Therapeutic Patient Education Program Research Articles

Development of a Therapeutic Education Program for Patients With Metastatic Prostate Cancer Treated With New Generation Hormone Therapy

Development of a Therapeutic Education Program for Patients With Metastatic Prostate Cancer Treated With New Generation Hormone Therapy

Self-directed learning: A framework for understanding therapeutic patient education through online health forums

Online Health Forums (OHFs) allow patient learning and therapeutic patient education (TPE). To reinforce the pedagogical dimension of these tools, it is necessary to understand the learning processes and conditions involved in OHFs. A potential framework for the analysis of this phenomenon is self-directed learning (SDL). The objective is to propose a framework for the analysis of learning and TPE in OHFs, based on existing SDL theories. This could allow to identify the learning characteristics of OHFs and to identify potential implications for TPE. A narrative review was conducted on the basis of 40publications whose analysis through three categories (elements of SDL's definition, learner role and environmental impact) allowed to identify the explanatory theories of SDL. The main result is a proposition for an analytical framework to examine OHFs according to their self-formative characteristics and, then, discuss their links with TPE programs. Indeed, similar principles between SDL and TPE are emerging such as the identification of needs, the autonomy of patients/learners, and the place of Self Efficacy. These similarities highlight the potential complementarity between OHFs and SDL. SDL allows us to understand how Internet users learn on OHFs. Although links between SDL, OHFs and TPE are identified, a better understanding of the learning modes used in OHFs and their functioning according to the user profile could clarify their learning potential and their empowering effect.

Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial

BackgroundDespite numerous guidelines, nearly one of two patients with cancer pain remains undertreated, thereby affecting their quality of life. Active patient involvement through Therapeutic Patient Education (TPE) is considered as a relevant strategy to overcoming hurdles in pain management. The aim of the EFFADOL study is to assess the effectiveness of a TPE program in improving cancer pain management.Methods/designThe EFFADOL study is a stepped-wedge randomised controlled trial. A total of 260 cancer patients with unbalanced background pain will be randomised over the institutional level, i.e. stepped-wedge cluster design. Six clusters will be formed, one at the regional level of “Basse-Normandie” for patients receiving the educational approach by health providers already trained to TPE. Then, five additional centers will be gradually included at the national level, making it possible to compare the “conventional” management of pain (before medical staff training to TPE) with the educational approach (after being trained). The main study parameter is pain interference on daily life assessed with the self-administrated and validated Brief Pain Inventory questionnaire. Secondary objectives comprised the evaluation of patients’ adherence to pain education program, the description of pain intensity, pain relief, analgesic adherence and pain emotional impact. Educational dimension of the program will be evaluated through the patients’ acquisition of knowledge and skills about their pain and treatment as well as their self-efficacy to participate actively in pain management. The patient’s feeling of pain changes will be measured. Finally, the satisfaction of participants and educators will be reported. We hypothetise active involvement of patients in TPE will lead to an improved pain management compared to standard care.DiscussionAnalyzing the impact of a TPE program in cancer pain patients will improve their pain management and quality of life. We expect that the dissemination of our project educational approach through the French territory will be accompanied by long term change in clinical practices with mutual benefit to patients and caregiver-educators.Trial registrationNCT03297723, registered: 09/28/2017.Protocol version: Version n°1.1 dated from 2016/09/08.

Therapeutic education program for patients with hypermobile Ehlers-Danlos syndrome: feasibility and satisfaction of the participants

Objectives: To describe a therapeutic education program for patients with hypermobile Ehlers-Danlos syndrome, called PrEduSED and to evaluate its feasibility and efficiency in terms of satisfaction and impact on disease management in daily life. Methods: Prospective observational study. Evaluation before, after and 6 months after PrEduSED, consisted in: CSQ-F, SF-12, HAD, QIC, FIS, Zarit, Quiz and Vignettes (knowledge and skills about the disease), satisfaction questionnaire, Goal Attainment Scales. Results: Nineteen (19) patients (89% women, mean age: 39.2) were included and 9 relatives (78% men, mean age: 44.1). Participants were generally highly satisfied with the content and the organization of PrEduSED. Knowledge about the EDS and skills significantly improved (p < 0.001 for patients, p = 0.016 for relatives). QIC score improved significantly (p = 0.047) and FIS score also for the relationships domain (p = 0.05). At the end of the program, 69% of participants thought they had achieved their goals (mainly about acquiring knowledge and managing their treatment) beyond what they had hoped for; at 6 months, 54% felt they had achieved them beyond what they hoped for. Conclusions: Real success of PrEduSED for patients with hypermobile EDS in terms of recognition, satisfaction, increase of knowledge about the disease and adaptative skills.

