From therapeutic patient education principles to educative attitude: the perceptions of health care professionals – a pragmatic approach for defining competencies and resources

Figures & data

Table 1 Description of the training programs

Characteristics of programs	Liege training (Belgium)	Nancy training (France)
Duration	1 year	1 year
Number of sessions	14 days	14 days
Total number of hours	120 hours	112 hours
Main objectives	– To provide an introspective approach to their practices and their representations. – To develop a rigorous methodology that can lead to construction of a single TPE course for each patient. – To center the support on the patient’s situation from the perspective of systemic approach of the person. – To work in a team, coordinating its work with other actors in the management toward common patient-centered goals. – To integrate TPE in care activities.	– To propose a comprehensive humanistic approach to patient care aimed at providing patients with the skills and strategies required to change their behavior, in order to improve the patient’s health and, in particular, quality of life. – To provide an integrated model of TPE in which significant emotional and behavioral needs of patients are met, ie, coherent interventions that center on the patients’ needs, encouraging the coordination of the educational team and emphasizing patient’s self-management. – To improve relations between the caregiver and the patient using a fundamental redefinition of their respective roles: patients become partners and health care professionals become “coaches.”
Main contents	Module 1: TPE: some ethics in our professional practices! What consequences for my practice? Module 2: Discovering the chronic patient Module 3: Learning to listen, communicate and talk: a good start in education Module 4: Learning to listen: motivations, resources and limits: How to stay relevant? Module 5: Announcing the diagnosis: how to optimize? Module 6: How to know my patients and their expectations better, in order to define appropriate goals? The educational diagnosis Module 7: A little method: definition, planning and implementation of learning teaching Module 8: Patient evaluation: a necessity	Module 1: Main concepts and tools used in TPE – Revisiting the concept of chronic disease. Quality of life. Pursuit of happiness – TPE versus disease management. – Motivation, self-management capabilities and self-efficacy, learned helplessness, readiness to change, self-determination theory – Psychological distress and resilience. Sociocultural factors, economic insecurity – Main principles of pedagogy: educational position between care and cure – Health psychology: contribution to TPE Module 2: Stages of education program development – Individual assessment of patient’s needs and resources; negotiation of objectives – Personalized care planning viewed as a collaborative process in which patients and health care professional identify and discuss problems related to the patient’s condition – TPE integrated into routine care – Educational individual or group sessions – Role and management of the patient-centered interdisciplinary team – Patient evaluation: acquisition of skills, experience with the disease, ability to cope, satisfaction; program evaluation: content and organization.
Educationaloptions	Training is based on a central pedagogical principle that constitutes the isomorphism: the idea is to teach how the TPE should be conducted with patients (use of active learning techniques, work on representations, centering on learner engagement experience of the learner, etc.). The evaluation test will consist of a personal work, based on analysis of clinical situations encountered by the participant.	Active teaching methods are used for ∼40% of the program. Learning takes place through discoveries based on investigations, for example, case studies or role games. The training is based on a problem-solving approach. Both experienced health care professionals and university professors are involved.
Target audience	Health practitioners in direct contact with patients. Requirements: higher education diploma	– Medical students or pharmacy students who have completed the second cycle – Physicians and pharmacists – Health care professionals who have completed a paramedical training: dietitians, physiotherapists, nurses, psychologists and podiatrists.
Maximum number of participants	15	25
Training sponsor	University of Liege (Faculty of Medicine)	University of Lorraine (Medicine Faculty)
More information	http://www.facmed.ulg.ac.be/cms/c_1457759/fr/certificat-d-universite-en-pratique-d-education-therapeutique-du-patient	http://www.edulor-formation.fr/

Abbreviation: TPE, therapeutic patient education.

Figure 1 The data collection process.

Abbreviations: BE, Belgium; FR, France.

Table 2 Description of the sample

Characteristics	n (N=33)
Country
France	20
Belgium	13
Gender
Female	29
Male	4
Age (years)
25–35	11
36–45	10
46–55	12
Profession
Dietitian	8
Nurse	17
Physician	3
Project coordinator	2
Physiotherapist	2
Pharmacist	1
Work settinga
Hospital	25
Private office	4
Health care network	6
Nursing home	3
Other	1
Method of payment
Fee for services	1
Employee	28
Mixed	4
Patient environmentb
Urban	27
Rural	3
Mixed	2

Notes:

a Several answers allowed.

b Data missing for one participant.

