5.1.3. Therapeutic patient education
The WHO produced a document in 1998 on therapeutic patient
education (Report of a WHO Working Group on Therapeutic Patient Education.
Continuing education programmes for healthcare providers in the field of
chronic disease prevention).
The management of chronic diseases requires the
development of a particular partnership between the patient and his health care
professional in order to achieve awareness, knowledge, confidence and skills
which could help the patient to have a major role in the management of his/her
disease. This approach is called “guided self management” and there is proof it
can help to reduce asthma morbidity in both adults and children. The
educational aspect should constitute the basis of the interactions between
patients and physicians and a good communication is essential for an adequate
compliance and adherence.
Therapeutic patient education should enable patients to
acquire and maintain abilities that allow them to optimally manage their lives
despite their disease. It is, therefore, a continuous process, integrated in
health care. Moreover, it is patient-centered and includes organized awareness,
information, self-care learning and psychosocial support for what concerns the
disease, prescribed treatment, care, hospital and other health care settings,
organizational information, and behaviour related to health and illness.
Therapeutic patient education has been designed to help patients and their
families understand the disease and the treatment, cooperate with health care
providers, live healthily, and maintain or improve their quality of life. There
are a growing number of centres that practice therapeutic patient education,
hoping therefore to improve patients’ autonomy and self-management. Moreover,
nowadays there is an important drive for long-term accompaniment of patients where
the various characteristics – i.e. personal, family, professional, social,
economic, etc. -, have to be taken into account in the long-term follow-up.
Medical schools are lagging behind this global need. Therapeutic patient
education is a systemic, patient-centered learning process, provided by health
care providers trained in the education of patients that takes into account:
patient’s adaptation processes (coping with the disease, locus of control,
health beliefs, and socio-cultural perceptions);
and objective needs of patients, whether expressed or not. This is an integral
part of treatment and care.
Therapeutic patient education is about the patient’s daily
life and psychosocial environment, and also involves the patient’s family and his/her
closest friends. This is a continuous process, which has to be adapted to the
course of the disease, to the patient and to his/her daily life. It is part of
the long-term care of the patient and has to be structured, organized and
systematically provided to each patient using different means. We are talking
of a multi-professional, inter-professional and inter-sectoral methods, also
including the making of networks as well as an evaluation of the learning
process and its effects. Health care providers tend to talk to patients about
their disease rather than train them in the daily management of their
condition. Therapeutic patient education is designed, therefore, to train
patients in the skills of self-managing or adapting the treatment to their particular
chronic disease as well as in coping processes and skills. It should also
contribute to reducing the cost of long-term care for patients and our society.
Therapeutic patient education is essential for an efficient self-management and
high quality of care for all long-term diseases or conditions, although acutely
ill patients should not be excluded from its benefits. Therapeutic patient
education is education managed by health care providers trained in the
education of patients, and designed to enable a patient (or a group of patients
and families) to manage the treatment of their condition and prevent avoidable
complications, while maintaining or improving quality of life. Its main purpose
is to produce a therapeutic effect additional to that of all other
interventions such as pharmacological and physical therapy .