Bianca A. Simonsmeier Maja Flaig Michael Schneider The effects of patient education on health: A second order meta-analysis Bianca A. Simonsmeier Maja Flaig Michael Schneider

Risks and Side Effects of Surgery and Medication Complications Side effects Over dose Drug addiction Resistant bacteria problems Relevance of medical treatments other than surgery or drug prescription

Patient Education Patient education is an instructional intervention with the goal to inform patients and change attitudes and behavior patterns which in turn helps to recover from their disease For example pamphlets, conversation, trainings Mainly conducted by nurses, doctors, pharmacists, psychologists, or social workers Most commonly for patients with chronic diseases

Advantages of Patient Education Quick and easy Cheap as compared to surgery or drug prescription Key variable of informed consent Strengthens the patients self efficacy and autonomy No known side effects No harm of overtreatment

But is Patient Education Effective? “It is commonly believed that psychoeducation interventions are ineffective“ (Donket et al., 2009) Many studies and meta-analyses Goal of the current study: Integration of results from previous meta-analyses Research questions Causal effect of patient education on health? For what health outcomes? For what diseases? For what instructional methods?

2. Order Meta-Analysis 2. order meta-analysis Meta-analyses … Patients Our study Meta-analyses … Patients Single studies … …

Inclusion Criteria Comparison between treatment (with patient education) and control group (no patient education) Effect sizes related to patients (not significant others or healthy population) Effect for objective or subjective health outcome or health behavior reported Standardized effect size reported

Standardized Literature Search Databases: PsycINFO, PubMed, Cochrane Library, Eric, explorative search Search string: meta-analysis AND (patient education OR health education OR psychoeducation) 469 hits Screening of titles and abstracts  220 articles excluded Screening of full-texts  202 articles excluded When studies were included in more than one meta-analytic integration, effect size was excluded from analysis 47 meta-analyses were independently coded by two raters

Included Studies 173 effect sizes from 47 meta-analyses Meta-analyses were from 1980 – 2015 ICD-10-categories: A, B, C, E, F, I, J, K, M, O, Z (Surgery, diabetes, cancer, heart attack, stroke, arthritis, etc.) Outcomes: blood sugar, medication use, anxiety, death, hospital admission, etc.)

Mainly experiments (RCT) Overall Effect   Meta- analyses Effect sizes Cohens d 95% CI Overall 47 173 0.32 [0.26, 0.39] Mainly experiments (RCT)

2. Health Outcomes Meta- analyses Effect sizes Cohens d 95% CI   Meta- analyses Effect sizes Cohens d 95% CI Relapse and visits of medical facilities 15 23 0.28 [0.16, 0.39] Medication 5 7 0.34 [0.11, 0.57] Pain 8 10 0.23 [0.12, 0.34] Physiological functioning 27 0.25 [0.07, 0.44] Physical functioning 11 0.20 [0.02, 0.37] Psychological functioning 14 35 [0.08, 0.37] General functioning 0.39 [-0.09, 0.86] Beispiele für physisch/physiologisch/psychologisch nennen

2. ICD-10 Categories Meta- analyses Effect sizes Cohens d 95% CI   Meta- analyses Effect sizes Cohens d 95% CI C (Neoplasms) 5 10 0.32 [-0.13, 0.77] E (Endocrine, nutritional and metabolic diseases) 6 45 0.40 [0.20, 0.59] F (Mental and behavioural disorders) 7 12 0.48 [0.29, 0.68] J (Diseases of the respiratory system) 20 0.19 [0.07, 0.30] Z (Factors influencing health status and contact with health services) 16 0.20 [-0.02, 0.42] Various 18 0.29 [0.19, 0.39]

4. Instructional Methods   Employed Not employed Effect sizes Cohens d Fact knowledge 125 0.32 13 - Conceptual understanding 15 0.30 27 0.23 Attitudes 9 0.26 68 0.29 Self-management 82 25 Social skills 19 56 Other skills 38 54 Other content 33 0.22 60 0.33 Keiner der Unterschiede ist bisher statistisch signifikant

Discussion Patient education seems to be effective For various health outcomes For many diseases Not exclusively for chronic illnesses (but here more effective?)

Discussion Analyses are still running Statistical analyses for second order meta-analysis in some cases unclear (e.g. how to deal with first and second order sampling error) Some meta-analyses don't report number of participants or SD/variance of effect size – need to be excluded Many small meta-analyses

Conclusion Patient education has positive effects on a variety of health outcomes and disease patterns Results are especially promising as education is cheap and has less risks and side effects as compared to medication use or surgery Patient education might even be more effective when instructional design principles are considered

Thank you! 