Table 3 Statements regarding the characterization of the educative attitude

1. Concerning the relationship with time, educative attitude in the field of TPE is characterized by recognition of

– the need to take time for activities involving informing the patient of the diagnosis, patient identification, definition of a care plan;

– the possibility of postponing a TPE activity if the patient is not ready or to increase their motivation before undertaking the activity;

– the need to adapt the TPE to the patient’s psychological readiness and the caregiver’s need to be flexible and adaptable;

– the fact that chronic illness involves a long-term relationship (patient’s illness for life);

– the need to situate one’s intervention in relation to the patient’s life history and their medical treatment.

2. Concerning the benefits of TPE practice for the caregiver, the educative attitude in the field of TPE is characterized by the recognition that TPE

– helps reinforce the caregiver’s capacity for action in relation to the chronic patient;

– helps caregivers overcome the feeling of powerlessness and helps the caregiver get out of a dead-end/overcome an obstacle;

– allows the caregiver to have a more positive approach to their job (no longer being obliged to have a result-oriented approach);

– legitimizes (by giving real power) some of the caregiver’s activities (for instance, asking about the patient’s life history);

– helps improve the quality of the caregiver’s work life;

– improves the caregiver’s motivation.

3. Concerning the emotions, the educative attitude in the field of TPE is characterized by the recognition that TPE

– requires identifying and being aware of one’s emotions in order to avoid transference and projection;

– requires accepting and recognizing the patient’s emotions;

– requires an adjustment in the caregiver’s thoughts, emotions and actions (toward authenticity and coherence);

– requires acknowledging that patients’ resistance is an integral part of their development with regard to their illness;

– helps the caregiver recognize the impact of their verbal and nonverbal attitudes on the therapeutic relationship;

– helps the caregiver be more humble and more careful about their knowledge with regard to the patient;

– helps make caregivers more thoughtful about their professional practice.

4. Concerning the professionalizing nature of TPE, the educative attitude in the field of TPE is characterized by the recognition that TPE

– is more than just supplying information;

– requires trained, competent caregivers; in other words, TPE cannot be improvised;

– formalizes certain activities undertaken implicitly by caregivers;

– relies on an approach that acknowledges the essential stages such as assessment and educational diagnosis as therapeutic acts;

– requires in-depth biomedical knowledge of a specific chronic disease.

5. Concerning the holistic, interdisciplinary approach to the patient, the educative attitude in the field of TPE is characterized by the recognition that

– the aims of TPE are the individual’s QOL and health;

– TPE objectives, learning activities and indicators are situated in the biopsychosocial sphere;

– only a holistic approach to the patient is effective (vs compartmentalization or division): the illness is the result of a set of environmental and biopsychosocial determining factors;

– close friends and relations must be considered as a determining factor in the illness and a resource or obstacle to care;

– chronic illness requires recourse to health care professionals specializing in different areas and interdisciplinary approach;

– caregivers have their own limits with regard to patients and it is sometimes necessary to refer the patient to someone else or work with other caregivers.

6. Concerning the educational nature of the therapeutic relationship, the educative attitude in the field of TPE is characterized by the recognition that

– the caregiver’s role changes from a curative to an educational one;

– the educational role consists of learning to create, develop and recognize resources, facilitate learning and establish the right conditions for learning, to inform the patient so that they can make their own health choices;

– making mistakes is an integral part of learning, including in the learning associated with TPE;

– it is important to use the patient’s knowledge and perceptions of the illness as a starting point;

– the patient is solely responsible for changing their own behavior (active position of the patient);

– the patient is capable of making choices (patient’s competence);

– the patient’s internal motivation must be stimulated.

7. Concerning the ethical relationship, the educative attitude in the field of TPE is characterized by the recognition that

– above all, we are caring for a human being and not an organ/illness;

– TPE involves the following values: being nonjudgmental, positive, trustworthy, transparent and humble;

– TPE requires changing from an interventionist mode to a deliberative mode, ie, partnership;

– the patient must be recognized for who they are (personalized approach);

– the patient is an expert in the experience of his illness;

– the patient is free to make their own health choices, and the caregiver’s job is to make that choice is an informed one;

– the patient’s view can be different from the caregiver’s, especially with regard to therapeutic objectives.

Abbreviations: TPE, therapeutic patient education; QOL, quality of life.