Towards a New Integrated Model for Taking Into Account the Experiential Knowledge of People With Chronic Diseases, Integrating Mediation, Therapeutic Education and Partnership: The Expanded Chronic Care Patient-Professional Partnership Model.

INTRODUCTION: The Chronic Care Model (CCM), the Expanded Chronic Care Model (ECCM) and the eHealth Enhanced Chronic Care Model (eCCM) focus on how healthcare teams and eHealth support can offer effective care and relevant solutions for patients facing chronic care conditions. However, they do not consider how patients can help these teams in their work, nor do they promote ways in which patients can help themselves. However, in the last decade, three different models have emerged that can complete our capacity to design and deliver integrated care for people with chronic diseases. In this article, we propose a revised version of the model that integrates the patient perspective and patients' experience-based knowledge. It integrates three different ways of engaging patients that complement the other patient engagement point of view: the experience of care and mediation in healthcare, therapeutic patient education and patient learning pathways, as well as patient-professional partnership. METHODOLOGY: For each of the three models, we conducted a review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct and government reports on patient engagement and partnership with their healthcare providers, to integrate the different components of these models into the ECCM and eCCM. The goal is to create a model that better takes into account the experiential knowledge of patients and citizens throughout its different dimensions. RESULTS: We identified 129 papers based on their framework, design, sample, measures and fit with patient engagement and chronic illness and added our own research when relevant. Integrating the three models provides an opportunity to amplify the role played by the patient perspective in the management of chronic disease. The Expanded Chronic Care Patient-Professional Partnership Model (E2C3PM) is intended to rebalance power relations between healthcare professionals and patients (and their caregivers). This new model is based on recognizing patients' experiential knowledge and their roles as caregivers and as full members of the care team. Integrating patient empowerment into the E2C3PM underscores the importance of coproduction care with patients at the clinical, organizational and system levels within a supportive environment. CONCLUSION: Applying this new model should make it possible to better take into account the complexity of chronic diseases, improving the integration not only of care, services and eHealth support but also the various determinants of health and reaching a mutually beneficial settlement among all actors involved. PATIENT OR PUBLIC CONTRIBUTION: A patient-researcher contributed to the development of the protocol, the data collection and the preparation and writing of this manuscript.

Making Conscientious Decisions: Engaging in Venous Leg Ulcer Self-Management Following Nurse-Led Patient Education.

Venous leg ulcers (VLUs) provoke multiple symptoms and impact individuals and society as a whole. Their treatment and prevention strategies require individual's involvement in self-management strategies. Insufficient knowledge with regard to prevention, management, and treatment has been identified as a critical factor related to VLUs and their recurrence. Therapeutic patient education (TPE) proposed as part of a management strategy for this population provides unclear benefits regarding wounds healing or prevention of recurrence. The aim of the study was to develop a theory explaining how individuals with a VLU experience an individualized nurse-led TPE program regarding self-management strategies. The constructivist approach of Charmaz to the grounded theory method was used to develop the theory. A total of 26 individuals contributed to the co-construction of the theory through face-to-face or telephone semi-structured interviews. Data analysis and data collection occurs simultaneously with a comparative process to reveal the conceptual categories, apply theoretical sampling, and define theoretical saturation. The theory of "Conscientiously Engaging in Self-Management" was co-constructed with the participants encapsulating four categories: "Being influenced by my own story," "Being personally informed," "Making conscientious decisions to engage in self-adapted management strategies," and "Integrating a conscientious way of living." This theory highlights individuals' voices and stories toward their journey of VLU self-management taking contextual factors into consideration. This new theory offers new knowledge about implementation of self-management strategies for individuals living with a VLU and will inform clinical practice and contribute to the development of targeted interventions.

Use of qualitative methods to optimize collaborative practices by highlighting differences in perceptions between professionals: an example of patient education.

Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.

Communication in Chronic Disease Care: A Collaborative Conversation Map.

