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DISEASE SPECIFIC TEACHING BY A NURSE EDUCATOR: A RANDOMIZED TRIAL
M Stewart1, D MacIntosh2, K Phalen-Kelly2, J Stewart2
1University of Calgary, Calgary, Alberta; 2Dalhousie University, Halifax, Nova Scotia
Aims: The advantages of patient education have been well documented in the literature and include improved self care skills, enhanced patient compliance and reduced patient anxiety. The disease specific knowledge of IBD patients is known to be quite low. Patient education may be an integral part in improving care and was planned as a key intervention in the development of a dedicated IBD clinic in Halifax, NS. The goal of this randomized trial was to determine if disease specific teaching lead to improved knowledge and quality of life.
Methods: Patients presenting to an IBD clinic were randomized to receive either standard care or formal IBD education. The main outcomes were the Crohn's and Colitis Knowledge Score (CCKNOW) and IBD Quality of Life Score (IBDQ) that were completed at the time of enrollment and at 6 months follow-up. The Education group received two, one-on-one education sessions with a nurse educator at months 2 and 4 of the study. A formal education curriculum was designed specifically for use in this study. The participants in the Standard Care group were offered the same education upon completion of the study. Pearson Chi squares, t-tests, and an ANOVA were used to assess differences within and between the study groups. All tests were considered statistically significant at the 0.05 level.
Results: Sixty-seven patients were enrolled. Four patients withdrew prior to the completion of the study. There were no significant differences in baseline characteristics. The average age of participants was 34.6 years; 48 were female and 15 were male; 15 had Ulcerative Colitis and 48 had Crohn's Disease. All participants had graduated High School, 11 had some post-secondary education, and 35 had completed post-secondary education.
The Education group CCKNOW scores at enrollment and 6 months were significantly improved (p<0.001), however, the IBDQ scores between enrollment and 6 months failed to reach significance (p=0.170). The Standard Care group had improvement on both the IBDQ and CCKNOW between enrollment and 6 months (p=0.02 and p=0.01, respectively). The degree of improvement on the CCKNOW was significantly greater in the Education group then the Standard Care group (p=0.034). There was no difference in improvement of IBDQ scores between the groups (p=0.892).
Conclusions: This study has established that IBD specific education can significantly improve patient knowledge as measured by the CCKNOW. The impact of improved knowledge on quality of life was not demonstrated by this study. The education curriculum developed for this study has been expanded and is now offered to all new IBD patients and their families.