Direct Patient Education Research Articles

Research Promoting Better Patient Education on Reproductive Health After Cancer

Although research on cancer survivors' experiences and attitudes about infertility is relatively new, existing literature suggests that only about half of men and women of childbearing age receive the information they need from their health care providers at the time of diagnosis and treatment planning. Thus, better patient education strategies are needed. Although the ideal would be to have oncologists conduct detailed discussions of options to preserve or restore fertility with all interested patients, this standard is unrealistic. A more practical alternative is to train nonphysician providers such as nurses and social workers to address this topic. In addition, innovative strategies of direct patient education could be helpful, including use of computerized media, peer counseling, or special educational modules tailored to a particular age group or cancer site.

Orthopaedic assessment in haemophilia.

Outcomes may be measured in terms of both objective and subjective variables and also on the basis of cost-efficiency. Most tools currently used to quantify outcomes, especially in orthopaedics, involve measurements of general health and of specific body part or organ system function. Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Rating results are fundamental to evaluation and comparison of different methods of treatment. The discrepancies existing among rating scales have been an impediment in the evaluation of haemophilic patients from the orthopaedic point of view. Progress depends on international cooperation to improve communication and on the evaluation of new surgical techniques. The World Federation of Haemophilia (WFH) physical joint examination instrument and the Colorado physical examination (PE) instruments made important contributions by developing forms that will serve as a foundation for future evaluation systems. Some authors have suggested that the Colorado PE instruments are more indicative of early joint dysfunction than the WFH instrument. Future goals of the Colorado PE instruments are to refine the standard forms, identify additional important reproducible criteria and develop a comprehensive method of evaluation. It is paramount to develop valid and reliable surveys that can be used preoperatively to direct patient education and shared decision making and to provide a framework for setting reasonable goals. Re-examining patients' responses postoperatively could provide a way to assess fulfilment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.

Acceptance of generic prescribing in general practice: effect of patient education and reference prices

AIMS To assess patient acceptance of the substitution of brand-name drugs for generic equivalents in the context of repeat prescriptions for chronic diseases. METHODS A prospective multicenter study of drug use was performed. Of the 31 centers included in the study, 8 were randomized to the intervention group and 23 to the control group. For 1 year, patients in the intervention group who visited the center to collect repeat prescriptions received verbal and written information on the advantages and disadvantages of generic and brand name drugs. Data on the number of patients taking brand-name drugs for which generic equivalents were available, as well as the reasons and variables related to refusal of generic drugs (age, gender, education, primary care centre, general practitioner, type of drug and total number of repeat prescriptions) were collected. The percentage of generic drugs among the total number of drugs prescribed was calculated at 2-monthly intervals. RESULTS A total of 98.9% of the 4620 patients in the intervention group agreed to change to a generic formulation. The percentage of patients accepting generic drugs was significantly associated with the primary care centre, the class of drug, doctors' influence, and patient satisfaction with the drug. Generic prescriptions represented 5.9% in the intervention practices compared with 2.8% in controls. After the intervention, and before the application of reference prices, the percentages were 6.7% and 3.9%, respectively. Immediately after application of the reference prices, the percentages were 8.6% and 6.3%, respectively. CONCLUSIONS Direct patient education is an effective strategy in increasing the prescription of generic equivalents. General practitioners' motivation and knowledge of generic drugs influenced their use. The application of reference prices increased the use of generic equivalents.

Aceptación de los fármacos genéricos en equipos de atención primaria: efecto de una intervención educativa y de los precios de referencia

To assess patient acceptance of the substitution of brand-name drugs for generic equivalents in the context of repeat prescriptions for chronic diseases. A prospective multicenter study of drug use was performed. Of the 31 centers included in the study, 8 were randomized to the intervention group and 23 to the control group. For 1 year, patients in the intervention group who visited the center to collect repeat prescriptions received verbal and written information on the advantages and disadvantages of generic and brand name drugs. Data on the number of patients taking brand-name drugs for which generic equivalents were available, as well as the reasons and variables related to refusal of generic drugs (age, gender, education, primary care centre, general practitioner, type of drug and total number of repeat prescriptions) were collected. The percentage of generic drugs among the total number of drugs prescribed was calculated at 2-monthly intervals. A total of 98.9% of the 4620 patients in the intervention group agreed to change to a generic formulation. The percentage of patients accepting generic drugs was significantly associated with the primary care centre, the class of drug, doctors' influence, and patient satisfaction with the drug. Generic prescriptions represented 5.9% in the intervention practices compared with 2.8% in controls. After the intervention, and before the application of reference prices, the percentages were 6.7% and 3.9%, respectively. Immediately after application of the reference prices, the percentages were 8.6% and 6.3%, respectively. Direct patient education is an effective strategy in increasing the prescription of generic equivalents. General practitioners' motivation and knowledge of generic drugs influenced their use. The application of reference prices increased the use of generic equivalents.

Patients' expectations of knee surgery.

Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Our goals were to measure patients" preoperative expectations of knee surgery and to develop and test patient-derived knee expectations surveys. An initial sample of 377 patients (mean age, 54.6 18.2 years; 52% women) was enrolled in the survey-development phase. One hundred and sixty-one (43%) of these patients subsequently underwent total knee arthroplasty; seventy-five (20%), cruciate ligament repair; eighty-five (23%), meniscal surgery; and fifty-six (15%), surgery for another knee condition. Preoperatively, these patients were asked open-ended questions about their expectations of knee surgery. Their responses were grouped with use of qualitative research techniques to generate categories of expectations. Categories were transformed into specific questions and were formatted into two draft surveys, one for patients undergoing total knee arthroplasty and one for patients undergoing other surgical procedures on the knee. A second sample of 163 patients (mean age, 55.1 17.5 years; 49% women) was enrolled in the survey-testing phase, and they completed the draft surveys on two separate occasions to establish test-retest reliability. Items were selected for the final surveys if they were cited by 5% of the patients, if they represented important functional changes resulting from surgery, or if they represented potentially unrealistic expectations. All selected items fulfilled reliability criteria, defined as a kappa (or weighted kappa) value of 0.4, or were deemed to be clinically relevant by a panel of orthopaedic surgeons. From the survey-development phase, a total of fifty-two categories of expectations were discerned; they included both anticipated items such as pain relief and improvement in walking ability and unanticipated items such as improving psychological well-being. Expectations varied by diagnosis and patient characteristics, including functional status. Two final surveys were generated: the seventeen-item Hospital for Special Surgery Knee Replacement Expectations Survey and the twenty-item Hospital for Special Surgery Knee Surgery Expectations Survey. Each required less than five minutes to complete. Patients have multiple expectations of knee surgery in the areas of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two valid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for setting reasonable goals. Reexamining patients' responses postoperatively could provide a way to assess fulfillment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.

Demographics, Personality Traits, Roles, Motivations, and Attrition Rates of Hospice Volunteers

ABSTRACT The authors conducted a review of prior research on hospice volunteering. The results show that, in most cases, the hospice volunteer is a white, married, middle-aged, financially comfortable, unemployed, female who has some college education, strong religious beliefs and has experienced the loss of someone close (see Tables 1 and 2). The results also show that hospice volunteers tend to share certain personality traits reflecting compassion, tolerance, empathy and sensitivity among others. Volunteers tend to fulfill four roles: direct patient support, education, clerical assistance, and professional services (Bunn 1985). Motivations for volunteering and for continuing one's work as a volunteer appear to be for both personal and altruistic reasons. Primary reasons for discontinuing volunteer service include burnout, communication problems, unrealistic expectations, and insufficient use of the volunteer staff. Gaps in this area of research are identified and topics for further research are presented.

The Walter Reed Army Medical Center Nephrology Service Website: A Tool for Military-Wide Provider and Patient Education

Military medical subspecialists consult with referring physicians, direct patient care and education, support isolated subspecialists, and maintain cohesive readiness plans. The World Wide Web appears promising in fulfilling these roles. A website providing directed resources, the Walter Reed Army Medical Center Nephrology Service website (http:@www.wramc.amedd.army. mil/departments/medicine/nephro/NEPHROLOGY/index.htm!), is described in the context of its role in military medicine and online publishing. The Walter Reed Army Medical Center Nephrology Service website provides educational resources for both patients and physicians worldwide. It remains the only Army internal medicine website to offer online category I continuing medical education credits free to military physicians, and it also allows online graduate medical education. Military medical subspecialty programs can use the World Wide Web to provide consultation and education to distant and isolated patients and providers in a practical, feasible manner. This process can be expanded to education in operational medicine and other military-specific medical topics.

Perception of chemotherapy side effects cancer versus noncancer patients.

This study was conducted to identify and compare perceptions regarding the disruption in quality of life caused by chemotherapy side effects in patients with cancer receiving chemotherapy and in noncancer, chemotherapy-naive patients. One hundred forty-six patients with cancer and 224 patients without cancer completed two instruments to assess the perceived magnitude of 41 physical and psychosocial chemotherapy side effects. Instrument 1 used a 5-point Likert scale (1 = not at all; 2 = a little bit; 3 = somewhat; 4 = quite a bit; and 5 = very much) to summarize patient responses to the question, "How much did or would each of the following side effects of chemotherapy bother you?" Instrument 2 was a serial ranking questionnaire that asked patients to select the 10 most bothersome side effects to numerically rank the top five. An index of the relative magnitude of chemotherapy side effects was calculated for each instrument. For patients with cancer, loss of hair 50%), changes in taste (46%), constantly being tired (42%), affects work duties (39%), changes in smell perception (35%) were most frequently perceived as bothering them "quite a bit" or "very much." Nausea and vomiting were ranked 11th and 22nd, respectively. With instrument 2, the five side effects perceived as most troublesome were, in decreasing order: nausea, loss of hair, constantly tired, vomiting, and changes in the way things taste. For noncancer patients, those factors potentially bothersome "quite a bit" or "very much" were: financial hardship (82%), hardship on family (78%), vomiting (73%), shortness of breath (70%), and ability to perform work duties (69%). Via instrument 2, the top five side effects, in decreasing order were: vomiting, hardship on family, loss of hair, financial hardship, nausea, having to move close to a treatment center. Noncancer, chemotherapy-naive patients perceived most chemotherapy-associated side effects as having greater impact on the quality of life than did cancer patients who had received chemotherapy. These findings can be used to direct patient education, education of the public, specific materials concerning cancer chemotherapy. The expertise of various members of the healthcare team can maximize the patient's comprehension of the adverse effects of the treatment options. The physician's knowledge of the overall treatment plan can assist in patient understanding; oncology pharmacists nurses are in a unique position to educate patients their families regarding potential chemotherapy side effects.

