Patiëntsatisfaction and patiënteducation with interactive education for coloncancerpatiënts

Yearly 10.000 people in the Netherlands will hear the diagnose colon cancer.
After lung cancer and prostate cancer, colon cancer is the most commonly form
of cancer by male. For female patients colon cancer has a second place after
breast cancer (source: central bureau for statistics 2005). Often there are
complaints of blood loss, loss of weight and excessive fatigue.
The patient will hear the diagnose colon cancer from the gastro-enterologist.
Mostly the colon cancer will occur in the last region of the colon. When this
occurs, therapy like an operation is necessary. Sometimes in combination with
chemotherapy.
Colon cancer is a severe medical condition. Cancer is an emotional burden,
there is no way you can be neutral about cancer. Because cancer has become a
synonym for life threat, there is no condition that brings so much fear and
anxiety than cancer. The treatment of cancer patients is often complex (Moene
et al. 2005). There are different health-workers involved, who all have their
own expertise.

The diagnose alone will not tell the patient what will happen in their daily
live. The diagnose colon cancer alone will not tell what consequences there are
for their family, their home, and it will not tell them what treatment there
will be. Not only time but also a lot of understanding and education will make
the patient understand what will happen in their live.
The law in The Netherlands describes patient education and an informed consent
like this:
*When practising as a health worker, you have to see to, that the patient gets
information about:
* The nature and the cause of the examination or treatment.
* The side-effects and risks of the examination or treatment.
* Other methods of examination or other treatments.
* The condition of the treatment options*.

This is no striving, but a law. This law obliges the health worker to provide
good information to the patient so he or she can make a deliberate choice: the
informed consent. Then why do we see so much bad informed patients in the
practice yet? Most patients would like to get involved with their treatment.
Most likely patients who have to walk through quite an attending route like
oncology patients needs (Jones, 2001).
However there are many patients who receive inadequate information after
receiving their cancer diagnosis (Sitzia & Wood 1998), there are different
reasons for it. Mills & Sullivan (1999) wrote in their article that the
information needs of patients are a combination of factors, these are personal
and context related factors. Also the learning ability of the patient plays a
big part. It is a logical result to assume that patients with a lower learning
ability become other information then patients that pick up information
faster. Also factors as a stress, fear and depression play a big part of the
need of information and the processing of this information. Patient*s
information should be tailored on the individual patient, considering the
existing knowledge of the patient, fear and stress, the learning ability and
the ability to gain information.
Patient education is been given through the years by nurses and surgeons,
sometimes also completed by other discipline*s. The information often is not
adjusted to the patient and is not consistent of character. Marple et al.
(1997) describes that the absence of unsatisfied expectations increases the
patient satisfaction. Expectations are really important for a patient. These
expectations must be real, this can be achieved by excellent patient education
and information that is tailored to the individual patient. This is also our
goal of good patient education: a satisfied customer, or a good educated
patient.
Within this theoretically framework, we started in 2005 with the development of
an interactive web-application programme for patients with colon cancer. The
hospital: Medisch Spectrum Twente, Kunst & van Leerdam Technology and the
University of Twente worked together to develop an interactive web-application
for teaching patients and also staff. The interactive web-application must be
seen as guidance for patient education for surgeons and nurses.

Patient satisfaction.
A goal of the development of the interactive web-application is to reach higher
patient satisfaction levels. Patient satisfaction has emerged as an
increasingly important health outcome. Thomlinson et al. (2006) describes in
his editorial that surgeons have to be clear about the increased weight of
patient satisfaction. Thomlinson describes that patient satisfaction depends
not from the satisfaction of the surgeon about the operating procedure, but
depends from the satisfaction of the patient. But when can we speak of a high
patient satisfaction? Or what is the influence of patient education on patient
satisfaction?
Satisfaction is believed to be an attitudinal response to value judgements that
patients make about their encounter. Jackson et al. (2001) describes four
disctinct purposes of patient satisfaction: to compare different health care
programs, to evaluate the quality of care (Rubin, Gandek, 1993), to identify
wich aspects need to be changed to improve patient satisfaction and to assist
organisations in identifying consumers.
When the education of the patient is at best, and the expectations of the
patient are real and adjusted (with good education), the patient satisfaction
will increase. That*s why we ask us the following question.

