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Patient education is an important component of quality cancer care. However, there remains much debate about its effects, merits and limitations. The primary objective of this thesis was to identify outcomes of importance for patient education interventions in breast cancer. Through the process of this inquiry, a systematic review of all patient education assessment instruments, a literature review of patient education studies in chronic diseases and cancer, and ultimately a qualitative study using interpretive description was conducted. The systematic review of assessment instruments revealed a lack of psychometrically sound instruments developed to assess quality and efficacy of patient education materials. There was also a lack of consensus as to what aspects of materials should be appraised to constitute good quality. The review of patient education intervention studies in both chronic diseases and cancer identified a general lack of consensus on the intended effects of educational interventions. Multiple outcomes were used without consistency and in differing combinations in the literature making it difficult to compare relative efficacy of interventions. To discover what key stakeholders in the process of patient education in breast cancer (patients, physicians and nurses) would identify as outcomes of importance, a generic qualitative study using interpretive description was conducted. Five common themes to all groups with respect to outcomes of importance were discovered: improving knowledge, improving coping ability, providing an orientation to the cancer system, enabling shared decision making and impacting behaviour during cancer treatment. Despite the surprising variability and inconsistency of outcomes discovered in the patient education literature, this qualitative study demonstrated that patients, physicians and nurses generally agree on what constitute important outcomes and serves as a first step in the process of developing validated outcomes for patient education interventions in cancer. / Thesis / Master of Science (MSc) / This thesis explores what are considered important outcomes of patient education in breast cancer. Firstly, a systematic review of all instruments created to judge patient education materials was completed and showed a lack of valid instruments for use in judging quality or outcomes in patient education. Secondly, a review of patient education studies in chronic conditions and cancer revealed a paucity of consistent or recommended outcomes for patient education. Lastly, the major focus of this thesis was a qualitative study that used focus groups to discover what breast cancer patients, physicians and nurses identify as important outcomes of patient education interventions at the Juravinski Cancer Centre. It identified that patients, physicians and nurse have five common beliefs about important outcomes of education interventions: improving knowledge, improving coping ability, providing an orientation to the cancer system, enabling shared decision making and helping to direct behaviour during cancer treatment.

Aim The aim of this qualitative study was to explore Indonesian nurses’ experiences of patient education and patients’ adherence to TB treatment. Background Tuberculosis (TB) is an infectious disease that 9.6 million people in the world suffer from. Indonesia is one of the world’s 22 high-burden countries with over 320.000 cases of TB in 2014. The UN’s (United Nation) goal is to have ended the TB epidemics by the year 2030. Nurses play a central role in accomplishing adherence to treatment and prevention of TB. Method To fulfil the aim a qualitative method using semi-structured interviews was used. The interviews were recorded and transcribed. The transcribed data was analysed by using a qualitative content analysis with a manifest approach. Findings The findings, based on the result of nine interviews, showed four themes: “Strategies for patient education”, “Factors affecting patient education and adherence to treatment”, ”Outcomes of patient education” and ”Feelings and opinions about patient education”. Conclusion This study showed that the nurses use different strategies when practicing patient education. It was also shown that the nurses are well aware about patient-related factors and how they affect patient education and adherence to TB treatment. Keywords Tuberculosis, nursing care, patient education, adherence

published_or_final_version / Nursing Studies / Master / Master of Nursing

Ley's Partial Model of Compliance suggests that patients who understand information given to them are more likely to remember the information and are more likely to be satisfied with the information. The model then suggests that these components will lead to greater patient compliance with medication regimens. To test the model, Patient Package Inserts (PPIs) describing thiazide diuretics from the American Association of Retired Persons, the American Medical Association, the Canadian Pharmaceutical Association, the Food and Drug Administration, the National Association of Retail Druggists, the United States Pharmacopoeial Convention and a Test PPI written by the Principal Investigator were used. The SMOG Readability Formula was used to determine the grade levels at which PPIs were written. One hundred thirty-six adults enrolled in GED classes in Tucson and other communities and 107 adults enrolled in remedial reading classes at Tucson's Pima Community College were administered the Zip Scale reading placement test and blocked by their reading abilities. Within each of the three blocks, subjects randomly received one of the seven information sheets or no sheet. Subjects took a multiple-choice test based upon information common to all of the PPIs, a cloze comprehension test based upon the PPI which they read, and completed a satisfaction survey which asked subjects to rate the PPI which they read. Subjects also read five vignettes describing fictitious patients taking thiazides who were confronted with different barriers to compliance. Subjects indicated how likely the fictitious patients were to overcome the barriers to compliance. Among this sample of remedial-reading adults, the Test PPI emerged as clearly superior to the others for any of the variables measured. This result would behoove providers of PPIs to rewrite PPIs, reducing the difficulty of these documents as much as possible. Ley's Partial Model of Compliance did not accurately describe the associations between Understanding, Memory, Satisfaction and Compliance for this sample. A New Model emerged describing different associations between these components and between subject reading ability and PPI readability.

