Patient satisfaction with therapeutic education in oncology: Antecedents, consequences, and the moderating effect of perceived value

This research aims to deepen our understanding of patients' satisfaction with therapeutic patient education (TPE) in oncology. The research model proposed was tested, with structural equation modeling, on 207 French breast-cancer patients who participated in a TPE program. The results confirm that post-TPE empowerment and relational proximity to the TPE team are two major antecedents of patient's satisfaction-and attitude and word-of-mouth toward TPE are two important consequences of this concept of satisfaction. However, the established relationships are moderated by the patients' profiles (i.e., utilitarin believers, passionate followers, or holistic followers) in terms of the perceived value of their own experience of patient education. These results will enable stakeholders to adapt their TPE promotion strategies to the profiles of the patients. The study will also help to demonstrate and highlight the patient benefits of TPE to various stakeholders and thus will favor access to this personalized care practice, which is essential in the management of chronic diseases, but is still limited in oncology.

Defining patient's experiential knowledge: Who, what and how patients know. A narrative critical review

Experiential knowledge is today increasingly valued in health-care practices, public health policies and health research and education programs. However, despite popular and institutional success, the concept remains loosely defined with the result of weakening its heuristic scope and paving the way for its commodification. In this article, we seek to provide a finer characterisation of patients' experiential knowledge's features and specificities through a critical narrative review of humanities and social science (HSS) literature published in English and French (1976-2021). Inspired by Jovchelovitch's analysis of social knowledge, we seek to highlight the diversity and plurality of forms and articulations of knowledge that characterise experiential knowledge, as well as the gradual, dynamic and entangled process that leads from experience to knowledge and expertise. Our analysis points to the need for future research to adopt a resolutely pragmatic and situated orientation in the study of experiential knowledge and the new figures of the contemporary patient that they help to create.

[Deployment of cross-functional patient education units in healthcare institutions in Île-de-France]

Therapeutic patient education (TPE) has proven its value and is a real challenge in the health care system. In order to coordinate the various TPE programs existing within health care institutions, transverse units for patient education have begun to be deployed. Although they have encountered some obstacles in their development, the teams, like the people being cared for, find them a real advantage. Research conducted in the Île-de-France region offers some ideas for strengthening their implementation.

[The place of therapeutic education in the care of the sickle cell patient]

Therapeutic education is an integral part of the management of sickle cell patients. It includes the medical aspects but also the psychological, family and social repercussions of their chronic disease. It allows, at every stage of the patient's life, a care practice centred on the patient as a subject by offering him tools to become an effective actor of the management of complications, in the search for an acceptable quality of life.

[Recognizing the lived experience of the disease: the "Crossing Experiences" research program]

INTRODUCTION

The action-training research project "Crossing Experiences: Towards a Transformation of Care Action in Chronic Illness" aims to offer an introduction to narrative approaches (NA), including moments of biographical narration and moments of explanation, to a mixed audience composed of patient-peer caregivers, care professionals and family caregivers interested in intervening in therapeutic patient education (TPE) programs.

OBJECTIVE

To present the initial results of the training component of this research and to identify the forms of enunciation revealing traces of the construction of an emancipatory approach to care and support relationships within the framework of TPE programs.

METHODOLOGY

The NAs were presented and then applied to different stages of TPE during three days of training. Collective discussions with participants were recorded. The ex-post content analyses carried out on the basis of these discussions sought to identify what interest(s) the NAs could offer, particularly in terms of experiential knowledge.

RESULTS

The design of the training, centred on ethics and a non-directive, comprehensive approach, made it possible to develop an atmosphere of confidentiality, favouring the learning and practice of the DAs involved. These were implemented at different stages of the TPE process, by both carers and patients and carer-partners, and were accompanied by the adoption of an educational stance conducive to the coconstruction of care.

DISCUSSION

The results show the potential of NAs to collaborate in strengthening democracy in health through the legitimisation of experiential knowledge that emerges from lived experience.