Hypertensive patients: Evaluation of a therapeutic education program

Evaluation of a therapeutic education program for hypertensive patients over a 6-month period with personalized objectives. A prospective single-center study conducted in 106 patients, the study was conducted as follows: – an initial collection of epidemiological, clinical and paraclinical data from patients in normal consultation; – each patient received a therapeutic education session -personalized- with education in the use of the “hypertension follow-up notebooks” developed by the work team ( Fig. 1 ); – the monitoring of the effectiveness of the education program was carried out over three evaluation consultations over the 6 months of the survey. One hundred and six patients participated in the study: mean age 47 ± 10 years; 62.26% of them were male (66 patients). Essential hypertension in 95.28% of patients, grade II to III, uncontrolled in approximately 70% of them. With an average evolution period of 9.5 ± 7.5 years. At 6 months, a significant decrease of SAP (from 154 ± 3 to 143 ± 3 mmHg, P less than 0.01) and DAP (from 95 ± 2 to 87 ± 2 mmHg, P less than 0.01) was notified. 50.7% versus 33.8% of patients have SAP and DAP in the therapeutic objectives. The monitoring of dietary and physical activity objectives is correlated with the decrease in BP ( P < 0.05). A significant increase in self-monitoring with therapeutic decision-making ( P < 0.01). A significant decrease in hypertension-related distress and feelings of failure ( P < 0.01). Success rate among patients who chose the objective “reduce salt”: 53%, “reduce fat”: 50%, “walk several times/week (30 min)”: 88%, “exercise at least once/week”: 22%. 67% have at least one physical activity objective in place. No significant decrease in weight (−0.6 ± 4.1 kg) but 39% lost at least 2 kg. A therapeutic education program with personalized objectives can give significant results at 6 months in terms of BP figures, dietetics and physical activity, self-monitoring of hypertension while reducing feelings of distress.

La photo-expression : un outil pour accompagner le patient en éducation thérapeutique et pour évaluer son évolution

IntroductionIn therapeutic patient education (TPE), photoexpression is often used by psychologists in order to work on patients’ perceptions and experiences, especially in group workshops. AimThe aim of this study was to explore diabetic patients’ discourse during two photoexpression group workshops at the beginning and the end of a TPE program. MethodSeventeen patients took part in this study. A lexicometric analysis was performed on their discourse during the two group workshops (Alceste® software). ResultsFor the first workshop, the analysis yielded two classes: the place of diabete in daily life as well as psychic and social functioning. For the second workshop, the analysis also yielded two classes: self-management and adjustement, as well as program experience and return back home. ConclusionThe results show an increase in adaptation skills and particularly in self-efficacy, motivation, positive emotions, perhaps illness acceptance. Photoexpression shows to be a very interesting tool in TPE to accompagny patients but also evaluate their discourse evolution during a TPE program.

Improving blood pressure control after a stroke: The place of therapeutic education in the acute phase

At the Paris Saint-Joseph Hospital Group neurovascular unit, the therapeutic patient education program "Treatment of high blood pressure after stroke" involved integrating a vascular physician. The objectives were to include a significant number of patients, to integrate learning self-measurement, and to make an initial analysis of the results concerning patient knowledge, self-measurement practices, adherence to treatment, and control of blood pressure. Eighty-six patients under 90 years of age admitted to the neurovascular unit were included in the program between January 1 and October 31, 2017, and participated in an in-hospital educational diagnostic interview followed by an initial session. During this period, 30 patients were reviewed within 3 to 6 months after discharge, with a post-session evaluation for 22 of them. Patient satisfaction was assessed with a questionnaire. A questionnaire was also proposed to the staff. The mean blood pressure of the 22 patients reviewed was on target and they had improved their level of knowledge. The number of sphygmomanometers increased from 5 to 20, but the practice of cycles was not yet mastered. Levels of observed compliance changed little. Patients and paramedics appreciated the program and were convinced of its usefulness. These results do not support a direct effect of therapeutic patient education on blood pressure control, but the observed results are positive and encouraging.