This study was undertaken to test the satisfaction process as it relates to the consumption of prescription medication. The disconfirmation of expectations model was used as a framework for the study. The study sought to evaluate the impact the provision of drug information has on the satisfaction/dissatisfaction process. To accomplish this, consumers recruited from two community pharmacies were provided with a scenario that described the purchase, and consequences of taking a prescription product intended for the treatment of migraine headache. Each subject received a scenario that contained one of four (4) levels of drug information. The four levels were: (1) no drug information; (2) information about side effects; (3) information about effectiveness; and (4) information about effectiveness and side effects. Each subject also received a scenario that described one of four therapeutic outcomes. They were: (1) no side effects with total elimination of headaches; (2) no side effects with partial elimination of headaches; (3) side effects with total elimination of headaches; and (4) side effects with partial elimination of headaches. The disconfirmation of expectation model was supported by the study. Using an ANOVA model, analyses revealed that the provision of drug information resulted in more positive disconfirmation and higher levels of satisfaction when the outcome of therapy was less than optimal. The measures of future intention were also affected by the provision of drug information. Further analyses revealed satisfaction was a function of expectation and disconfirmation.

This study examined the difference among 3 patient education intervention strategies and compliance in the hypertensive elderly. The strategies were verbal instructions, written instructions and both verbal and written instructions. An ex post facto descriptive design was implemented based on a Cognitive Information Processing Theory of Learning. Forty subjects were recruited and interviewed. Data analysis revealed that compliance did not differ significantly with the type of educational strategy.

This quasi-experimental study, using Orem's Nursing Systems Construct as a theoretical base, was conducted to determine the effects of education and support given by a lactation consultant on early breastfeeding problem incidence and resolution. Mothers were recruited in the hospital and interviewed by telephone two to three weeks postpartum to determine problem incidence, rate of resolution, perception of the problems' interference, self-care measures, and support network characteristics. The study sample consisted of 16 first-time breastfeeding mothers placed in naturally occurring experimental (n = 7) and control (n = 9) groups. The groups did not differ significantly in age, education, ethnicity, mode of birth, or presence of a support person in the home. The groups did not differ significantly in number of problems, problem resolution length, or perceptions regarding problems' severity. A significant difference was found in the use of formula supplements, with the control group using supplementation more than the experimental group.

M.Sc. (Med.), Dept. of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2011

In the United States, congestive heart failure (CHF) impacts 6.5 million adults and costs about $39 billion year with a projected incidence increasing by 25% by 2030. CHF can be addressed by advancing patient self-care knowledge through interactive patient education. For this project, the Health Beliefs Model guided a strategy to stimulate behavior modification based on perceived benefits of self-care. The purpose of this quality improvement project was to implement an interactive patient education video system, called the Get Well Network, to encourage patient self-care to reduce CHF readmission rates at a veteran's administration hospital. Four evidence-based CHF video order sets were developed with interactive multidisciplinary patient-provider teach back strategies and questions. The topics included: medication adherence, dietary restrictions, smoking cessation, and exercise. During the period of project implementation, all veterans admitted with a diagnosis of CHF were given the opportunity to view the educational videos; the completed viewing rate increased from 3% to 30% during the initial 6 weeks. An attempt was made to retrieve quarterly data on congestive heart failure patient readmission rates from the Veteran's Administration's computerized system. However, recent changes in the ICD coding system have slowed the data gathering process and it continues to be ongoing. This project has the potential for positive social change by increasing veteran knowledge of self-care, thereby reducing the likelihood of CHF readmission.