The results of this study point to the potential of an organized, patient education program in positively affecting safety seat usage among children of low income parents in an outpatient setting.

Patients were never asked to read or fill out forms. Interactions were oral, using everyday terms and short, clear sentences. Patients who declined during a screening call were considered Stage 1 Refusers. Patients who initially expressed interest but neither completed a baseline questionnaire nor provided consent were considered Stage 2 Refusers. Patients who consented were considered Enrollees. Age, gender, and insurance status were compared between Stage 1 Refusers and Enrollees. A second analysis compared these variables, plus educational attainment and working status, between Stage 2 Refusers, and Enrollees. Results: Of 408 eligible patients, there were 193 (47.3%) Stage 1 Refusers, 81 (19.9%) Stage 2 Refusers and 134 (32.8%) Enrollees. A higher proportion of Stage 1 Refusers than Enrollees were 65 years old (58% vs. 37%, p = .0003). Multivariate analysis, adjusting for gender and insurance status, confirmed the effect of older age on refusal (OR = 2.3 (1.4, 3.6)). There were no significant differences between Stage 2 Refusers and Enrollees. Conclusion: We found no evidence of refusal to participate due to educational attainment, working status, insurance status, or gender. Older patients were more likely to refuse participation at the first stage of recruitment. Practice implications: Researchers should continue efforts to increase participation among older patients, particularly when studies are designed to be generalized to an elderly population as is the case with arthritis research. Strategies used in this recruitment protocol designed to remove literacy-related barriers to recruitment may be responsible for the observation that subjects with lower education did not have a higher rate of refusal. Such strategies deserve further study. ß

Objective: To develop and psychometrically test a brief patient-report instrument for measuring Shared Decision Making (SDM) in clinical encounters. Methods: We revised an existing instrument (Shared Decision Making Questionnaire; SDM-Q), including the generation of new items and changing the response format. A 9-item version (SDM-Q-9) was developed and tested in a German primary care sample of 2351 patients via face validity ratings, investigation of acceptance, as well as factor and reliability analysis. Findings were cross-validated in a randomly selected subsample. Results: The SDM-Q-9 showed face validity and high acceptance. Factor analysis revealed a clearly onedimensional nature of the underlying construct. Both item difficulties and discrimination indices proved to be appropriate. Internal consistency yielded a Cronbach's a of 0.938 in the test sample.

Objectives Empirical studies have confirmed that a trusting physician-patient interaction promotes patient satisfaction, adherence to treatment and improved health outcomes. The objective of this analysis was to investigate the relationship between social support, shared decisionmaking and inpatient's trust in physicians in a hospital setting. Methods A written questionnaire was completed by 2,197 patients who were treated in the year 2000 in six hospitals in Germany. Logistic regression was performed with a dichotomized index for patient's trust in physicians.

This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education and clinical health promotion. Five important factors are identified in the development of patient education: (1) research and evidence based standards; (2) the organization of care; (3) training and methodological support; (4) professional values; and (5) acknowledgment, funding and place of patient education in health policy. Several of the discussed common orientations and priorities in the patient education in the reviewed countries are highlighted in this issue. And finally, an example of the possible integrated international practice in patient education in the field of diabetes is described in this issue. Several conclusions are drawn concerning future development of communication in health care within the framework of patient education in Europe. #

This study was developed by a group of professionals from different areas (nurses and educators) concerned with health education. It proposes the use of a problem-posing model for the transformation of professional practice. The concept and functions of the model and their relationships with the educative practice of health professionals are discussed. The model of problem-posing education is presented (compared to traditional, ''banking'' education), and four innovative experiences of teaching-learning are reported based on this model. These experiences, carried out in areas of environmental and occupational health and patient education have shown the applicability of the problem-posing model to the practice of the health professional, allowing transformation.

