The effects of patient education on health: A second order meta-analysis

1. The effects of patient education on health: A second order meta-analysis Bianca A. SimonsmeierMaja Flaig Michael Schneider

2. Risks and Side Effects of Surgery and Medication • Complications • Side effects • Over dose • Drug addiction • Resistant bacteria problems • Relevance of medical treatments other than surgery or drug prescription

3. Patient Education • Patient education is an instructional intervention with the goal to inform patients and change attitudes and behavior patterns which in turn helps to recover from their disease • For example pamphlets, conversation, trainings • Mainly conducted by nurses, doctors, pharmacists, psychologists, or social workers • Most commonly for patients with chronic diseases

4. Advantages ofPatientEducation • Quick and easy • Cheap as compared to surgery or drug prescription • Key variable of informed consent • Strengthens the patients self efficacy and autonomy • No known side effects • No harm of overtreatment

5. But is Patient Education Effective? • “It is commonly believed that psychoeducation interventions are ineffective“ (Donketet al., 2009) • Many studies and meta-analyses • Goal of the current study: Integration of results from previous meta-analyses • Research questions • Causal effect of patient education on health? • For what health outcomes? • For what diseases? • For what instructional methods?

6. 2. Order Meta-Analysis 2. order meta-analysis Ourstudy Meta-analyses … Single studies … … Patients … … … …

7. Inclusion Criteria • Comparison between treatment (with patient education) and control group (no patient education) • Effect sizes related to patients (not significant others or healthy population) • Effect for objective or subjective health outcome or health behavior reported • Standardized effect size reported

8. Standardized Literature Search • Databases: PsycINFO, PubMed, Cochrane Library, Eric, explorative search • Search string: meta-analysis AND (patient education OR health education OR psychoeducation) • 469 hits • Screening of titles and abstracts 220 articles excluded • Screening of full-texts 202 articles excluded • When studies were included in more than one meta-analytic integration, effect size was excluded from analysis • 47meta-analyses were independently coded by two raters

9. Included Studies • 173 effect sizes from 47 meta-analyses • Meta-analyses were from 1980 – 2015 • ICD-10-categories: A, B, C, E, F, I, J, K, M, O, Z (Surgery, diabetes, cancer, heart attack, stroke, arthritis, etc.) • Outcomes: blood sugar, medication use, anxiety, death, hospital admission, etc.)

10. Overall Effect Mainly experiments (RCT)

11. 2. Health Outcomes

12. 2. ICD-10 Categories

13. 4. InstructionalMethods

14. Discussion • Patient education seems to be effective • For various health outcomes • For many diseases • Not exclusively for chronic illnesses (but here more effective?)

15. Discussion • Analyses are still running • Statistical analyses for second order meta-analysis in some cases unclear (e.g. how to deal with first and second order sampling error) • Some meta-analyses don't report number of participants or SD/variance of effect size – need to be excluded • Many small meta-analyses

16. Conclusion • Patient education has positive effects on a variety of health outcomes and disease patterns • Results are especially promising as education is cheap and has less risks and side effects as compared to medication use or surgery • Patient education might even be more effective when instructional design principles are considered

17. Thankyou! 