A Therapeutic Education Program for patients that underwent at temporary tracheotomy and total laryngectomy: leading to improved the "Diagnostic, Therapeutic and Assistance Path".

Background and aim of the study: Therapeutic education helps patients with a chronic disease to acquire and maintain the ability to live their life while handling their illness. Patients with temporary medium-term tracheotomy or permanent tracheostomy need to acquire skills to be able to handle the stoma, tracheal tube, related issues, and other apparatuses. This was the purpose of our therapeutic education program, which was aimed to take patients and caregiver to an efficient level of self-care. Methods: In 2018, was created a CME-accredited (Continuing Medical Education) “Workplace-based Learning Project” involving all the nurses in the Otolaryngology Head and Neck Operational Unit, along different specialists on the Disease Management Team, thereby forming an “Improvement Group”. We established parallel workgroups for bibliography research on data-based like PubMed, Cinahl, Cochrane, Google scholar, in order to obtain the information to write up a shared document. Results: We wrote out an Operational Protocol which lined up nursing skills – when handling patients with medium-term tracheotomy or tracheostomy – with scientific evidence. Our standard educational plan (customizable, based on each patient’s characteristics) promote the patient’s learning with respect to self-care. Conclusions: This project has set the basis for the improvement of the quality of assistance given to the patients and therapeutic education provided them. It has encouraged the development of the skills of the nurses involved, along with their motivation, and their integration on the Disease Management Team. But, it will be necessary in the future to further evaluate the effectiveness of the program in terms of self-care. (www.actabiomedica.it)

The impact of therapeutic patient education and physical activity programs on the fall risk of elderly people

Objective: The objective of this study is to evaluate the effectiveness of a combined therapeutic education/physical activity program on risk factors for falls in elderly fall patients hospitalized in a rehabilitation healthcare service. This combined program is compared to a control program, which offers physical activity only. Method: Thirty fall patients are evaluated on the TUG, Tinetti, and FES-I tests and randomly assigned either to the group consisting of 24 sessions of physical activity alone, with endurance, stretching, balance and muscle strengthening exercises, or to the physical activity group combined with four therapeutic fall prevention education sessions. Results: For both programs, results reveal significant differences between the pre-tests and post-tests on each balance score and equally on fear of falling. An interaction effect (group × time) is observed on the FES only, which means that fear of falling decreases significantly more in the Physical Activity and Patient Education group than in the Physical Activity alone group. Conclusion: Therapeutic patient education seems to reduce fear of falling. This highlights the potential impact that such programs could have on elderly people who have had a previous fall/falls in terms of regaining self-confidence when going about their daily activities.

Qu’est-ce qui influence le choix de la dialyse péritonéale chez les patients ? une étude qualitative.

L’objectif de cette étude était d’identifier les facteurs qui influencent le choix de la dialyse péritonéale (DP) chez les patients insuffisants rénaux, dans un centre de dialyse en France offrant un dispositif d’éducation thérapeutique du patient (ETP) aux patients en pré-dialyse. Pour ce faire, nous avons mené trente six entretiens semi-directifs avec des patients, des médecins de l’équipe d’ETP et un cadre de santé. Nous avons également observé dix séances d’ETP afin d’explorer la nature des interactions entre les patients, leurs accompagnants et l’équipe soignante. Nos résultats révèlent que les facteurs qui poussent les patients à choisir la DP sont l’influence des proches, les préférences personnelles, l’influence des médecins, l’ETP à travers l’information transmise par les éducatrices. En plus de l’influence de ces facteurs dans la construction du choix des patients à s’orienter vers une méthode de dialyse, il pourrait être encore plus productif d’intégrer des patients ressources dans les dispositifs d’ETP grâce au partage de leur expérience de patients traités en dialyse avec les patients en pré-dialyse.&#x0D; &#x0D; Cette revue est mise à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International.

