EULAR recommendations for patient education for people with inflammatory arthritis

Slide 1: Target population/question Rheumatology health professionals including rheumatologists, patients with inflammatory arthritis, policy makers and patient and professional organisations. Objectives to develop a set of recommendations for PE for people with inflammatory arthritis (IA) to identify the need for further research and to define HPs’ educational needs for providing evidence-based PE 20/11/2018

Slide 2: Methods/methodical approach The EULAR standardised operation procedures for the elaboration, evaluation, dissemination and implementation of recommendations were followed.1 A multidisciplinary task force including patients, was convened, and led by an epidemiologist, formulated a definition for patient education and 10 research questions Systematic review was conducted by a research fellow The results of the systematic review were discussed and used as a basis for developing the recommendations, a research agenda and an educational agenda The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement) 1Dougados M, Betteridge N, Burmester GR, et al. Ann Rheum Dis 2004;63:1172-1176 20/11/2018

Slide 3: Overarching principles Patient education is a planned interactive learning process designed to support and enable people to manage their life with inflammatory arthritis and optimise their health and well-being Communication and shared decision making between people with inflammatory arthritis and their healthcare professionals are essential for effective patient education 20/11/2018

Slides 5-7: Individual Recommendations Patient education should be provided for people with inflammatory arthritis as an integral part of standard care in order to increase patient involvement in disease management and health promotion All people with inflammatory arthritis should have access to and be offered patient education throughout the course of their disease including as a minimum; at diagnosis, at pharmacological treatment change and when required by the patient's physical or psychological condition The content and delivery of patient education should be individually tailored and needs-based for people with inflammatory arthritis Patient education in inflammatory arthritis should include individual and/or group sessions, which can be provided through face-to-face or online interactions, and supplemented by phone calls, written or multimedia material 20/11/2018

Slides 5-6: Individual Recommendations Patient education programmes in inflammatory arthritis should have a theoretical framework and be evidence-based, such as self-management, cognitive behavioural therapy or stress management The effectiveness of patient education in inflammatory arthritis should be evaluated and outcomes used must reflect the objectives of the patient education programme Patient education in inflammatory arthritis should be delivered by competent health professionals and/or by trained patients, if appropriate, in a multidisciplinary team Providers of patient education in inflammatory arthritis should have access to and undertake specific training in order to obtain and maintain knowledge and skills 20/11/2018

Slide 7: Summary Table Oxford Level of Evidence Recommendations Level of evidence Strength of recommendation 1. Patient education as an integral part of standard care 1A–2B A–C 2. Patient education throughout the course of the disease 3–4 C–D 3.  Tailored and needs-based patient education 1B A 4.  Modes of delivery of patient education 1A–B 5.  Theoretical framework and evidence for patient education 6. Outcomes of patient education 4 D 7. Competency in delivery of patient education 3 C 8.  Training competency for delivering patient education 20/11/2018

Slide 8: Conclusion Eight evidence-based and expert opinion-based recommendations for patient education for people with inflammatory arthritis have been developed The recommendations address when and by whom patient educaiton should be offered, modes and methods of delivery, theoretical framework, outcomes and evaluation The recommendations are intended to provide a core framework for the delivery of patient education and training for health professionals A high level of agreement was achieved for all recommendations (mean range 9.4- 9.8) The task force proposed a reearch agenda and an educational agenda 20/11/2018

Slide 9: Lay summary of Recommendations Education for people with inflammatory arthritis Patient education should be a part of normal care for people with inflammatory arthritis.**** Patient education should be offered more than once.** The content of patient education should be designed according to the needs for each person.**** Patient education might be given in a variety of different ways.**** Patient education should be based on theory and evidence.**** Patient education should be evaluated.* Patient education should be delivered by health professionals e.g. doctors, nurses, psychologists, physiotherapists and/or trained patients as part of a team.** People providing patient education should be trained and maintain their knowledge and skills.** One star (*) means it is a weak recommendation with limited evidence. Two stars (**) means it is a weak recommendation with some evidence. Three stars (***) means it is a strong recommendation with some evidence. Four stars (****) means it is a strong recommendation with a lot of evidence. 20/11/2018

Slide 10: Acknowledgements Kari Matre (medical librarian, Diakonhjemmet Hospital Library) for providing expertise in search methods. Contributors of lay summary: Dieter Wiek, Margot Bakkers, Petra Balazova, Fearghal O’Nia, Irene Pitsillidou European League Against Rheumatism (EULAR) for funding the project. Grant reference: HPR024 Members of the consultation group: Adewale Adebajo, Michael Backhouse, Ulrika Bergsten, Tricia Cornell, Jenny de la Torre-Aboki, Silvia Garcia Diaz, Ricardo Ferreira, Kjersti Gronning, Bernadette Hardware, Agnes Kocher, Marja Leena Kukkurainen, Ingrid Larsson, Azucena Pedraz Marcos, Andrea Marques, Jorit Meesters, Sue Oliver, David Pickles, Birgit Prodinger, Sarah Ryan and Karen Vinall 20/11/2018