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Course: Oncology Nursing

Topic: Patient and Family Education

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Define patient education.
Discuss nurse’s role in provision of patient education.
Identify benefits of patient education in cancer patients.
Describe evidence-based approaches and process of patient education.

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Patient Education

According to WHO (1998), ‘Therapeutic Patient Education’:

‘Therapeutic patient education is education managed by health care providers trained in the education of patients and designed to enable a patient (or a group of patients and families) to manage the treatment of their condition and prevent avoidable complications, while maintaining or improving quality of life.’

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Patient Education

eviQ Education, n.d., Patient education resource

Is a planned learning experience provided to-

Patients of all ages
Patient care givers
Family members of patients

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Nurse’s Role in Patient Education

Reiger & Yarbro (2003)

Compared to other healthcare team members the nurses have better opportunities to:

Develop the required rapport with patient for patient education
Initiate patient education early in the care
Provide patient education throughout the continuum of patient care
Continual reinforcement of the important information

Usually first person to observe changes in the patient condition and identify education needs

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Nurse’s Role in Patient Education

Nurses must incorporate principles of patients right in planning and execution of patient’s education:

Right to Informed Consent^1.2
Right to Adequate Information^1,2
Right to Health Education¹
Right to Continuity of Care^1,2
Right to Privacy and Confidentiality^1,2
Right to Dignity¹
Right to Religious Assistance¹

World Medical Association, August 2018
Olejarczyk & Young, 2020

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Patient Education

Benefits of education for cancer patients:

Improved understanding of their diagnosis and disease and any associated disability.
Increased ability to cope with and manage their health in the context of their disease and its treatment.
Better understanding of treatment options, side effects and toxicities.
Improved self-advocacy and greater empowerment to make decisions related to their care.

eviQ Education, n.d., Patient education resource

Contact info: info@nursesinternational.org

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Patient Education

Continued….

Increased compliance with treatment regimens.
Decreased treatment related complications.
Promotion of recovery and improved function during and following completion of treatment.
Increased confidence in self management strategies.
Reduced psychological distress and stress.

eviQ Education, n.d., Patient education resource

Contact info: info@nursesinternational.org

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Patient Education

eviQ Education, n.d., Patient education resource

Long term outcomes of effective education for patients/care- givers/family:

Increased use of self management strategies
Improved health related quality of life
Improved patient outcomes
Increased satisfaction with care

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Priorities of Patient Education

Information must include but is not limited to:

What patient needs to do and why¹
When patient can expect results (if applicable)¹
Warning signs patient should watch for¹
What patient should do if problems occur¹
Who should the patient contact for questions and concerns¹

Must be individualized based on patient’s needs²

Keeping it simple is critical !²

Dugdale & Zieve, 2019, Choosing effective education materials.
Aston & Oermann (2014).

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What Would the Nurse Do?

A patient who is being treated with chemotherapy on an outpatient basis complains of nausea and vomiting.

What should the nurse do? And why?

____________________________________________

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What Information is Exchanged during Patient Education?

Gilligan et al (2017)

According to the ASCO consensus guideline- ‘Patient-Clinician Communication (2017)’, Clinician should inform cancer patient about:

Goals of Care and Prognosis
Treatment Options and Clinical Trials
End-of-life Care
Cost of Care

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Patient Education: Information Exchanged

Goals of Care and Prognosis

Diagnostic and prognostic information tailored to the patient’s needs
Reassessment of goals, priorities, and desire for more information

Treatment Options and Clinical Trials

Clarify goals of treatment:
Cure vs Prolongation of survival vs Improved quality of life
Information on all treatment options with their potential benefits and burdens (proportionality)
including clinical trials and palliative care

Gilligan et al (2017)

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Patient Education: Information Exchanged

End-of-life Care

End-of-life care preferences for an incurable illness
Re-address the topic periodically based on clinical events or patient preference
Empathetically address grief and loss among patient and families
Suggest local resources that provide support to patients, families and loved ones transitioning to end-of-life care

Cost of Care

Explore cost of care and if it is a concern for the patient

Gilligan et al (2017)

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Components of Patient Education

Aston & Oermann (2014).
Dugdale & Zieve, 2019, Maximizing your teaching moments

Assessment¹

Assess readiness to learn

Identification¹

Gaps in knowledge and needs of the patient

Planning¹

To effectively fill the gaps in the patient’s knowledge

Implementation¹

Provision of information appropriately

Evaluation^1,2

Confirming patient education was provided in understandable way²

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Patient Education: Assessment