A multidisciplinary and interprofessional therapeutic education program for patients suffering from amyloidosis: Amylo-PEP (Amyloidosis patient education program)

Amyloidosis is a severe disease in which proteins (amyloid fibrils) build up in tissues. Numerous organs can be affected, resulting in multiple vascular, cardiac, neuropathic, digestive and kidney dysfunctions. Three forms of amyloidosis particularly affect the heart: AL amyloidosis (hematologic) and hereditary or senile transthyretin-related amyloidosis. These dysfunctions disable the patient and induce a loss of independence and a decline of his quality of life. Objectives are to improving global treatment for patients suffering from amyloidosis by integrating it to a therapeutic education approach. Maintaining their quality of life by offering them knowledge and skills to better handle their disease. Carrying out a global therapeutic education program for patients suffering from amyloidosis, with the participation of ‘resource patients’ and of the French Association Against Amyloidosis (from conception until final evaluation). Twenty-one therapeutic education workshops have been created for patients and their helpers (cf. Fig. 1 below) and organized by type of dysfunction, of treatment, of therapeutic approach or support of which 5 work groups prevent denutrition and adapt to the type of denutrition. Creating a self-completed ‘AmyloAFFECT’ questionnaire, coupled with an initial check-up, makes it possible to assess patients’ needs and direct them towards work groups. The program is evaluated through assessments of acquired skills and whether or not quality of life is maintained (ODD, AmyloBURDEN). Amylo-PEP has been created two years ago and is validated by the Regional Health Authority since 2017. Evaluating this program will assess if to some extent it has improved or stabilized quality of life for patients suffering from cardiac amyloidosis, as well as if it has had a positive impact on knowledge and understanding, on the patient's global treatment and on communication within the multidisciplinary team.

Education care in patients with psychiatric disorders in France: Psychoeducation or therapeutic patient education?

Psychoeducation and therapeutic patient education can be effectively included in treatments for patients with psychiatric disorders. These two effective educational therapies have the common purpose of improving disorder-related morbidity, compliance with treatment and patients' quality of life. While they have different methods of application, both teach patients to play an active role in their own care. However, it is still critical to combine them for care of patients with psychiatric and addiction disorders in a manner that allows for specificity. To do this, the differences between psychoeducation and therapeutic patient education must be considered, and their potential for the management of patients with psychiatric and addiction disorders must be determined. In our article, we review the literature concerning therapeutic education programs for patients and discuss the literature based on the experiences of psychiatrists trained in these therapies. Despite rather nonrestrictive guidelines, and after reviewing numerous studies, we found that psychoeducation seems to be rarely used in psychiatry. The use of therapeutic patient education programs for psychiatric patients has doubled in four years but still accounts for less than 4% of validated programs in France. Only 154 programs were developed in 1175 public psychiatric facilities in 2016. Therapeutic patient education has a legal framework and recommendations, which make it suitable for inclusion in care and in the training of care providers. The rigor in the development of therapeutic patient education programs and the requirement for training and financial support reinforce the need for their establishment in healthcare institutions. As such, they could help to modify professional practices and the culture of care in mental health fields. There is a place for therapeutic patient education in psychiatry as it provides a real benefit for patients. It could modify care practices and costs, and is suitable for patients with psychiatric or addiction disorders by helping them play an active role in their care, thereby improving treatment outcomes and quality of life.

Therapeutic patient education improves knowledge and skills for patients with chronic spontaneous urticaria.

Therapeutic patient education (TPE) allows patients to better understand their disease and cope with treatment. TPE programmes have not yet been evaluated for chronic spontaneous urticaria (CSU). To investigate the cognitive and behavioural impact of TPE on CSU patients. CSU patients were selected who completed a TPE programme. A pre-post comparison was performed using a skill/knowledge questionnaire, based on six educational objectives, before and after the intervention. The course of CSU was also analysed, according to daily hive count and itch intensity. All of the 61 enrolled patients improved their knowledge and skills following TPE, with greatest improvement in itch management and use of alternatives to scratching. CSU activity was reduced at the end of the programme in 60% of patients. TPE improves knowledge and skills for CSU patients. Further research is needed to demonstrate the positive impact of TPE on CSU activity.

Epilepsy surgery: A therapeutic patient education program

Before the creation of a therapeutic patient education (TPE) program for epilepsy surgery, a needs analysis was conducted with 29 people, including patients (n=13), family members (n=9) and healthcare providers (n=7). Most of them highlighted the psychological difficulties of the surgical process, and the need for considerably more precise information concerning the immediate postoperative period. In addition, several patients and/or family members requested meeting with a patient who had undergone the surgery. The majority of subjects were interested in epilepsy-surgery TPE. These data were important in the creation of our TPE program and, more generally, for the management of these patients.

