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VENETO REGION - PADUA UNIVERSITY HOSPITAL, ITALY
THERAPEUTIC EDUCATION INCREASES HEALTH LITERACY OF
MULTIPLE MYELOMA PATIENTS
^Belleggia G., ∞Goegan L., ∞Pizzocaro F.,*Marcolongo R.
^Psychologist, Clinical Immunology Unit, Padua University Hospital
∞Student, faculty of Science of Education, Padua University
*Physician, Clinical Immunology Unit, Padua University Hospital
INTRODUCTION
METHODS AND STUDY POPULATION
Multiple myeloma (MM) is a neoplastic plasmacell disorder affecting
adult or elderly people, that usually exhibits an indolent clinical
evolution. Many MM patients have to take long-term oral
chemotherapy to maintain the disease under control; moreover, they
must learn and put in to practice adequate health behaviour and
coping strategies in order to prevent disease or treatment related
complications and to preserve a good quality of life. This situation
makes necessary the empowerment of patients by an adequate health
literacy and knowledge about disease and treatment. Nevertheless,
besides alarming prejudice about neoplastic diseases and
chemotherapy, many elderly MM patients have a low level of
instruction and of health literacy and a partial or total lack of
information about the disease and the treatment that makes difficult
their active engagement.
Fifteen patients, mean age 70 years (s.d. 7,2, min.54 - max 82), were
enrolled in the TPE. It consisted of 5 structured teaching sessions that have
been carried out together by an haematologist and a psychologist. They
taught patients and their caregivers specific knowledge about the disease
and the treatment, and provided them with some basic safety and emotional
self-management skills. A professional educator and a general practitioner
gave their advice and contribution to the planning and the implementation of
the programme.
Evaluation tools: knowledge pre- and post-test questionnaire, State Trait
Anxiety Inventory, Beck Depression Inventory, Quality of Life Questionnaire.
Phases
Sessions
Educational and Psychological Diagnosis
2
Training
Session themes: disease, therapy, disease and therapy related
risks, prevention of bone fractures, coping strategies.
With the purpose to promote the empowerment of MM patients, the
Clinical Immunology Unit of Padua University Hospital devised a
specific Therapeutic Patient Education (TPE) programme.
5
weekly sessions taking
about 90 minutes
Evaluation of the cognitive learning and of the impact of
the training in the patients quality of life
1
RESULTS
We found a statistical difference in patients’ knowledge level before and
after educational programme (T = -5,969 ; p = .000).
After TPE, besides the increase of patient perceived quality of life, we
also observed both a significant decrease of anxiety and depression
level.
Indeed, the percentage of correct answer before TPE (educational
diagnosis) was 43,69%, while after education (post-test) it was 78,46%.
%
correct
answer
s
BEFORE
AFTER
STATISTICAL
TPE
TPE
ANALYSIS
QUESTIONS:
% correct
answers
BEFORE TPE AFTER TPE
STATISTICAL
ANALYSIS
Anxiety Level (STAI-Y)
48 RP*
37 RP*
ns
12,9 slight
depression
6,53
.00
4,15
7,46
.00
PRE POST
43,69
78,46 T= -5,969
P=.000
100
90
80
70
60
50
40
30
20
10
0
Name of the disease
46,7
76,9
Depression Level (BDI)
Description of the disease
46,7
92,3
Risks of the disease
60
100
Perceived quality of life
(Range: 0=worse -10
=better)
Safety strategies for preventing the
disease risks
60
100
Drug therapy
20
61,5
26,7
69,2
40
69,2
Risks of the therapy
Safety strategies for preventing the
risks of therapy
before-TPE
after-TPE
Health Literacy Pre- and Post- TPE
100
DISCUSSION
In the old age, the effective and safe treatment of MM requires the active
and aware participation of both patients and their caregivers. This results
can be accomplished only throughout the empowerment of patients and
their caregivers in the management of the disease. An effective
therapeutic patient education is the most important tool in the hands of
healthcare professionals to achieve such a result.
Indeed, TPE represents a good empowerment strategy that, increasing
patients’ health literacy, can be effective in the control of patient’s
emotional distress; moreover, by active learning, patients and their
caregivers can improve their quality of life.
80
60
40
CORRESPONDING AUTHOR:
20
0
Name of the disease
Description of the
disease
Risks of the disease
Saf ety strategies f or
preventing disease risks
Drug Therapy
Risks of the therapy
Saf ety strategies f or
preventing treatment
risks
Pre-TPE
Post-TPE
Dr. Renzo Marcolongo: Clinical Immunology Unit, Padua Universital Hospital
via Giustiniani, 3 – 35128 PADUA (Italy)
E-mail: [email protected]
THERAPEUTIC PATIENT EDUCATION LABORATORY – PADUA (ITALY)