Aston & Oermann (2014)
eviQ Education, n.d., Patient education resource

Patient’s learning needs:

What patient already knows
What patient needs to know
What patient wants to know

Patient’s learning abilities:

Important for identifying effective teaching methods
Cognitive level of understanding: education level, language, etc
Learning styles: visual, auditory, or kinesthetic
Physical and mental conditions affecting cognitive abilities

visual/hearing acuity, speech problems, developmental stage

Limits on amount of information they can handle at a time

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Patient Education: Assessment

Patient’s readiness to learn^1,2:
A continuous process throughout the care^1,2
Consider physical, psychological, and cognitive readiness^{1, 2}

physical health limitations- pain medication, sedation, etc.
Psychological state- anxiety, stress, ability to concentrate, etc.

Patient’s readiness to learn is evident when the patient::¹

asks question about their care
expresses concerns about their care
engages in instructional process
attentively observes care given to then

Aston & Oermann (2014).
eviQ Education, n.d., Patient education resource.

Contact info: info@nursesinternational.org

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Patient Education: Assessment

According to the ASCO - ‘Patient-Clinician Communication (2017)’ :

A patient’s goals, priorities, and desire for information should be reassessed whenever a significant change in the patient’s care is being considered
Assess if patient is³

Prepared for explicit information
Ambivalent: discuss pros and cons of knowing
Does not want information: negotiate future discussion or discussion with family members

Assess if family members are involved, in agreement, and supportive

Gilligan et al (2017)

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Patient Education: Assessment

Assessment Strategies

Informal and targeted conversation while providing care
Observations during delivery of care
Asking open ended and probing questions about the patient’s condition, treatment, and what does they want to learn
Avoid making assumptions
Developing good rapport with the patient is essential

Aston & Oermann (2014).
eviQ Education, n.d., Patient education resource.

Contact info: info@nursesinternational.org

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Patient Education: Identification and Planning

It is based on assessment made of patient’s learning needs, abilities, and readiness to learn
Identification of:

Gap in the knowledge of patients and their needs

Focus must be on what patient needs to know and not on what is nice to know

Barriers for patient education
Resources to resolve or mitigate the barriers

Validate identified needs with the patient/families

Aston & Oermann (2014)

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What Would the Nurse Do?

A patient was diagnosed with a brain tumor and, after careful evaluation and discussion with the patient, radiotherapy was initiated as treatment.

After two cycles of radiotherapy, the doctors concluded that the tumor was incurable.

How does this affect patient education?

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Six Principles of Adult Learning (Malcolm Knowles)

eviQ Education, n.d., Patient education resource

Principles of adult learning must always be considered when planning for patient education.

Adults are internally motivated and self-directed.
Adults bring life experiences and knowledge to learning experiences
Adults are goal oriented
Adults are relevancy oriented
Adults are practical
Adult learners like to be respected

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Patient Education: Identification and Planning

Without proper planning, identified needs cannot be met
Careful planning includes:

Determining appropriate teaching methods
Determining appropriate environment
Determining time required
Making all preparations ahead of time

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Determining Appropriate Teaching Methods

Should be based on patient’s literacy, language, culture, physical conditions/constraints, developmental stage²
Group session: for similar needs like nutrition, skin care, etc.²
One-to-one session for patients with specific needs
Use of different resources²

brochures, posters, charts, models, props
powerpoint presentations, videos, podcasts

Demonstration of skills, return demonstrations, and teach-back¹
Written instruction is best way to reinforce verbal instructions
Use layman terms and culturally appropriate language

Dugdale & Zieve, 2019, Maximizing your teaching moments
Dugdale & Zieve, 2019, Choosing effective patient education materials

Contact info: info@nursesinternational.org

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Determining Appropriate Environment

Adequate privacy is of utmost importance!¹
Setting up a good learning environment:¹

adjust the lighting
adjust the comfortable room temperature where possible
ensure quiet environment, no disturbance from others
maintain culturally appropriate distance and eye contact

Ensure appropriate size of the room where education session is conducted

comfortable size room for group classes
comfortable space for demonstration of the clinical skill, etc.

