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Therapeutic Education: Cancer
Patients on chemotherapy:
Shamim Akhter QURESHI
MBBS,MPH, Ingénieur d’étude(EHESP)
June 2010
2nd June 2012
Project
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Contribution to a program of Therapeutic
Education of Patients (TPE) treated for a cancer
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Special concern at Educational Diagnosis
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Main concern about patients on chemotherapy
Host Institution
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Teaching Hospital Rouen, France
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Under the supervision of Prof. Czernichow, the head
of Public Health and Epidemiology.
Definition of TPE
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A comprehensive approach to support patients and
their families
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To better understanding of their diseases
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To acquire or maintain the skills they need to manage
their life with a chronic disease in the best possible way.
WHO (1998)
Why TPE ?
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More chronic diseases now
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Multiple healthcare professionals
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Patients empowerment for decision making
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Better prognosis for patients
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Best satisfaction at work for professionals
Why Cancer ?
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A leading cause of death worldwide
Cancer has been approved as chronic disease
TPE could both prevent cancer deaths and reduce
complications
Many information needed by patients
Making the quality of life better
Several associated therapies with possible Side Effects
involved (radiotherapy, chemotherapy, surgery)
Two Cancer plans in France
Pressures from patients groups
Basic Steps of TPE
1.
2.
3.
4.
To make an educational diagnosis
To Establish a tailored TPE programme
with learning priorities
To provide group or individual sessions
(or both)
To Assess acquired skills and to revise
programme if necessary
(HAS)
What is Educational Diagnosis ?
•
A systematic, comprehensive, iterative collection of
information by the health care provider
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Concerning each patient' bio clinical, educational,
psychological and social status.
•
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A basis to set the targets tailored for each patient
Aim of the study:
To identify the best method and time for
educational diagnosis of hospitalized cancer
patients on chemotherapy.
Methods (1)
Literature review (Internet, Pub Med, Journals)
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Main concepts : Cancer and therapies, Side effects,
TPE, Educational diagnosis, Timing and method,
To make questionnaires
Observation and interviews
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The whole Healthcare process for cancer patients (Announcement
consultations, Medical staff, Multidisciplinary –RCP- and Routine
Meetings)
Data used (Medical records, Notes taken during meetings, Special
workbooks (“classeur”)
Consultations of coordinating nurse
Consultation with psychiatrist for the caregiver
Informal conversations with dietician, hair dresser, Geriatric,
kinesthesist, psychologist
10 days in two different departments
Methods (2)
Observation and interviews (cont)
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Project meetings of Hospital staff for the TPE program elaboration
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Two courses for the educational training of medical staff for TPE
Ethical aspects
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Verbal consent from the medical staff to access to the medical
records,
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Verbal consent from patients and professionals before interviews
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Permission from the patient during my consultation observations
Results on health care process (1)
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Outpatient is referred from family doctor with reports, see
specialist, have more investigations, if provisional diagnosis cancer,
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Patient is called for announcement of diagnosis during a special
consultation
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Record submitted to RCP, diagnosis and treatment is finalised
according to the reaction the patient.
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For chemotherapy : Patient goes to nurse to have explanations on
intravenous chamber, side effects or any other question
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Nurse notices his psychological and social life status, gives him the
detail of all professional he is going to meet
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Day hospital : medical examination, chemotherapy session, during
weight check by dietician and advice if necessary, help from
attending assistant
Results on health care process (2)
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Inpatients more sick are admitted in weekly or traditional hospital
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Diagnosis announcement in a room and followed by other
professionals (95%)
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Everyday meeting of staff for taking charge and brief description of
patient to each other
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Special workbooks explanation and consent
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Consultation with different professionals if required or asked
before next weekly meeting
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Coordinating nurse works as relationship between patient and all
professional
Results from Patients
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All patients agreed on that
◦ structured interviews is a best method
◦ education should not be started just after diagnosis
announcement
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Two out of three patients did not like the Special workbooks
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One out of three did not like the announcement consultation and
educational language,
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Two of them did not want to take part in decision making about
treatment
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All of them never attended any special session for education
Results from 11 Professionals
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None of them have got the training for TPE.
6 did not know about educational diagnosis
All agreed with personal interviews as the best option for
educational diagnosis.
Only one did not like the idea of TPE.
Concerning time for ED :
◦ 8 agreed with the next weekly meeting
◦ 3 agreed with chemotherapy sessions
5 considered that Special workbooks can help as a part for ED
while 3 thought it can’t,
4 considered that patients can understand about disease and
therapy,
6 have the experience of patients asking questions
5 told that some patients participate in the decision-making
Limitations of the study
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Short Pilot study
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A single hospital, only 2 specific wards
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Qualitative data without statistical significance
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Both patients and professionals should have altered their behaviour
because of the observation (Hawthorn effect).
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Access to the patients but no data on family
Conclusion
TPE seems to be not well known by professionals, including ED
Oncopsychlogy should be improved
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Time for ED has to be discussed :
Weekly meetings can be a good place to finalize the educational
needs of the patient
Just after the diagnosis announcement the patients should not be
given education
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Method for Educational Diagnosis
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Personal Interviews