Study goal is to answer the following question:

Is there an effect of interactive education with a web-application on patient
satisfaction for patients undergoing a colonic resection?

Sub-questions are:

1. Do patients with a higher education level have a higher patient satisfaction?
2. Is there a relation between satisfaction and post-operative complications?
3. What are resemblances and differences between the first and the second
measurement?

A randomized monocenter study, experimental design. This study will take place
in the Medisch Spectrum Twente. Patients seen in the outpatient clinic with
colon cancer will be asked to participate in this study. The patients must
undergo a hemicolectomy left or right.
After written informed consent, the patient will be randomly be given to the
experimental group or the conventional group.

Group A: the experimental group:
This group will receive patient education through word by mouth and the
interactive web-application. The information will be given by a Nurse
Practitioner gastro-enterology. This will take 30-45 minutes. The information
items will be equal to the information-items in group B. The web-application
also uses animations to clear things up.

Group B: the conventional/control group:
The conventional or control group will receive also information through word by
mouth. This is also given by the Nurse Practitioner gastro-enterology. The
session will take 30-45 minutes. The information items will be equal to the
information-items in group A.
After the conventional or interactive education the patient will be asked to
fill in the patient survey. The IN-PATSAT32 a validated instrument will be used
to measure satisfaction. After operation the same IN-PATSAT32 survey will be
send to the home address, to measure the patient satisfaction after treatment.
Patients will be informed through a information letter and will be asked to
give written consent. The health-care providers will be given information
through information meetings.

Conventional education:
The conventional education currently exists of a intake from the surgeon with
education about the operation and complications and risks. The patients
currently will get no other information before the operation. That*s why the
control group also get*s education through wordt by mouth, to eliminate other
variables and decrease bias.

Interactive information:
The interactive information consists of a number animations, text and images
that have relations on the disorder of the patient. The information items are
the same for all patients (the content of the information depends on the
diagnosis: hemicolectomy-right gets other information then hemicolectomy-left).
Surgeons looked at the information and approved it. Also a team of specialised
nurses from *Medisch Spectrum Twente* Looked at the information and approved
the content of the information. The interactive information will be tailored to
the individual patient. The information is based, as much as possible, on the
level of the patient. The discussed information will be printed so the patient
can look at information again when he/she is at home.

The interactive information consists two steps:
• The intake conversation with the attending surgeon in which information will
be given. The surgeon asks permission at the patient after which he/she
receives an extra outpatient clinics appointment for the interactive
information before the operation.
• Interactive information by the Nurse Practitioner at the outpatient clinic.
The information will be given on the basis of an information path in which
different information items will be discussed.

The interactive information consists of a number animations, text and images
that have relations on the disorder of the patient. The information items are
the same for all patients (the content of the information depends on the
diagnosis: hemicolectomy-right gets other information then hemicolectomy-left).
Surgeons looked at the information and approved it. Also a team of specialised
nurses from *Medisch Spectrum Twente* Looked at the information and approved
the content of the information. The interactive information will be tailored to
the individual patient. The information is based, as much as possible, on the
level of the patient. The discussed information will be printed so the patient
can look at information again when he/she is at home.

The advantages for the patients in the experimental group could be better
information and fear reduction, it*s also possible patients could get an
overdose of information which able to arise more fear (better informed about
complications of the operation). Therefore the information will give with a
health worker beside it; they can overcome possible fear or questions. On the
other hand patients in the control group will not experience disadvantageous of
not be seeing the interactive information. They will be informed orally as
before.