Objective: The aim of this study is to investigate to which extent diversity is part of current healthcare practices and to explore opportunities and barriers in the implementation of diversity dimensions in healthcare practices. Methods: Nine in-depth, semi-structured interviews and three focus groups were conducted in three healthcare settings (mental health, hospital, nursing home care). Results: Results demonstrate that (the potential of) diversity is an ambiguous issue; diversity is said to be important, but this has not led to adjustments of the neutral, disease-oriented approach of patients. If recognized at all, diversity is reduced to one dimension (sex). Barriers in the implementation of diversity relate to: (a) lacking awareness and knowledge of diversity, (b) poor information and communication, and (c) organizational constraints. Opportunities to implement diversity in healthcare include: (d) an emerging sense of urgency to attend to diversity, (e) the development of good practices, and (f) the political climate. Conclusion: Various barriers and some opportunities for the implementation of diversity in healthcare practices have been identified. There is an ambiguity in how professionals deal with diversity. As a result, the neutral approach remains dominant in practice and policy. Practice implications: In order to raise the awareness and enhance the competence of professionals, educational programmes and learning networks are required.

Previously we had speculated that the patient-proxy relationship existed on a contractual to covenantal continuum. In order to assess this hypothesis, and to better understand the moral obligations of the patient-proxy relationship, we surveyed 50 patient-proxy pairs as well as 52 individuals who had acted as proxies for someone who had died. Using structured vignettes representative of three distinct disease trajectories (cancer, acute stroke, and congestive heart failure), we assessed whether respondents believed that proxies should follow explicit instructions regarding life-sustaining therapy and act contractually or whether more discretionary or covenantal judgments were ethically permissible. Additional variables included the valence of initial patient instructions-for example, "to do nothing" or "to do everything"-as well as the quality of information available to the proxy. Responses were graded on a contractual to covenantal continuum using a modified Likert scale employing a prospectively scored survey instrument. Our data indicate that the patient-proxy relationship exists on a contractual to covenantal continuum and that variables such as disease trajectory, the clarity of prognosis, instructional valence, and the quality of patient instructions result in statistically significant differences in response. The use of interpretative or covenantal judgment was desired by patients and proxies when the prognosis was grim, even if initial instructions were to pursue more aggressive care. Nonetheless, there was a valence effect: patients and proxies intended that negative instructions to be left alone be heeded. These data suggest that the delegation of patient selfdetermination is morally complex. Advance care planning should take into account both the exercise of autonomy and the interpretative burdens assumed by the proxy. Patients and proxies think inductively and contextually. Neither group viewed deviation from patient

Objective: ''Michael's Game'' is a card game which aims at familiarizing healthcare professionals and patients with cognitive therapy of psychotic symptoms. The present study tests the feasibility and the impact of the intervention in naturalistic settings. Methods: 135 patients were recruited in 11 centres. They were assessed pre-and post-tests with the Beck Cognitive Insight Scale (BCIS) and the Peters Delusion Inventory-21 items (PDI-21). Results: Data about 107 patients were included in the entire analyses. Significant improvements were observed on BCIS subscales as well as a reduction of severity of conviction and preoccupation scores on the PDI-21. The intervention has a moderate effect on the PDI-21 preoccupation and conviction as well as the BCIS subscales. Patients who benefit the most from the program are patients who have a low degree of self-reflectiveness and patients who are concomitantly preoccupied by their symptoms. Conclusion: The present study supports the feasibility and effectiveness of ''Michael's Game'' in naturalistic settings. Practical implications: The game seems to be a useful tool for patients with psychotic disorders. ß

Goals of work  Based on meta-analyses regarding the preparation of patients for potentially threatening medical procedures, a DVD, incorporating behavioral role modelling, was developed to prepare patients for chemotherapy and assist them to self-manage side effects. It was hypothesized that patients who watched the DVD (vs those who did not) would report (1) lower anxiety; (2) higher self-efficacy related to coping