Chronic diseases require long term commitment from both the patient and the treating physician for improving their clinical outcomes. This journey can be made more easier if a proper communication bridge can be made between both of them. This paper describes an alliterative C-based flow-chart to describe a Collaborative Conversation Map for chronic disease care. It crafts a map which serves as a checklist for chronic health care providers, especially those dealing with obesity and diabetes. This conversation map is concordant with the WATER (welcome warmly, ask and assess, tell truthfully, explain with empathy, reassure and return) conversation approach described earlier.

[The use of medical imaging as a therapeutic patient education tool in radiotherapy : a feasibility study]. / L'utilisation de l'imagerie médicale en tant qu'outil d'éducation thérapeutique du patient en radiothérapie : étude de faisabilité.

Because of its prevalence and high mortality rate, cancer is a major public health challenge. Radiotherapy is an important treatment option, and makes extensive use of medical imaging. Until now, this type of tool has been reserved to professionals, but it is now opening up to wider use, including by patients themselves for educational purposes. However, this type of usage has been little explored so far. An experimental feasibility study was carried out in the radiotherapy department of the University Hospital of Liège on adult patients with cancer or pulmonary metastases, assigned to two randomized groups. In addition to the usual information given by the radiotherapist, the patients of the experimental group benefited from an intervention consisting in the 3D visualization of their own medical images via the free and open-source computer software «Stone of Orthanc¼. The study results show a low refuse rate (8.2 %) for the 15 patients recruited. Although non-significant, the experimental group showed a median gain in global perception of knowledge, a decrease in anxiety scores and emotional distress. A significant reduction (p = 0.043) was observed for the depression score. The positive results of the feasibility study encourage further work and reinforce the positioning of medical imaging as a tool for therapeutic patient education.

De par sa fréquence et son taux de mortalité élevé, le cancer représente un problème de santé publique majeur. Parmi les traitements possibles, la radiothérapie tient une place importante et fait appel massivement à l'imagerie médicale. Jusqu'ici réservé aux professionnels, ce type d'outil s'ouvre à un usage plus large, y compris par le patient lui-même dans une perspective éducative. Mais cette utilisation est restée peu explorée jusqu'à présent. Une étude expérimentale de faisabilité a ainsi été menée au sein du service de Radiothérapie du CHU de Liège sur des patients adultes avec cancer ou métastases pulmonaires, répartis en deux groupes randomisés. En plus des informations habituellement données par le radiothérapeute, le groupe expérimental a bénéficié d'une intervention consistant en la visualisation en 3D de ses propres images médicales via le logiciel libre et open-source «Stone of Orthanc¼. Les résultats de l'étude indiquent un taux de refus faible (8,2 %) pour les 15 patients recrutés. Bien que non significatif, le groupe expérimental a montré, par rapport au groupe contrôle, un gain médian dans la perception globale de connaissances ainsi qu'une diminution des scores liés à l'anxiété et à la détresse émotionnelle. Une réduction significative (p = 0,043) est observée pour le score de dépression. Les résultats positifs de l'étude de faisabilité encouragent la poursuite des travaux et renforcent le positionnement de l'usage de l'imagerie médicale en tant qu'outil d'éducation thérapeutique du patient.

Emergence of the "e-patient" and "e-caregiver" around a serious game in ETP / Émergence du « e-patient ¼ et du « e-soignant ¼ autour d'un serious game en ETP

Introduction: The advent of e-health has an impact on many areas of health care practice, including TPE. The impact of the introduction of information and communication technologies (ICTs) in health care, such as serious games, remains largely unexplored in the field of e-TPE. Purpose of the Research: To ask patients and health care professionals about the use of a serious game, in order to clarify the impact of these technologies on health care practices and on the relationship between caregiver and patient, as well as their advantages and limitations. Method: A qualitative study based on the grounded theory approach, using semi-structured interviews with six health care professionals and six patients using the DRAGO© serious game, a smartphone application designed to improve compliance with allergy treatment. A lexicometric analysis was carried out, with classification by theme and sub-theme, followed by a statistical breakdown of verbatims according to whether they expressed a favorable or unfavorable opinion. Results: 64% of professionals surveyed are in favor of digital innovations in health care, and 67% of patients. Health care professionals have reservations about their patients' eligibility for these new technologies. In both categories, the ethical issues surrounding the emergence of e-health are positively echoed, with 69% of health care professionals and up to 83% of patients in favor. Both categories are more reserved about the impact of ICTs on the health care relationship. Conclusion: Health care professionals and patients alike consider the presence of ICTs in TPE to be "acceptable," although they remain vigilant about the impact they can have on the health care relationship. These developments imply a necessary change in the practices of health care professionals, leading them to think about and encourage the emergence of the profile of tomorrow's e-caregiver working with e-patients.