Impact of an educative program on dialysis patients’ knowledge and mental health: controlled before and after program

Introduction:Psychological impact of Therapeutic Patient Education (TPE) for dialysis patients is rarely evaluated since the focus of many studies is on medical variables (i.e., adherence).Objectives:The aims of this study were: 1) to estimate the impact of a TPE program on knowledge, depression and anxiety, 2) to examine change in knowledge as a mediator of the effects of a TPE program on mental health.Method:This study was conducted in three hemodialysis units and comprised two groups: an experimental group with education and a control group with routine care. The program was based of 5 educative sessions. Knowledge, depressive and anxious symptoms were assessed with self-reported outcomes measured before and 3 months after the program.Results:The sample comprised 125 patients. Knowledge about vascular access and nutrition (p &lt; 0.01) and depressive symptoms increased in the experimental group (p &lt; 0.01). Analysis of mediation showed that changes in knowledge about vascular access were a significant mediator of the effects of the program on depressive symptoms (F = 4.90;p = 0.01).Discussion:Knowledge acquired during an educational program could lead to an emotional change. Improving knowledge often leads to an awareness of the risks that can modify the psychological state of patients by reminding them of their vulnerability. This study shows that it is required to be attentive to the way of transmitting knowledge. It’s necessary adapting this transmission to the needs of patients and promoting the acquisition of psychosocial competence too.Conclusion:This study shows that knowledge acquired during an educational program can lead to an emotional change in the short term. A long-term follow-up of the population should be interesting to observe these emotional effects.

Follow-up of patients with chronic obstructive arterial disease, some months after their rehabilitation: Assessment of a therapeutic education program

This study aims to assess, in the long term, the effects of TPE in VR, and to observe the transformation of certain lifestyle habits of patients. We convened 68 patients (51 men and 17 women) 6 months and 1 year after VR treatment during which these patients participated in an TPE program. We assessed: knowledge by questionnaire, walking range, weight and body composition by impedimetric techniques. We found that patients improved their knowledge at the end of rehabilitation 45.8 (±7.6) of good responses on average, compared to 36.2 (±8.6) at the beginning of rehabilitation and these results are consolidated 6 months after 43.4 (±7.5) and 1 year after 44.1 (±8.1). We also found that walking distances during treadmill testing and outdoor walking improved at the end of rehabilitation and were maintained at six months and one year. Finally, weight, fat mass and lean mass decreased slightly compared to the end of rehabilitation. Only 7 patients out of 22 gave up smoking. An education program concerning risk factor management during vascular rehabilitation enables patients to acquire knowledge that can be used to maintain new lifestyle habits and stabilize their health status.

Evaluation of two therapeutic patient education programs for prevention of diabetic foot ulcers

Objectives: The purpose of this study is to evaluate and compare the effects of two education programs on patients’ understanding of the disease, self-efficacy, locus of control, and application of prevention behaviors for foot ulcer. Methods: In four centers that manage patients with diabetes and grade 2 or 3 neuropathy, the first arm of patients (G1 = 53) participated in a “standard” program usually managed in each center, and those in the second arm (G2 = 56) in a “new” program. The patients completed four questionnaires at inclusion (T0) and six months after the education (T1). Occurrence of a new foot ulcer and care behaviors were collected at T1. Z-test was used to compare mean scores for each questionnaire and Fisher’s exact test for percentages (p = 0.05). Results: There was no significant difference between groups G1 and G2 in terms of scores for each questionnaire at T0 and T1. Group G2 showed a significant change in score between T0 and T1 for understanding the disease (p = 0.04) and prevention behaviors (p = 0.01). For the sample as a whole (n = 109), there was a significant improvement between T0 and T1 for two questionnaires: understanding of disease (p &lt; 0.01) and declared prevention behaviors (p &lt; 0.01). Patients who reported having relative to participate in care had a significantly higher mean score on prevention behaviors (p &lt; 0.01). Twenty patients had developed one new ulcer since the education (20.2%). Conclusion: This study reinforces the importance of devoting time during education to patients’ understanding of the disease and involving relatives to improve foot ulcer prevention behaviors.

