Is there value in educating patients?
Gene S Lysko, Medical Writer
Despite the paucity of definitive or robust clinical evidence, we recognize the inherent value of patient education. In the broadest sense, especially in the context of patient-centered care (rather than disease-centered care), patient education empowers people to take responsibility for managing their own health in the face of disease or medical complications. Comprehending the need
A key element of patient education is to provide patients with the knowledge that will empower them to participate as an important member of the healthcare team: think of compliance with treatment instructions or postoperative care directives. Patient education can help patients appreciate the importance of following directions, solving problems, and preventing or minimizing avoidable complications, and it can teach them the skills needed to handle these tasks successfully. Additionally, patient education is also credited with increasing a patient’s satisfaction with their care. Surrogate markers
Responsibility, participation, skill-learning, and satisfaction are all credible objectives or outcomes of patient education. I call these outcomes “surrogate markers.” However, positive changes in behavioral and clinical outcomes that improve the lives of patients matter most—improving rates of morbidity and mortality are the most important objectives of patient education.
Recently, I reviewed the literature on the effectiveness of patient education on improving outcomes. The results of eight meta-analyses of more than 300 studies published during the last 20 years aren’t very encouraging.(1-8) Little or no difference
While the scope of the patient education initiatives and their educational methods and objectives varied greatly, for the most part, the results of the meta-analyses show that patient education made little or no difference in the measured outcomes, surrogate markers or otherwise.(1-3,5,7)
That’s contrary to what we expect from patient education. However, some meta-analyses paint a better picture. These studies establish that patient education does directly and positively influence behavior and improve not only surrogate markers such as levels of knowledge, satisfaction, and physical activity, but more importantly, rates of morbidity and mortality as well.(4,6,8) This was especially true in patients with chronic illnesses such as coronary heart disease.(8)
What can we learn from the patient education initiatives analyzed in these meta-analyses?
Bluntly, when patient education is done right, it works. More than knowledge
This is not breaking news. Three decades ago, Mazzuca(9) learned that patient education designed only to improve patients’ health by increasing their knowledge was rarely successful. In that study (of 300 reports), patient education that focused on behavior-oriented programs that modified the environment to allow patients to care for themselves, were consistently successful at improving the clinical course of chronic disease.
Behavioral strategies that provide positive reinforcement, feedback, and personalization form a strong foundation for patient education; however, these strategies must meet the needs of patients and match their abilities(8) (eg, literacy). Specifically, behavioral strategies that promote tactics such as tracking or self-monitoring,(4,6) and those that exploit multiple communication approaches (“channels”)(6) and increase a patient’s knowledge of their condition, form the basis of successful patient education.
Is there value in educating patients? Yes. When it’s done right. References
1. Välimäki M, Hätönen H, Lahti M, et al. Information and communication technology in patient education and support for people with schizophrenia. Cochrane Database Syst Rev. 2012;10:CD007198. doi:10.1002/14651858.CD007198.pub2
2. Gross A, Forget M, St George K, et al. Patient education for neck pain. Cochrane
Database Syst Rev. 2012;3:CD005106. doi:10.1002/14651858.CD005106.pub4
3. Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009;(1):CD005268. doi:10.1002/14651858.CD005268.pub2
4. Conn VS, Hafdahl AR, Brown SA, Brown LM. Meta-analysis of patient education
interventions to increase physical activity among chronically ill adults. Patient
Educ Couns. 2008;70(2):157-172. Epub 2007 Nov 26
5. Gysels M, Higginson IJ. Interactive technologies and videotapes for patient education in cancer care: systematic review and meta-analysis of randomized trials. Support Care Cancer. 2007;15(1):7-20. Epub 2006 Sep 23
6. Mullen PD, Simons-Morton DG, Ramírez G, et al. A meta-analysis of trials evaluating patient education and counseling for three groups of preventive health behaviors. Patient Educ Couns. 1997;32(3):157-173
7. Brown SA. Meta-analysis of diabetes patient education research: variations in
intervention effects across studies. Res Nurs Health. 1992;15(6):409-419
8. Mullen PD, Mains DA, Velez R. A meta-analysis of controlled trials of cardiac
patient education. Patient Educ Couns. 1992;19(2):143-162
9. Mazzuca SA. Does patient education in chronic disease have therapeutic value?
J Chronic Dis. 1982;35(7):521-529