CONCLUSIONS

Training in NA based on the narration of experiences and learning acquired and their explicitation through a relationship based on respect provides avenues for collaborative work in TPE by bringing out forms of mediation, capable of grasping the dimensions of life before, during and after the disease, which are formative for people. The use of NAs is also a lever for transforming the educational process, by allowing patients and caregivers to become partners with TPE caregivers.

Interaction and conflict between outreach workers and research officers in implementing collaborative action research in the field of harm reduction: a qualitative study

BACKGROUND

The effectiveness of collaborative approaches in health interventions is underlined in the literature. Given the serious challenges to adequately managing the HCV epidemic in people who inject drugs (PWID), and the need to improve existing harm reduction (HR) interventions in this population, it seems important to investigate how collaboration between stakeholders is ensured in action research interventions. The present study aimed to explore interactions between outreach workers and research officers collaborating in the implementation of an action research project for PWID entitled OUTSIDER.

METHODS

Using three focus groups, we studied the views of 24 outreach workers involved in the implementation and evaluation of a harm reduction educational intervention to help PWID inject more safely in off-site settings.

RESULTS

The analysis of participants' discourses highlighted the mixed perceptions they had about OUTSIDER. Several limitations to collaboration emerged. Epistemological (theoretical vs. practical knowledge), methodological (science vs. intervention), axiological (standardised vs. adapted approach), and material (mobilised vs. available resources) issues all placed a burden on the outreach worker-research officer relationship. Outreach workers' acceptance of the project's intervention dimension but rejection of its scientific dimension highlights a lack of contractualisation between the stakeholders involved, and a more general problematisation of the role of outreach workers in implementing action research in HR. How collaboration was perceived and practised by outreach workers participating in OUTSIDER can be considered a reflection of the current challenges to implementing action research in HR.

CONCLUSION

This study of the interaction between the research and implementation dimensions of an action research project explored the tensions between different intervention stakeholders that must work together. Equitable participation and integration of the expertise, practices, and knowledge of all stakeholders involved is essential for successful action research. Given current HCV epidemiological challenges, new forms of cooperation are needed when developing healthcare services and when strengthening collaborative approaches.

Étudier de près les modes de coordination pour construire un partenariat visant à réduire les inégalités épistémiques

Cette recherche interventionnelle analyse les dynamiques d’engagement dans la collaboration entre des chercheur.se.s de sciences humaines et sociales et deux soignantes en cancérologie, pilotes d’un dispositif d’éducation thérapeutique de patient·e·s sous anticancéreux oraux. Nous nous attachons à analyser et à réduire les asymétries de savoirs et de pouvoirs pour favoriser les relations d’échange entre diverses expertises. Cet article retrace plus particulièrement les processus sociaux et épistémiques qui font évoluer les modes de coordination entre acteur.ice.s. Une enquête ethnographique (par observation participante et entretiens auprès des enquêtés) des trois années de partenariat permet de relever, au sein de différentes arènes collaboratives, la variabilité des formes de traduction entre ces acteur·ice·s et les ajustements méthodologiques de la recherche lorsqu'elle se confronte aux enjeux de l’intervention. Différents registres de médiation sont mobilisés par les chercheur.se.s, comme par les pilotes, qui impactent les formes de coordination. Nos résultats montrent que des négociations et des accords sont réalisés sans aboutir à des coordinations maximalistes, qui autoriseraient un travail commun de promotion de la RISP.

