Tools as a means to achieve person-centered patient education?

Sir,

If the 21st century should indeed become the century of the patient, as it has been stated,[1] radically new methods and models for person-centered practice are required. Patient education is a cornerstone in caring for patients with chronic illness, such as type 2 diabetes, heart disease and chronic obstructive pulmonary disease (COPD). For patient education to be truly person-centered, patients must participate in identifying their problems and in formulating solutions to problems. Unfortunately this is rarely the case.[2] Most patient education is based on a professional understanding of patients’ needs for learning, rather than patient perspectives and preferences.[3] This generates a risk of neglecting issues that are important to patients but unrecognized by educators. As shown in the large DAWN and DAWN2 studies, psychosocial issues such as diabetes distress are pronounced among people with diabetes. Hence, there is still a substantial need globally for translating this research into the actual delivery of person-centered diabetes care.[4] Health education as a professional task potentially has a lot to offer the healthcare system in using patient input to design and implement person-centered care.[2]

Following this we were guided by two health education concepts dialogue and participation in the development of tools to be used in person-centered patient education:

Dialogue is to be understood in a broad sense as an approach to patient education. Patient education has most commonly been delivered using the one-way didactic model, in which the educator provides information to participants in a teacher-student relationship. This approach has proven successful in conveying information but is less useful when it comes to encouraging, enabling and supporting patients to change behavior and manage their condition. Behavior change theory indicates that educators must engage participants in a dialogue to identify challenges, set goals, increase self-efficacy, and address barriers to change.

Participation likewise implies a shift from a disease-centered and paternalistic approach toward care centered on the challenges of persons living with and managing chronic illness.

These principles are currently translated into the development of flexible tools to be used in group-based patient education for people with chronic illness, in individual consultations targeting people with diabetes with high blood sugars and low medication adherence, for individual patient education in diet, and for vulnerable people with diabetes.

The tools make use of pictures, quotes, and statements to engage and give voice to the people with chronic illness. The tools and the participatory and patient-centred approach thus support the call for flexible and dynamic approaches to patient education.[5]

The tools have shown promise in feasibility studies. Further research is needed to assess whether they will actually translate into better quality of care and better health outcomes.