Introduction: L'avènement de la e-santé vient impacter de nombreux domaines dans la pratique soignante dont l'Éducation Thérapeutique du Patient (ETP). L'incidence de l'introduction de Technologies de l'Information et de la Communication (TIC) en santé de type serious game reste peu étudiée dans le domaine de l'e-ETP. But de l'étude: Questionner des patients ainsi que des professionnels de santé autour de l'usage d'un serious game afin de préciser l'incidence de ces technologies sur les pratiques soignantes, sur la relation soignant-soigné ainsi que leurs intérêts et leurs limites. Méthode: Étude qualitative selon l'approche par théorisation ancrée au travers d'entretiens semi-directifs menés auprès de 6 professionnels de santé et 6 patients usagers du serious game DRAGO©, application sur smartphone visant à renforcer l'observance du traitement contre les allergies. Réalisation d'une analyse lexicométrique avec classement par thématiques et sous-thématiques puis répartition statistique des verbatims selon qu'ils portent une opinion favorable ou défavorable. Résultats: Les professionnels interrogés sont favorables à 64 % au sujet des innovations numériques en santé et les patients à 67 %. Les professionnels de santé émettent des réserves quant à l'éligibilité de leur patientèle à ces nouvelles technologies. Dans les deux catégories de populations, les questionnements éthiques autour de l'émergence de l'e-santé trouvent un écho positif à raison de 69 % d'avis favorables pour les professionnels de santés et jusqu'à 83 % pour les patients. Les deux catégories sont plus réservées quant à l'incidence des TIC sur la relation de soin. Conclusion: Professionnels de santé comme patients estiment comme « acceptable ¼ la présence de TIC en ETP, bien qu'ils restent vigilants sur l'incidence qu'ils peuvent avoir sur la relation de soin. Ces évolutions impliquent un nécessaire changement de pratiques des professionnels de santé amenant à penser et favoriser l'éclosion du profil du e-soignant de demain exerçant auprès de e-patient.

[The shared educational assessment in the smoking cessation process]. / Le bilan éducatif partagé dans le processus de sevrage tabagique.

In the context of smoking cessation, the shared educational assessment (BEP) enables us to assess the smoker's needs, define specific objectives and set up appropriate educational workshops. This multidisciplinary approach helps smokers to maintain their smoking cessation. The BEP is the first step in the educational process, exploring the various classic dimensions of therapeutic patient education (TPE) and then defining an action plan based on the priorities identified.

The experience of caregivers providing therapeutic patient education for people living with bipolar disorder: a qualitative study.

BACKGROUND: Therapeutic patient education (TPE) programs are psycho-educational treatments suggested for all chronic diseases. For several years, these programs have been developing for people living with bipolar disorder. However, to date, only few qualitative studies have explored the experience of caregivers. We wanted to explore the experience of caregivers working in psychiatry as facilitators of a therapeutic education program for people living with bipolar disorder. METHOD: A single-center qualitative study was carried out. We conducted an inductive exploration, examining the content of the discourse produced in a focus group of eight caregivers in therapeutic education. The corpus was transcribed manually and a thematic analysis was conducted by two authors in a blinded fashion before combining. RESULTS: Four dimensions and twenty themes were identified: i) facilitators' pleasant experiences of the TPE sessions with a secure climate and a sense of belonging to a group, ii) being a TPE facilitator with a new horizontal and collaborative posture valuing the experiential knowledge, iii) the role of the TPE sessions with knowledge provision, empowerment and destigmatization, and iv) perceived changes in patients with an appeasement, the awareness of a shared experience, openness to others, a phenomenon of identification to peers and a new commitment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The observations noted overlap with the elements of the personal recovery well known CHIME framework (Connectedness, Hope, positive Identity, Meaning in life and Empowerment). Therapeutic education is a developing form of psychosocial rehabilitation care: through the mobilization of a new attitude of caring, the facilitation of TPE programs could be a lever for changing the posture of caregivers in favor of supporting the personal recovery of people with bipolar disorder. These results would need to be confirmed by further studies.