Intérêt d’outils digitaux dans le maintien d’un parcours de soins obésité dans le contexte épidémique Covid-19. Retour de l’expérimentation article 51 Espace Médical Nutrition et Obésité

L’épidémie de Covid-19, au-delà de mettre en évidence l’obésité comme facteur pronostique important, modifie grandement la prise en charge de cette maladie chronique. L’expérimentation article 51 Espace médical nutrition et obésité (EMNO) a dû intégrer des outils numériques pour maintenir les parcours de soins. Cette démarche a également été enrichie par l’apport d’un outil d’éducation thérapeutique digital. L’ensemble du processus de prise en charge a ainsi été réalisé malgré la situation, avec un retour très positif des patients inclus dans l’expérimentation. En contexte épidémique, le maintien des parcours de soins d’une maladie chronique comme l’obésité peut ainsi être assuré avec l’apport du numérique tout en dépassant le simple cadre de la téléconsultation et du suivi en y associant une approche pédagogique digitale.

[How health care professionals perceive chronic disease: Changes in therapeutic patient education (TPE) assessment from 2011 to 2017 in a French university hospital]

BACKGROUND

Since 2010, in France, Therapeutic Patient Education (TPE) programs have applied to the Regional Health Agency (RHA) for authorization. Every four years, these programs are mandatorily re-evaluated, and the assessment allows for change in the program management criteria. In our hospital, we studied the evolution of the Therapeutic Patient Education (TPE) appraisal benchmarks, otherwise known as "indicators", in the 17 programs having been authorized and renewed at least once by the RHA.

METHOD

The TPE program appraisal benchmarks are classified in terms of structure, process and outcomes; program activity itself as well as pedagogic, psychosocial and bioclinical indicators are taken into consideration. We wished to determine the extent to which these indicators were addressed, applied and renewed or created during renewal of the TPE programs. Statistical tests were carried out in order to compare changes in the number of benchmarks in each category before and after the renewal process.

RESULTS

During the first authorization, there existed 533 appraisal benchmarks, while they numbered 550 for the second. As for "before-and-after" changes, they consisted in a reduced number of outcome indicators (43.7% to 35.1%), whereas process indicators increased (36.8% to 43.1%) (P=0.0141). In comparison to the category pertaining to pedagogic, psychosocial and bioclinical indicators, the most widely registered indicator category (55.5%) and the most frequently collected indicator category involved the program activity itself (54.7%) (P<0.0001), which increased pronouncedly during renewal periods (67.6%) (P=0.0002). Conversely, the pedagogic and psychosocial indicators were little if at all collected. As regards the latter, there was nevertheless a considerable increase in indicators related to skills and changes favoring health-promoting behaviours. Strictly bioclinical indicators have been largely supplanted by those having to do with the disease evolution, its impact and risk management.

CONCLUSION

The major role assigned to process and structure indicators reflects the fact that they are predominantly structured by RHA requests. Even if this initial study necessitates further research, it highlights a change in the design of educational and psychosocial assessments among caregivers, a change likely to reflect their interest in how patients go about managing their illnesses, (more or less healthy) lifestyles and daily lives.

[Designing and evaluating therapeutic education tools for people living with HIV]

In the context of therapeutic education for people living with HIV in Africa, educational tools must be adapted to their living environment.

OBJECTIVES

To describe the process of designing education tools for patients living with HIV and evaluate their use by African caregivers-educators.

METHODS

An eight-step participatory and formative process was carried out to design educational tools. Twenty-one caregivers-educators from nine French-speaking African countries in three focus groups were interviewed on the way in which they used these tools.

RESULTS

Fourteen people were trained in the process of designing the tools and training caregivers-educators in their use. Two toolkits were developed (adults and children/adolescents). The image folder was the tool most commonly used. Educators in all countries used tools to address self-care and psychosocial coping skills. The criteria for choosing the tools were linked to their attractiveness, ease of use, their adaptation to the patient's needs and characteristics, and the degree of mastery by the caregiver-educator. The tools helped to structure the education sessions. Brakes to their use were organizational and lack of experience or mastery.

CONCLUSION

The participatory and formative approach enabled educators working with patients living with HIV in French-speaking Africa to appropriate the tools. Training was a crucial step in enabling caregiver-educators to master and disseminate the tools, and design new tools.