Patient education

1. Patient education Considering the aspects for effective education of haematological toxicities

2. Patients rights • Information on risks • Involvement in decisionmaking • Trainedtobeknowledgeableandvigilant • Safetyassharedresponsibility WHO, 2010

3. Patient education Isanysetofplannededucationalactivities, using a combinationofMethods (teaching, counseling and behaviourmodification) thatisdesignedtoimprovepatients knowledge and healthbehaviour. Bergh, 2012; Friedman et al. 2011; Johansson et al. 2003

4. Key principles of effective patient education – the ASSURE Model • Analyze the learner • State the objectives • Select the instructional methods and materials • Use the instructional methods and materials • Require learner performance • Evaluate the teaching plan and revise as necessary Bastable, 2016; Heinich, R.M 2001

5. Analyze the Learner – possible patient barriers to education • Stress and anxiety level • Illness representation • Coping style • Motivation to learn • Caused by illness (Memory, attention spam, hear or sight deficits) • Cognitive impairment • Lack of time • Health literacy level • Cultural appropriateness Bastable, 2016; Arida, 2016; Finnie, 2010

6. External barriers of education • Limited knowledge and skills of the educator • Poor communication skills • Lack of specialist knowledge • Poor understanding of principles of patient education • Low priority status of client education • Questionable effectiveness on client education • Lack of time • Timing of information delivery • Environment not conducive to learning • Limited and poor quality resources • Cooperation among nurses and doctors Bastable, 2016; Bergh, 2012

7. The problem of low health literacy • From 2% in the Netherlands to 27% in Bulgaria • From 28% in the Netherlands to 62% in Bulgaria Approximately 50% of the European population have poor reading and comprehension skills Cannot perform basic reading tasks required to function in society - Have trouble reading maps and completing standard forms Storms 2017; Sörensen, 2015; EC, 2015

8. Determinants of health literacy in Europe • Low socio-economic status • Lower education • Poor health status • High use of health care services • Older age • Language and cultural background EC, 2015; Halverson, 2015; Sörensen, 2015; Wangdahl, 2014

9. Multiple componentsofhealthliteracy • Cultural andconceptualknowledge • Print literacy • Numeracy • Oral literacy • Media literacy Oldach and Katz, 2014

10. Tell me and I forget, teach me and I may remember, involve me and I learn Benjamin Franklin, inventor & writer

11. Six steps to improving patient understanding 6. Encourage patient questions 5. Assure understanding with the “show me” technique 4. Use pictures/models to explain concepts 3. Avoid medical jargon 2. Slow down • Limit the amount of information provided at each visit Rigdon, 2010, Davis et al, 2002; Williams et al, 2002

12. Avoid medical Jargon   Removalof a small sample oftissue biopsy Novisiblysignsorsymptomsofcancer Remission Take itbymouth p.o.

13. State the Objectives • WHOneedstobetrained? • WHATneedstobetrained? • WHENistheright time? • WHEREistherightplace? • HOW do youwantto do it?

14. State the objectives – haematological toxicities Patient education Understanding of implications Informed decisions Better concordance Faster treatment of symptoms Awareness of warning signs Patients often experience complications of haematological toxicities at home Better patient outcomes Better patient outcomes Bastable, 2016; Davis et al, 2002

15. Select the instructional methods and materials Telephone • Helpline • Apps • Follow-up calls Audio-visual aids • Verbal interaction • individual • group Printed materials • DVD/CD/USB • MP3 player • Podcast • Video/audio tape • Booklets • Brochures • Posters • Flip-charts • Multimedia • Internet/online • Interactive learning • materials, e-health tools

16. Select the instructional methods and materials – written patient education Content • Keep sentences short • Use plain and simple language. Eliminate jargon, medical terminology, and acronyms • Define any technical terms that must be included • Be direct and specific. Use the active voice • Make sure the information is culturally and linguistically appropriate Format • Break up paragraphs into shorter sections with clear subheadings • Use bullet points and numbers • Leave plenty of white space • Use a serif font for the text and a sans serif font for headings • Use a font size of 12 points or higher • Left justify the text, and leave the right margin uneven Design • Create an obvious path for the eye to follow • Include illustrations that aid comprehension. The illustrations should be clear and effective, whether printed in color or in black and white • Use color sparingly. Remember that dark letters on a white background are easier on the eyes • Use icons or images to call out important content • Make the resource appealing at first glance Foster, 2016

17. Multimedia and patient education • Multimedia offers many advantages • Engages patients in active learning • Provides concrete, objective information • Allows personalization of the information • The patient controls amount, type and pace of information delivery • Multimedia is effective • Increases knowledge and retention of information • Improves management of side effects and may decrease symptoms • Satisfies a broad range of educational needs • Improves patient satisfaction Lam, 2017; Mank 2008; Skalla et al, 2004; Williams and Schreier, 2004; Agre2002; Chelf et al, 2001

18. Use the instructional methods and materials - examples Developtools in different wayshowtogiveinformation: e.g. remindersfor oral intake • Calendars • Pillboxes • Smartphone applications

19. Use the instructional methods and materials – examples – Folder AHOP, Austria

20. Examples of multimedia patient education methods • Telephone helplines/recordings can provide personalised information and support • Videos of patients who have undergone treatment • Virtual tour of treatment rooms • Interactive DVD /CD-Rom/USB/Online course about side effects of treatment • Recording a visit to the doctor to listen to later • Audiotapes to improve self care Mank, 2008; Williams and Schreier, 2004; Skalla et al, 2004

21. Use the instructional methods and materials – examples – CD-Rom Academic Medical Centre, Amsterdam, The Netherlands

22. Evaluate the teaching plan and revise as necessary Teach-back method Pretend I am the patient and you are the clinician. What do I need to know about… I want to see how well I explained … How would you explain what I just told you to your family member/ friend… Tell me what you know about… How would you explain that to… Tamura-Lis, 2013

23. Evaluatetheteaching plan andreviseasnecessary Return-demonstration method: Formulateshortanswertests Show me, what I just did. ? ? ? Bastable, 2016; Tait, 2014

24. Educate your colleagues Only as a team the patients education can be a success. When implementing a new way to educate / teach patients, always think about also to integrate your team so that everyone can use those materials the same way….

25. Summary • Education has an essential role to play in the prevention, detection and management of haematological toxicities • The need to develop diverse, person-centred education strategies to support patients’ knowledge and understanding of their health situations grows • Individualizing interventions in this manner can increase patient investment in health-related behavior change and enhances the likelihood of satisfactory outcomes Arida, 2016; Bergh, 2012