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The Changing Concepts of Patient Education
In the early years, physicians were regarded as the only authority and source (or
“transmitters”) of information while patients, playing a passive role, were expected
to listen (or “receive”) and comply by changing their behaviors. Hoving et al. [ 13 ]
has described the development of patient education from the early 1960s to the
twenty-fi rst century. The major development has been identifi ed as the patients have
become more active participants in their care and are increasingly taking more
responsibility for their health. It is now generally accepted that effective disease
management requires a partnership between the patient and the treating healthcare
professional. Shared decision-making helps combine the patient’s experience of liv-
ing with the disease, their values and preferences, together with the health profes-
sional’s skills and knowledge of the best scientifi c evidence available [ 14 ]. This
partnership in care enables effective disease management—targeting the common
facets such as management of pain, fl are-ups, fatigue, physical, and emotional dis-
abilities, as well as medications—while taking into account the patient’s values and
needs. A shared decision-making approach is now incorporated in most disease
management guidelines [ 8 , 10 , 11 , 15 – 18 ].
The definition of patient education also has gone through many changes
over the years. Although most definitions agree that patient education is a
planned systematic process, initially the emphasis has focused on the patients’
behavioral change or compliance to manage their disease [ 19 , 20 ], whereas
more recently they embrace a more collaborative, health-promoting, and well-
being approach [ 5 , 21 , 22 ]. Recently, an international task force of health pro-
fessionals and patients defined patient education as “a planned interactive
learning process designed to support and enable people to manage their life
with inflammatory arthritis and optimize their health and well-being” [ 5 ]. This
definition includes a wide range of educational activities, such as provision of
knowledge, written material, e-health, self- management programs, cognitive
behavioral therapy (CBT), mindfulness, stress management, individual consul-
tations with healthcare professionals, sharing experiences among patients,
motivational discussions, exercise counseling, lifestyle change interventions,
and self-help courses. This definition focuses on “supporting” and “enabling”
the patients, which for some may lead to behavior change, whereas in others
may equip and enable them to make choices that would help optimize their
health.
The health-promoting approach is increasingly more relevant in the current man-
agement of infl ammatory arthritis, which incorporates treat-to-target, time in remis-
sion, and management of comorbidities such as cardiovascular diseases. The current
management of infl ammatory arthritis is such that health professionals and patients
need to think about prevention (or management) of comorbidities in addition to
their rheumatic disease.
D. Palmer and M. Ndosi