Implementation and evaluation of a therapeutic patient education programme during a clinical trial in Yaoundé, Cameroon – Trial ANRS-12286/MOBIDIP

ObjectivesHigh adherence is needed to maintain antiretroviral therapy efficacy. Few attempts at therapeutic patient education (TPE) have been made in sub-Saharan Africa. We describe patients’ achievements before intervention and identified needs, TPE programme implementation and evaluation, and patients’ satisfaction. MethodsThe TPE programme was proposed to patients in the ANRS-12286/MOBIDIP trial. Beforehand, a directory of competences to manage HIV infection was designed. Patients’ HIV-related knowledge and skills assessment was realised, leading to an educational contract. Evaluation was performed using a standardised collection form and a satisfaction survey. ResultsOf 154 patients, 146 underwent TPE. During a median of 1.8 years, 47% of patients had ≥3 consultations. Educational assessment revealed limited knowledge about HIV disease. Conversely, patients had frequently managed issues of adherence or disclosure. A median of 12 objectives were considered per patient, and 75% were attained. Objectives from the cognitive domain were less frequently attained. Patients appeared satisfied with the intervention: more emphasis was placed on psycho-affective aspects or experience-sharing than on the acquisition of knowledge. ConclusionActive listening, know-how and a space for discussion appear more important for patients than knowledge on disease or treatments. Practice implicationsIn HIV care, the directory of learning objectives should be revised to include more objectives concerning practical skills for disease management.

A quality improvement program for adolescents with cystic fibrosis: focus on psychosocial skills

BackgroundThe two pediatric cystic fibrosis centers (CFCs) in Paris (Robert Debré) and Nantes, France, have been developing therapeutic patient education (TPE) programs since 2006 and have been engaged in the pilot phase of the quality improvement program (QIP) named the Hospital Program to Improve Outcomes and Expertise in Cystic Fibrosis (PHARE-M) since 2011. The objective was to improve the FEV1 of the cohort of adolescents to prepare them for their optimal transition to an adult CFC.MethodsThe two CFCs formed a multidisciplinary quality team and used the analysis of causes of insufficient respiratory function taking into account the adolescents’ psychosocial factors. At the Nantes CFC, the approach was centered on adolescents’ body image and their motivation to take care of themselves by assigning specific aspects of patient follow-up to each professional in the team. At R. Debré, an individual cause-and-effect diagram identified for each patient the medical and psychosocial factors that could account for insufficient respiratory function. Personalized actions were offered to each patient.ResultsIn 2014, the median FEV1 (Forced Expiratory Volume in 1 Second) of the adolescent cohort exceeds 90% at the 2 CFCs (Nantes and R. Debré). Between 2011 and 2014 both centers improved their ranking for FEV1% in adolescents in the Registry histograms. At R. Debré, the personalized process allowed to reinforce equality of care, offering to all the opportunity to benefit from TPE sessions and coaching with an adapted physical activity teacher. The psychologist developed a specific tool to support the patient-centered process.ConclusionThe link between TPE and QIP was strong at our two centers enhancing patient centered care and targeting an optimal transition to an adult program.

Bleeding and asymptomatic overdose in patients under Vitamin K antagonist therapy: Frequency and risk factors

BackgroundVitamin K antagonists are widely used in the treatment and prevention of thromboembolic disease. However, these drugs can cause serious side effects, especially bleeding. This study aims to evaluate frequency and risk factors of both bleeding and asymptomatic overdose in North African patients undergoing Vitamin K antagonist therapy.MethodsWe performed a cross-sectional study in patients undergoing Vitamin K antagonist therapy. A statistical analysis has been conducted to identify overdose and bleeding risk factors by using chi-square test (p < .05).ResultsOne hundred and eleven patients were included. We recorded 14 cases of bleeding and 26 cases of asymptomatic overdose. Advanced age, poor adherence, concomitant use of paracetamol and history of previous bleeding are significant risk factors of over-anticoagulation. An INR value over 6 at admission, a high therapeutic target range for INR, concomitant use of acetylsalicylic acid, lack of information on overdose signs and measures to be taken in case of bleeding were identified as risk factors for bleeding.ConclusionMost of the risk factors identified in our study seem to be related to patients lack of information and education. These results highlight the importance of creating a therapeutic patient education program.