Patient's learning needs and self-efficacy level after percutaneous coronary intervention: A descriptive study.

AIMS AND OBJECTIVES: Identify and compare learning needs, levels of self-efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital. BACKGROUND: After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self-efficacy must be considered when developing effective therapeutic patient education (TPE). METHODS: Learning needs and self-efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self-Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross-sectional studies was used in reporting this study. RESULTS: Ninety-three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self-efficacy level. CONCLUSIONS: This study shows that after PCI, patients have high learning needs and moderate levels of self-efficacy that require addressing. RELEVANCE TO CLINICAL PRACTICE: Patient's individual learning needs and self-efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self-efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process. NO PATIENT OR PUBLIC CONTRIBUTION: For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.

The Bariatric Pyramid: A framework for therapeutic targets.

The Bariatric Pyramid is a model which serves to explain the goals of obesity management, act as a milestone for monitoring of therapy, and to benchmark the utility of various anti-obesity medications and interventions. Built upon a base of sustainability, it lists three more desired aspects of care: sufficiency (sufficient strength) safety and security. Each of the four aspects of the pyramid: sustainability, sufficiency safety and security have three angles, which allows the reader to understand them easily. The model that we propose is useful in training health care professionals, in therapeutic patient education, for assessing various anti-obesity therapies, and in reaching the right decision while managing obesity.

A municipal health center's co-constructed therapeutic patient education program for patients with single or multiple morbidities / Co-construction d'un dispositif d'ETP mono et polypathologique dans un centre municipal de santé

Introduction: The accessibility of Therapeutic Patient Education (TPE) is essential to reduce social inequalities and to meet the challenges posed by the increase in chronic diseases. In France, the distribution of TPE throughout the territory is heterogeneous and patients still lack sufficient access. With these perspectives in mind, a municipal health center has developed an innovative TPE device by involving concerned patients from the outset. Objectives: The objectives of this article are to present the methodology implemented to co-construct a TPE program for patients with one or more prevalent diseases in the territory, as well as the results of the co-construction. Methods: Creation of a project team with various actors: patients, health professionals, administrators, researchers. Organization of synchronous and asynchronous times. Results: Four meetings and numerous exchanges made it possible to: define the common values and operating rules of the project team, reflect on the coordination of the care pathway, identify the specific and shared needs of patients affected by type 2 diabetes, arterial hypertension and/or obesity, agree on the principles of the device. Conclusion: The advantages of this device were discussed: flexible organization with numerous links with local actors, development of partnerships, expansion of the population concerned. Questions and difficulties were encountered, such as the coordination of actors and the representation of partner patients for the targeted diseases. This device will be tested and evaluated, mainly with an objective of improving it.