Patient education programmes have shown only small to modest effects on diabetes self-care and metabolic control. Despite that, almost all diabetes teams agree that patient education is an extremely important part of the treatment of diabetes. It is, therefore, important to identify components of successful patient education as a basis for creating and testing an evidence-based education programme. In a review of controlled studies evaluating patient education such components were identified and these were then used in building up the new programme. This programme, called 'I'm the Boss', is based on the notion that the patient is an active care participant, setting his own self-care goals, and is the one responsible for his own life. The content of the programme did not, therefore, focus on diabetes as such, but on life with diabetes. Six themes were explored during six three-hour weekly sessions. The educational method used was problem-based learning. This method is founded in cognitive theory and views the learner as active in seeking knowledge and able to solve the self-care problems identified. The aim of this study was to explore the feasibility of the programme which was tested in four small groups (five to eight participants) of diabetic patients together with two facilitators. After completing the programme, the patients participated in focus group interviews to evaluate the programme. They identified both positive and negative factors. After each session the two facilitators reflected upon the group dynamics. In particular, problems with allowing patients to be the experts should be highlighted. This programme has been modified according to the evaluation and it is now being tested in a randomised, controlled, multicentre study.

Background: Innovative technologies that enable the collection of family history information and the assessment of breast cancer risk have a potential to enhance the quality of preventive care. We developed a computerized tool that supports stratification of breast cancer risk, genetic risk assessment in the clinical environment (GRACE). Methods: In a preliminary evaluation of the tool's impact, we randomized women with a family history of breast cancer (n = 72) to either use the GRACE tool or undergo risk counseling by a nurse specialist. Results: There was no statistically significant differences between the GRACE and nurse counselling groups in risk perceptions (F = .03, P > .05) and cancer-related worries (F = .80, P > .05). However, patients reported more positive attitudes toward working with the nurse. Conclusion: It was feasible to use GRACE in a Clinic. Additional research is required to identify solutions for providing emotional support in conjunction with the tool. #

Patient education is an important aspect of care to young diabetic children. The use of playthings and recreational activities is an effective way to help children develop harmoniously by integrating the paradox of having to become compliant with treatment and medication while becoming autonomous in life. This paper presents the evaluation of a therapeutic education programme which was attended by 14 young diabetic patients aged 10-12. In order to take into account the learning capacities and strategies linked to the children's age and development stage, the programme's methods were mainly interactive and recreational. In particular, puppets were used as a means to enable the children to express themselves on different aspects of diabetes-related difficulties in their everyday life. The results of the study show that recreational methods and tools can effectively be implemented into therapeutic patient education programmes so as to enable children to develop various treatment-related skills. As far as the psychosocial skill of expressing one's difficulties and emotions is concerned, the use of puppets was found to be an effective means to facilitate the development of such a skill. Moreover, puppets were found to have a projective and transactional function that allowed children to make decisions and react autonomously, and thus regain control on situations in which they had previously felt disempowered.

Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess whether patient education strategies are of benefit for pain, function/disability, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with or without radiculopathy. Cochrane systematic review. Computerized bibliographic databases were searched from their start to May 31, 2008. Eligible studies were randomized trials investigating the effectiveness of patient education strategies for neck pain. Paired independent reviewers carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences were calculated. Because of differences in intervention type or disorder, no studies were considered appropriate to pool. Of the 10 selected trials, two (20%) were rated as of high quality. Patient education was assessed as follows: 1) eight trials of advice focusing on activatio...

Objective: To systematically review the research on stroke patients' and caregivers' educational needs. Methods: A search of the literature prior to and including the year January 2009 was conducted using Medline, CINAHL, EMBASE, PsychINFO and the Cochrane Library, yielding 959 articles. Of these, 21 studies were included in the review. Results: Stroke patients and caregivers reported many and diverse educational needs, which often were not met. The educational needs of stroke patients and caregivers concerned knowledge about the clinical aspects of stroke, prevention, treatment and functional recovery. The most commonly reported needs of caregivers involved patients' moving and lifting, exercises, psychological changes and nutritional issues. Patients and caregivers wanted information that was tailored to their situation. Conclusion: Patients and caregivers have many unmet educational needs. The findings call for improved education of patients and caregivers on various issues that are specific to the various recovery phases after stroke. Practice implications: The findings of this review can be used to develop educational interventions for stroke patients and caregivers. Further research is needed to investigate the feasibility and effects of educational interventions and whether they meet the educational needs of patients and caregivers. ß

Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments. Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients' perception of GPs' affective performance, GPs' verbal attention, patients' self-reported anxiety level and gender differences. The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The sca...

Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.

Objective: Mailing test results are frequently used to provide patients with information about their medical condition and enhancing their participation in subsequent management. This study explores patients' experiences of the written notification process and its implications. Methods: Telephone interviews were conducted with 128 patients who had undergone endoscopic examinations in two gastroenterology clinics after the received of their mailed biopsies results. The interviews (open and closed questions) focused on patients' perceptions and emotions while waiting, and after reading the reports. Results: The findings are divided to emotions experienced, comprehension and behavioral implications. The reports arrived 6-33 days later than promised. Many patients were dissatisfied but most did nothing to hasten the process. Over half of them were unable to understand the information in the letters and the future steps needed to be taken. Explanatory covering letters, sent by the hospital clinic, enhanced comprehension and diminished confusion. Conclusions: Mailed biopsy reports frequently failed to enhance patient understanding and participation in decisions. Incomprehensibility of written information, and unmet expectations, evoked negative emotional responses. Practice implications: Improving readability with simple, non-technical information; and verification of understanding and fulfillment of recommendations using a follow-up call are critical for accomplishing the goals of mailed biopsy reports. ß

Fatigue complaints are frequent and important problems affecting people's quality of life and creating puzzles for the General Practitioners they consult. Little is known about what actions people undertake to deal with fatigue, and even less about their success. As revealed by multivariate analyses health-related action patterns can classify people as being particularly successful or unsuccessful in dealing with their complaints of chronic fatigue. This study suggests that a few actions applied in combination and in a concentrated manner constitute the basis for a successful action pattern. The number, type and predictive power of the relevant actions vary depending on the persons in question: having chronic diseases or not and being under 44 or over 44 years old. hepatitis or chronic renal failure [7-9]. However, 0738-3991 / 99 / $ -see front matter

We focus on graduating students from two medical schools in Lebanon to identify the proportions who select primary care careers, to highlight factors that are considered when making a career choice, and to compare these among primary care (PC) and non-primary care (NPC) candidates. Anonymous self-administered questionnaire was used to assess student demographics, chosen career, and perceived level of importance concerning 27 career influencing factors using a 5-point Likert scale. 127 (97%) students responded. 53 (42%) students selected primary care. 20 (61%) of the females were in the primary care group. Among all, the most important factors scored (3.30 to 3.06) represent: "intellectual opportunities", "match of personal interest and skills" and "helping and social responsibilities". Least important factors scored (1.96 to 1.13) and represent: "encouragement/role models", "clerkships and courses", and "residency issues". ...

1 Homebound older adults constitute a "hardly reached" population with respect to health communication. Older adults also typically suffer from health literacy challenges, which put them at increased risk of adverse health outcomes. Suboptimal interactions with providers are one such challenge. Interventions to improve interactive health literacy focus on training consumers/ patients in question preparation and asking. Meals on Wheels volunteers are uniquely suited to coach their clients in such interaction strategies. Seventy-three Meals on Wheels volunteers participated in workshops to train as health literacy coaches. The 3-to 4-hour workshops included units on communicating with older adults, on the nature of health literacy, and on the process of interactive health literacy coaching. Participants viewed and discussed videos that modeled the targeted communication behaviors for older adult patients interacting with physicians. They role-played the coaching process. After 9 months, coaches participated in a "booster" session that included videos of ideal coaching practices. Evaluation questionnaires revealed that participants had favorable reactions to the workshops with respect to utility and interest. They especially appreciated learning communication skills and seeing realistic videos. A measure of knowledge about the workshop material revealed a significant increment at posttest. Fidelity of coaching practices with respect to workshop curriculum was confirmed. This training in interactive health literacy for community-based lay volunteers constitutes one way to implement the National Action Plan to Improve Health Literacy for one "hardly reached" population. An online tool kit containing all workshop materials is available.

Patient–professional communication is a critically important element of effective chronic illness care. However, the dynamics of health care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct “disease worlds” among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further analysis of the interactional dynamics associated with chronic conditions.