391Education Tailored to the Patient’s Needs
The Institute of Medicine [ 23 ] has defi ned patient-centered care as “providing care
that is respectful of and responsive to individual patient preferences, needs, as well
as values, and ensuring that patient values guide all clinical decisions.” The underly-
ing principle is similar to that of shared decision-making. This highlights the impor-
tance of assessing the patients’ needs at the start of the education process. For an
individual patient, this may mean assessing where they are in the disease trajectory,
their immediate priorities, motivation, and expectations. This may provide an “inter-
vention point,” where the health professional may fi nd an area to target patient edu-
cation leading to an effect that is meaningful to the patient. Since rheumatic diseases
have different effects on patients’ lives, patients may indeed have different educa-
tional needs and priorities for which, if not taken into account, the provided educa-
tion may not be relevant or meaningful to the patient. Studies of education needs
have consistently revealed different levels of needs based on different patient char-
acteristics. For example, in the Netherlands, younger patients with rheumatoid arthri-
tis (RA) had higher levels of educational needs than older patients, especially in
dealing with pain and feelings [ 24 ]. In the UK, the opposite was true; older patients
had a higher level of needs [ 25 ]. In psoriatic arthritis (PsA), older patients had a
higher level of needs than their younger counterparts in managing pain [ 26 ]. Country
differences have also been observed. For example, while female patients with RA
have been shown to have more educational needs than their male counterparts in the
UK [ 25 ] and Austria [ 26 ], there were no gender differences in educational needs in
the Netherlands [ 24 ]. This emphasizes the fact that needs may change from time to
time and education should be planned to target individual priority needs.
Assessment of needs should culminate in a tailored plan of patient education and
goal setting. This may mean, for example, that if a patient’s priority need is return-
ing to work, then education and support should be planned with an emphasis and
focus on issues related to work; this may well include control of pain, pacing, and
maximizing physical function amongst others. The goals of education should spec-
ify if patient education at this point is aimed at increasing knowledge, changing
attitude, behavior, or all. The goals that constitute SMART [ 27 ] are: S pecifi c,
M easurable, A chievable, R elevant, and T ime-bound. Furthermore, assessment of
needs and goal setting will help later in the process of evaluation of the education,
making the evaluation more relevant and sensitive to the intervention provided.
Clarifying these aims will help both the patient and the clinician to assess the needs
and to use effective delivery methods and the most appropriate measures to evaluate
the effects. Seeing positive results is likely to motivate patients.
Patient Education: Challenges
Demonstrating the evidence for patient education has been problematic, especially
in group-based education. This diffi culty is partly contributed to by the u se of
generic health measures to evaluate the effects of educational programs, some of
16 PROMs and Patient Education