Dugdale & Zieve, 2019, Maximizing your teaching moments

Contact info: info@nursesinternational.org

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Determine Time Required

Make Preparations Ahead of Time

Estimate time frame for education session

What patient knows and what is they need to know will help identify main teaching points and save time
Consider how much information patient is able to grasp at a time
Date/time set must be convenient for patient¹

Dugdale & Zieve, 2019, Maximizing your

teaching moments

Set when, where, and how long of the education session with patient¹
Book room, gather audio/visual aids, demonstration equipments¹
Give information resources to patient before meeting if possible¹

reduces patient’s anxiety, and saves your time

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Providing Patient Education

Dugdale & Zieve, 2019, Maximizing your teaching moments
Aston & Oermann (2014.

Obtain patient’s consent
Assess patient’s readiness to learn throughout the session
Ensure appropriate environment
Use appropriate resources for information provision¹
Demonstrate caring attitude and behavior
through effective communication skills
Review and reinforce the important information¹
Partner with the patient! ¹

Be ‘facilitator of information’ and not a ‘authoritative’ figure!²

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Providing Patient Education

According to the ASCO- ‘Patient-Clinician Communication (2017)’:

Use mixed framing (eg, chance of a cure and chance of a relapse, or best/worst/most likely outcome)
Provide information in multiple formats (words, numbers, ranges)
Provide information in chunks (small discrete units)

When providing bad news, clinicians should take additional steps to address the needs and responses of patients

Gilligan et al (2017)

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Patient Education: Evaluation

Teach-Back Method^{1, 2}

Have patient repeat information back

Return Demonstration^1,2

Have patient demonstrate skills back (where possible)

Patient Feedback

Was the amount of information adequate/too much? understandable? space of improvement in future?

Was the learning objective was met?

Were there unexpected questions? Was time adequate?

Was resource adequate/appropriate? Need for another session?

Aston & Oermann (2014).
Dugdale & Zieve, 2019, Maximizing your teaching moments.

Contact info: info@nursesinternational.org

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Effective Communication Skills

Gilligan et al (2017)

Effective communication

informs
supports
sustains hope
comforts
guides

It includes:

listening
empathising
encouraging
being aware of other people emotions

Use gentle voice, appropriate language, simple and direct terms

use interpreter where necessary

Maintain culturally appropriate distance and eye contact

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What Would the Nurse Do?

The patient is being treated for relapsed cancer complained of extreme fatigue.

What would the nurse assess regarding the education needs of this patient before providing patient education on the management of fatigue ?

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Reference:

Aston, K., & Oermann, M.H. (2014). Patient education in home care: Strategies for success. Home Healthcare Now, 32 (5); 288-294. Retrieved from: https://www.nursingcenter.com/journalarticle?Article_ID=2460148&Journal_ID=2695880&Issue_ID=2460020

Dugdale D.C & Zieve D., 2019, Choosing effective education materials. US National Library of Medicine- MedlinePlus. Accessed from: https://medlineplus.gov/ency/patientinstructions/000455.htm

Dugdale D.C & Zieve D., 2019, Maximizing your teaching moments. US National Library of Medicine- MedlinePlus. Accessed from: https://medlineplus.gov/ency/patientinstructions/000460.htm

Contact info: info@nursesinternational.org

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Reference:

eviQ Education (n.d.). Patient education resource. Government of New South Wales. Accessed from: https://education.eviq.org.au/patient-education-resource

Gilligan, T., Coyle, N., Frankel, R.M., Berry, D.L., Bohlke, K., Epstein, R.M., Finlay, E., Jackson, V.A., Lathan, C.L., Loprinzi, C.L., Nguyen, L.H., Seigel, C., & Baile, W.F. (2017) Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. Journal of Clinical Oncology, 35 (31): 3618-3632. Accessed from : https://ascopubs.org/doi/10.1200/jco.2017.75.2311

Olejarczyk, J.P., & Young, M.(2020) Patient Rights. [Updated 2020 Sep 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538279/

Contact info: info@nursesinternational.org

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Reference:

Rieger, P.T. & Yarbro, C.H. (2003). Role of the Oncology Nurse (6th ed.). Kufe D.W., Pollock R.E., Weichselbaum R.R., et al.(Eds). Hamilton (ON): BC Decker. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13570/

WHO (1998). Therapeutic Patient Education: Continuing education programmes for health care providers in the field of prevention of chronic diseases. Report of a WHO Working Group. Accessed from: https://apps.who.int/iris/handle/10665/108151

World Medical Association, August 2018, WMA DECLARATION OF LISBON ON THE RIGHTS OF THE PATIENT. Retrieved from: https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/

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