Introduction: L'accessibilité de l'Éducation Thérapeutique du Patient (ETP) est essentielle pour contribuer à une réduction des inégalités sociales et répondre aux défis posés par l'accroissement des maladies chroniques. En France, la répartition de l'offre d'ETP sur le territoire est inhomogène et les patients y occupent une place encore trop modeste. Dans ces perspectives, un centre municipal de santé a élaboré un dispositif innovant d'ETP en impliquant, dès le début, des patients concernés. Objectifs: Les objectifs de cet article sont de présenter la méthodologie mise en œuvre pour co-construire un dispositif d'ETP pour des patients porteurs d'une ou de plusieurs maladies prévalentes sur le territoire, ainsi que les résultats de la co-construction. Méthodes: Constitution d'une équipe projet avec divers acteurs : patients, professionnels de santé, administratifs, chercheurs. Organisation de temps synchrones et asynchrones. Résultats: Quatre réunions et de nombreux échanges ont permis de : définir les valeurs communes et les règles de fonctionnement de l'équipe projet, réfléchir sur la coordination du parcours de soins, identifier des besoins propres et partagés des patients touchés par le diabète de type 2, l'hypertension artérielle et/ou l'obésité, se mettre d'accord sur les principes du dispositif. Conclusion: Ce dispositif présente des avantages certains : organisation souple avec de nombreux liens avec les acteurs locaux, développement du partenariat, élargissement de la population concernée. Néanmoins, des questionnements et des difficultés ont été rencontrés comme la coordination des acteurs et la représentation des patients partenaires pour les maladies ciblées. Ce dispositif sera expérimenté et évalué principalement en vue de son amélioration.

Therapeutic patient education in dental practice: For a pedagogical commitment / Du concept d'éducation thérapeutique du patient à la pratique des chirurgiens-dentistes : pour un engagement pédagogique

The exponential development of chronic noncommunicable diseases requires a rethinking of health systems, which are commonly focused on the curative management of diseases. There is a need to reinvent them to involve lifelong health promotion. For patients, it is no longer just a matter of surviving an acute disease, but also of avoiding its occurrence, and even more often, learning to live and age with it. This is where therapeutic patient education (TPE) plays a role. Supporting this paradigm shift in practice requires a commitment through initial training to help the student­ future dentist­to acquire the knowledge, skills, and attitudes relevant and easily applicable to the field of oral medicine, even in independent practice. Integrating TPE teaching into the curriculum is undeniably a challenge, but also a chance for students to develop a different stance and become conscious, competent, and committed professionals.

Le développement exponentiel des maladies non transmissibles à caractère chronique oblige à repenser les systèmes de santé, communément centrés sur une prise en charge curative des maladies. Ils doivent se réinventer pour y associer la promotion de la santé tout au long de la vie. Pour les patients, il ne s'agit plus seulement de survivre à une maladie aiguë, mais aussi d'en éviter la survenue, et encore plus souvent d'apprendre à vivre et à vieillir avec celle-ci. La prévention et la stabilisation de nombreuses maladies bucco-dentaires requièrent l'adoption et le maintien tout au long de la vie de comportements adaptés. L'éducation thérapeutique du patient (ETP) trouve alors toute sa place. Soutenir ce changement de paradigme dans les pratiques nécessite de s'engager dans la formation initiale pour aider l'étudiant ­ futur chirurgien-dentiste ­ à acquérir des connaissances, des savoir-faire et savoir-être pertinents et facilement applicables dans le champ de la médecine bucco-dentaire, et ce, même en pratique libérale. Intégrer l'enseignement de l'ETP au curriculum constitue indéniablement un défi, mais aussi une chance pour les étudiants de développer une autre posture et de devenir des professionnels conscients, compétents et engagés.

[History and challenges of the transition from pediatrics to adult care]. / Histoire et enjeux de la transition pédiatrie-soins d'adultes.

Transition from pediatrics to adult care involves a growing number of young people living with chronic health conditions. Now a field of study and practice, transition has been built up in successive stages, the nature of which informs us about its evolution and current issues.

[TPE in oncology, also assessing the perceived value of the patient experience]. / ETP en oncologie, évaluer aussi la valeur perçue par le biais de l'expérience patient.

Evaluating what patients get out of therapeutic patient education (TPE) from their point of view makes it possible to enrich traditional educational evaluations and satisfaction measures (ad hoc indicators, defined a priori). A scale of the perceived value of TPE has been developed for research on the patient experience in oncology (analytical version), or for routine evaluations (synthetic version). Researchers and teams will thus be able to better appreciate and value the contributions of TPE.

[A day in the pediatric day hospital: towards a successful transition]. / Une journée en hôpital de jour pédiatrique : vers une transition réussie.

