therapeutic education: cancer patients on chemotherapy:
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Therapeutic Education: Cancer Patients on chemotherapy:. Shamim Akhter QURESHI MBBS,MPH, Ingénieur d’étude(EHESP) - PowerPoint PPT PresentationTRANSCRIPT
Therapeutic Education: Therapeutic Education: Cancer Patients on Cancer Patients on chemotherapy:chemotherapy:
Shamim Akhter QURESHI
MBBS,MPH, Ingénieur d’étude(EHESP)
2nd June 2012
June 2010
ProjectProject
Contribution to a program of Therapeutic Education of Patients (TPE) treated for a cancer
Special concern at Educational
Diagnosis
Main concern about patients on chemotherapy
Host InstitutionHost Institution
Teaching Hospital Rouen, France
Under the supervision of Prof. Czernichow, the head of Public Health and Epidemiology.
Definition of TPEDefinition of TPE
A comprehensive approach to support patients and their families
To better understanding of their diseases
To acquire or maintain the skills they need to manage their life with a chronic disease in the best possible way.
WHO (1998)WHO (1998)
Why TPE ? Why TPE ?
More chronic diseases now
Multiple healthcare professionals
Patients empowerment for decision making
Better prognosis for patients
Best satisfaction at work for professionals
Why Cancer ?Why Cancer ?
A leading cause of death worldwide Cancer has been approved as chronic
disease TPE could both prevent cancer deaths and
reduce complications Many information needed by patients Making the quality of life better Several associated therapies with possible
Side Effects involved (radiotherapy, chemotherapy, surgery)
Two Cancer plans in France Pressures from patients groups
Basic Steps of TPEBasic Steps of TPE
1. To make an educational diagnosis 2. To Establish a tailored TPE
programme with learning priorities 3. To provide group or individual
sessions (or both) 4. To Assess acquired skills and to
revise programme if necessary (HAS)
What is Educational What is Educational Diagnosis ?Diagnosis ?
• A systematic, comprehensive, iterative collection of information by the health care provider
• Concerning each patient' bio clinical, educational, psychological and social status.
• • A basis to set the targets tailored for each
patient
Aim of the study:Aim of the study:
To identify the best method and time for educational diagnosis of hospitalized cancer patients on chemotherapy.
Methods (1)Methods (1)Literature review (Internet, Pub Med,
Journals) Main concepts : Cancer and therapies, Side effects, TPE, Educational diagnosis, Timing and method, To make questionnaires
Observation and interviews The whole Healthcare process for cancer patients
(Announcement consultations, Medical staff, Multidisciplinary –RCP- and Routine Meetings)
Data used (Medical records, Notes taken during meetings, Special workbooks (“classeur”)
Consultations of coordinating nurse Consultation with psychiatrist for the caregiver Informal conversations with dietician, hair dresser,
Geriatric, kinesthesist, psychologist 10 days in two different departments
Methods (2)Methods (2)Observation and interviews (cont)
Project meetings of Hospital staff for the TPE program elaboration Two courses for the educational training of medical staff for TPE
Ethical aspects
Verbal consent from the medical staff to access to the medical records,
Verbal consent from patients and professionals before interviews
Permission from the patient during my consultation observations
Results on health care Results on health care process (1)process (1) Outpatient is referred from family doctor with reports, see
specialist, have more investigations, if provisional diagnosis cancer,
Patient is called for announcement of diagnosis during a
special consultation
Record submitted to RCP, diagnosis and treatment is finalised according to the reaction the patient.
For chemotherapy : Patient goes to nurse to have explanations on intravenous chamber, side effects or any other question
Nurse notices his psychological and social life status, gives him the detail of all professional he is going to meet
Day hospital : medical examination, chemotherapy session, during weight check by dietician and advice if necessary, help from attending assistant
Inpatients more sick are admitted in weekly or traditional hospital
Diagnosis announcement in a room and followed by
other professionals (95%)
Everyday meeting of staff for taking charge and brief description of patient to each other
Special workbooks explanation and consent
Consultation with different professionals if required or asked before next weekly meeting
Coordinating nurse works as relationship between patient and all professional
Results on health care process Results on health care process (2)(2)
Results from PatientsResults from Patients All patients agreed on that
◦ structured interviews is a best method ◦ education should not be started just after
diagnosis announcement
Two out of three patients did not like the Special workbooks
One out of three did not like the announcement consultation and educational language,
Two of them did not want to take part in decision making about treatment
All of them never attended any special session for education
Results from 11 Results from 11 ProfessionalsProfessionals
None of them have got the training for TPE. 6 did not know about educational diagnosis All agreed with personal interviews as the best option
for educational diagnosis. Only one did not like the idea of TPE. Concerning time for ED :
◦ 8 agreed with the next weekly meeting ◦ 3 agreed with chemotherapy sessions
5 considered that Special workbooks can help as a part for ED while 3 thought it can’t,
4 considered that patients can understand about disease and therapy,
6 have the experience of patients asking questions 5 told that some patients participate in the decision-
making
Limitations of the studyLimitations of the study Short Pilot study
A single hospital, only 2 specific wards
Qualitative data without statistical significance
Both patients and professionals should have altered their behaviour because of the observation (Hawthorn effect).
Access to the patients but no data on family
ConclusionConclusionTPE seems to be not well known by professionals,
including EDOncopsychlogy should be improved
Time for ED has to be discussed : Weekly meetings can be a good place to finalize the
educational needs of the patient Just after the diagnosis announcement the patients
should not be given education
Method for Educational Diagnosis
Personal Interviews