Waterman H, Bull S, Shaw M, Richardson C
1School of Healthcare Sciences, University of Cardiff, Eastgate House, 35-43 Newport Road, Cardiff, CF24 0AB UK.
McCann Health, London, UK.
Pilot Feasibility Stud. 2018 Jul 3;4:121. doi: 10.1186/s40814-018-0313-5. eCollection 2018.
Globally, glaucoma is the leading cause of irreversible blindness. However, many patients with glaucoma do not understand their disease which reportedly impacts on their ability to manage their condition successfully. The aim of this feasibility study was to undertake research to inform a future randomised controlled trial of the effectiveness of group-based education for patients to improve adherence to glaucoma eyedrops.
Key objectives were to understand current provision of information during routine nurse-led glaucoma consultations, to investigate if it is possible to deliver patient information in line with a clinical standard by training nurses to deliver group-based education in multiple hospital sites and to explore the acceptability of group-based education to nurses and patients compared with usual information provision in consultations. This study employed quantitative and qualitative research methods situated in a sequential design across three hospitals in England and Wales. Current provision of information given to 112 patients with glaucoma across the three hospitals was observed and compared to that recommended in a clinical standard. Then, six nurses were trained to deliver group-based education. Following which, the level of information was assessed again in line with the clinical standard as the group-based education programme was delivered in the three hospitals to 16 patients in total. All nurses and six patients were interviewed to explore experiences of the group-based education sessions.
The main area of information provided during routine nurse-led consultations concerned the management of glaucoma and that least covered was about prognosis of the disease and information about support services. Nurses were trained to implement group-based education for patients. Information was provided more often by the nurses about all the items of the clinical standard when delivering group based education. However, patients' motivation to attend were negatively impacted mainly by delays in delivering the education for the third phase and because the majority were established patients. Nurses and patients who participated found it useful and comprehensive.
This feasibility study demonstrates that the proposed intervention for the randomised controlled trial, the group-based education, goes beyond current information provision, is in line with that articulated by a clinical standard and is implementable across several sites. This bodes well for a future randomised trial, but the following needs to be taken into account to ensure success: independent implementation of the research, training and delivery at each site, timely provision of the patient education, inclusion of new patients, and consistently delivered nurse training.
International Standard Randomised Controlled Trial number, ISRCTN91188805.
在全球范围内，青光眼是不可逆失明的主要原因。然而，许多青光眼患者并不了解自己的病情，据报道这影响了他们成功管理病情的能力。这项可行性研究的目的是进行研究，为未来一项关于以小组为基础的教育对青光眼患者提高眼药水依从性有效性的随机对照试验提供信息。
主要目标是了解在常规护士主导的青光眼会诊期间当前的信息提供情况，调查是否有可能通过培训护士在多个医院地点开展小组教育来按照临床标准提供患者信息，并探讨与会诊中常规信息提供相比，小组教育对护士和患者的可接受性。本研究采用定量和定性研究方法，在英格兰和威尔士的三家医院进行顺序设计。观察了三家医院向112名青光眼患者提供信息的当前情况，并与临床标准中推荐的情况进行比较。然后，培训了六名护士开展小组教育。之后，随着小组教育项目在三家医院总共向16名患者实施，再次按照临床标准评估信息水平。对所有护士和六名患者进行了访谈，以探讨小组教育课程的体验。
在常规护士主导的会诊期间提供的主要信息领域涉及青光眼的管理，而最少涉及的是疾病的预后和支持服务信息。护士接受了为患者实施小组教育的培训。在开展小组教育时，护士更频繁地提供了临床标准所有项目的信息。然而，患者参加的积极性主要受到第三阶段教育延迟以及大多数是老患者的负面影响。参与的护士和患者认为其有用且全面。
这项可行性研究表明，为随机对照试验提议的干预措施——小组教育，超越了当前的信息提供，符合临床标准的要求，并且可在多个地点实施。这对未来的随机试验是个好兆头，但为确保成功需要考虑以下几点：在每个地点独立开展研究、培训和实施，及时提供患者教育，纳入新患者，以及持续开展护士培训。
国际标准随机对照试验编号，ISRCTN91188805。
