Abstract
BackgroundGlobally, glaucoma is the leading cause of irreversible blindness. However, many patients with glaucoma do not understand their disease which reportedly impacts on their ability to manage their condition successfully. The aim of this feasibility study was to undertake research to inform a future randomised controlled trial of the effectiveness of group-based education for patients to improve adherence to glaucoma eyedrops.MethodsKey objectives were to understand current provision of information during routine nurse-led glaucoma consultations, to investigate if it is possible to deliver patient information in line with a clinical standard by training nurses to deliver group-based education in multiple hospital sites and to explore the acceptability of group-based education to nurses and patients compared with usual information provision in consultations. This study employed quantitative and qualitative research methods situated in a sequential design across three hospitals in England and Wales. Current provision of information given to 112 patients with glaucoma across the three hospitals was observed and compared to that recommended in a clinical standard. Then, six nurses were trained to deliver group-based education. Following which, the level of information was assessed again in line with the clinical standard as the group-based education programme was delivered in the three hospitals to 16 patients in total. All nurses and six patients were interviewed to explore experiences of the group-based education sessions.ResultsThe main area of information provided during routine nurse-led consultations concerned the management of glaucoma and that least covered was about prognosis of the disease and information about support services. Nurses were trained to implement group-based education for patients. Information was provided more often by the nurses about all the items of the clinical standard when delivering group based education. However, patients’ motivation to attend were negatively impacted mainly by delays in delivering the education for the third phase and because the majority were established patients. Nurses and patients who participated found it useful and comprehensive.ConclusionThis feasibility study demonstrates that the proposed intervention for the randomised controlled trial, the group-based education, goes beyond current information provision, is in line with that articulated by a clinical standard and is implementable across several sites. This bodes well for a future randomised trial, but the following needs to be taken into account to ensure success: independent implementation of the research, training and delivery at each site, timely provision of the patient education, inclusion of new patients, and consistently delivered nurse training.Trial registrationInternational Standard Randomised Controlled Trial number, ISRCTN91188805
Highlights
Glaucoma is the leading cause of irreversible blindness
I think we did it [provided education] before but we hadn’t got a structure and I think we’ve got a structure haven’t we? Nurse 1, hospital 3. They reported that the course covered almost everything that patients ask about in clinic. What we found This is the first study to consider how nurses might achieve a clinical standard for glaucoma information provision to patients
The interview data support the quantitative findings demonstrating the challenges involved in trying to impart sufficient information during routine consultations. These results suggest that patients received more information about their glaucoma in accordance with the clinical standard during the group-based education programme than they did during their usual clinical appointments
Summary
Many patients with glaucoma do not understand their disease which reportedly impacts on their ability to manage their condition successfully The aim of this feasibility study was to undertake research to inform a future randomised controlled trial of the effectiveness of group-based education for patients to improve adherence to glaucoma eyedrops. Our previous research focusses on defining the parameters needed to design a randomised controlled trial of a group-based education intervention to improve adherence to glaucoma eyedrops [1, 2]. This included work to identify the willingness of patients to be recruited and consent to participate in the education and clinicians’ willingness to approach potential participants. There is no research which has considered whether nurses conform to the quality standards of information provision with regard to UK NICE glaucoma clinical guideline, hereafter referred to as the ‘clinical standard’
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