Persuasive communication: Marketing health promotion

How can nurses become more effective health educators? The message-learning approach to persuasive communication provides useful strategies for direct patient education and, when integrated with other teaching techniques, helps health educators promote change in the health behavior of their patients. IIIIIII N urses and physicians, in their role as helping professionals, serve as both educators and persuaders. ~ Persuasion is inherent in the efforts of these professionals to promote health. One means of enhancing the effectiveness of educators is to integrate specific persuasive communication strategies based on theories of social marketing and consumer behavior with other health education approaches. Persuasive communication is an interaction between the recipient of the message and the source of the message, who consciously tries to influence the recipient's attitudes or behaviors by means of a specifically designed persuasive message, z This article explores strategies based on the message-learning approach to persuasive communication that are applicable to nursing.

Home Health Nurses’ Perceptions of Nutrition Services Needs in Home Health Care

LEARNING OUTCOME: To assess perceptions of home health nurses regarding need and value of nutrition services in home health care and their ability to deliver nutrition care to patientsNutrition services in home health care promote optimal health and well-being of patients, and provide a treatment modality for a variety of conditions. Most home health care agencies provide nutritional services through their nursing department due to lack of reimbursement for registered dietitians’ home visits to clients. Home health nurses responded to open-ended questions on the adequacy of their training and support materials and services provided them for delivering nutrition care to patients, and on needs for nutrition services in home health. Sixty-six nurses representing the 31 agency members of the state Association for Home Care in a southeastern state responded to the mail questionnaire. Seventy percent of respondents were employed in an agency that did not have a registered dietitian on staff. The majority of respondents indicated they felt comfortable providing nutrition counseling to clients only if appropriate educational support materials were provided to them, if a registered dietitian were available for consultation, and if the nutrition counseling required was simple and basic. Educational support materials needed included sample diets, updated references on nutrition care and nutrition education resources for illiterate patients and patients with impaired vision. Seventy-three percent of nurses responding indicated that a registered dietitian involved in direct patient home care and education would be very beneficial, with particular needs associated with nutrition assessment and recommendation of nutrition care plans for patients.

The advanced practice nurse: meeting the information needs of the rural cancer patient.

The goal of the Rural Cancer Care Project is to assist patients and families residing in rural areas to receive the highest-quality cancer care in their own communities. An advanced practice nursing clinic, serving as an adjunct service to specialty cancer care, is the core of the intervention model demonstrated by the "Rural Partnership Linkage for Cancer Care", a National Cancer Institute grant awarded to Michigan State University in 1990. The nursing intervention is directed to meeting patient and family needs. One hundred seventy patients enrolled in the study beginning in January 1993 through September 1995. Knowledge deficit proved to be one of the most frequently identified problems (in 78% of the 170 patients evaluated), although the patient and family had often received care at a community oncology center with specialist health care professionals. Teaching was a major nursing intervention employed in patient care to address patient problems and needs as presented (e.g., chronic pain, fatigue). The data also demonstrated that the patients had more knowledge needs in the later stages of disease when they had cancers in all sites but the breast, where patients with Stage I and II disease had the greater learning needs. Nursing interventions were directed primarily at education regarding cancer as a disease or the understanding of chemotherapy. The advanced practice nurse, by providing direct patient and family education in a community setting, does improve patient knowledge and subsequent outcomes.

Total home care management of the burn patient

The home health care team can be of paramount importance to the burn patient in assis tance with direct care, patient education, rehabilitation, and psychosocial recovery. This article presents helpful information on types of bums, the home care assessment, support services, the process of healing, and the nursing role in the prevention of infection and further injury.

Parenteral nutrition: Hospital to home

Parental nutrition support is the provision of essential nutrients intravenously, bypassing the intestinal tract. It is used in a variety of clinical settings and medical conditions. Parenteral nutrition is a complex technology that requires the input of many professionals, including dietitians. The role of the dietitian in parenteral nutrition support involves direct patient care, consultative services, education, program development, and research. Even though this field of practice is still developing, some common practices can be described. Nutrition assessment determination of macronutrient and micronutrient requirements, and monitoring are vital aspects of the provision of parenteral nutrition support that benefit from the knowledge and experience of a dietitian. The future of parental nutrition includes identification of preferred fuels for specific disease states, development of new lipid emulsions, and identification of conditionally essential nutrients.