Medical advances now enable children with chronic illnesses to live better and longer. As a result, the transition from adolescence to adulthood is increasingly being addressed in pediatric wards, with the aim of optimizing continuity of care. This was achieved at the pediatric day hospital at the Centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, near Paris.

[Digital adaptation of a therapeutic education program in the context of Covid-19]. / Adaptation numérique d'un programme d'éducation thérapeutique dans le contexte de la Covid-19.

The context of containment due to the Covid-19 epidemic forced professionals to suspend their face-to-face therapeutic education programs. For young patients with asthma, the situation was made even more complex by anxiety-provoking communications (which turned out to be inaccurate) about the possible aggravating role of corticosteroids in the event of Covid-19, which led to untimely discontinuations and sometimes to a decrease in their therapeutic adherence, exposing them to an increased risk of poor control of their disease. Faced with the feeling of abandonment felt by some families in this singular context, a team at Trousseau Hospital in Paris decided to rethink and adapt its distance therapeutic education workshops.

[The city-hospital link in the care of severely obese patients]. / Le lien ville-hôpital dans le parcours de soins des patients obèses sévères.

After the initial weekday hospital stay, a personalized, multidisciplinary care pathway is offered to each patient followed at the specialized obesity center (CSO). This article illustrates the support approach adopted by the CSO at Caen Normandy University Hospital.

Tailored patient therapeutic educational interventions: A patient-centred communication model.

BACKGROUND: Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions. OBJECTIVES: We used a data-driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization. DESIGN: Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria. RESULTS: Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions. CONCLUSION: From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions. SHORT INFORMATIVE: Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient-centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient-centred communication model for tailoring patient education intervention.

Comprehensive Approach: Current Status on Patient Education in Atopic Dermatitis and Other Allergic Diseases.

Allergic diseases are characterized by a complex complex chronic pathophysiology. Therapeutic patient education (TPE) programs are an important part of health care for allergic patients. These programs aim to increase the patient's adherence to evidence-based treatment and improve their ability to cope with the disease. TPE led by a multiprofessional team covers the complex pathogenesis of the disease, trigger factors, nursing and dietary issues, and the broad variety of treatment options available including psychological and behavioral aspects.Regarding atopic dermatitis (AD), randomized, controlled studies have demonstrated the beneficial effects of delivering structured group training to children, their caregivers, and adult patients with AD. Such intervention achieved substantial improvements in quality of life and objective clinical disease parameters. Besides AD, training programs have also been developed and evaluated for patients with anaphylaxis and asthma. This article provides an overview of the multitude of TPE concepts and their impact on subjective and objective outcomes. It focuses on AD but also sheds light on other allergic diseases such as anaphylaxis and asthma.

Cancer Pain and Patient Education: Strategy, Implementation, Difficulties and Opportunities of EFFADOL, a Regional Collaborative Programme.

While pain remains a burden for many cancer patients, their active involvement in dealing with it through therapeutic patient education (TPE) has proved effective in overcoming hurdles to pain management. This article describes how a regional TPE programme devoted to cancer pain was set up, as well as the difficulties and opportunities encountered during its implementation. Ten nurse-doctor pairs from the chronic pain units of Lower Normandy, after being trained in TPE, designed and built the EFFADOL (Ensemble Faire Face A la DOuLeur [Cope together with pain]) programme. They collaboratively developed the pedagogical, evaluation and communication tools used in the programme. After the educational diagnosis step, patients are able to follow three sessions in order to acquire the following skills: (1) understanding the different types of pain, (2) understanding pain treatments and their adverse reactions and (3) optimally managing pain on a daily basis. Patients can ask a relative to join the sessions and can choose their preferred modality (individual and/or collective sessions). Programme implementation and the importance of communicating with oncologists and independent health professionals are discussed. The programme, which is available to patients close to home, meets their needs as previously assessed through a regional prospective survey. Difficulties to include patients and opportunities to address them are identified. The programme's limitations mainly concern its organization, structure and communication issues. The main challenge remains the overhaul of care practices and the role of the caregiver to allow patient autonomy.