Future Trends in Patient Education Marion

E. Morra

E

VERY HOUR, 24 hours a day, 125 people in the United Statesare told they have cancer. Every day, 365 days a year, 3,014 people hear the dreadeddiagnosis. Every week, 52 weeks a year, 2 1,154 people learn to live with the disease.That totals 1,100,000-the number of newly diagnosed cancer patients this year in the United States alone.’ This issueof Seminars in Oncology Nursing has attemptedto look at the needsof these cancer patients and their families for information and for education, along with the roles nursesplay in fulfilling these needs in a changing health environment. As we end this issue, we needto look to the future, for as we go through the 1990sto the year 2001, there will be many changesthat will create challengesand opportunities in the field of patient education. There are at least five trends that will modify our methods and means of educating our patients and their families. We need to examine them and think about how we will deal with them as we approachthe 21st Century.

treatment. Older people with cancer are more likely to have other chronic diseases,such as heart conditions, vascular problems, and arthritis. Medication for each of these conditions is likely to be prescribed, which may influence learning or thought processes.In preparing materials and in presenting programs to this target group, we will need to pay special attention to specific strategies to overcome these barriers. We will also seea more educatedolder population. In 1960, only 20% of older people in this country were high school graduates.By the turn of the century, 64% will be high school graduates.6 Along with increasededucation comes a desire to be more involved with the decision-making processand a demandfor more detailed and sophisticated information. Add to this the proliferation of self-help literature and of consumeractivism in the health field. The result will be a need to involve patients and their families more fully in making health care decisions, including those decisions concerning quality of life issues.

Our population will be growing older and living longer. Just 5 years from now, the median ageof

There will be more cancer patients and more cancer survivors. With an aging population, the

the population will be nearly 40.2 Sixty will be considered the threshold of middle age, as 50 is today and 30 was just two generationsago. As we approachthe 21st Century, our life spanwill have gone from 48 years to an average of 72 years. Children born today can expect to live for 83 years-10 years more than their parents, 20 more than their grandparents, and 30 more than their great-grandparents3 The fastest-growing demographic group in the country is composedof those over 85; this group will account for nearly 5 million people by the turn of the century.4 The older population will continue to provide different challenges and obstacles to anyone involved in health education. On the average, the elderly do not learn as quickly and as easily as do younger persons. Almost all have had some sight loss, and about a quarter have had serious hearing loss. Older personsare diagnosedwith a more advanced stage of cancer and are less likely to receive definitive treatment for cancer than are younger persons.5They may have had many negative lifetime experienceswith cancer and cancer

number of cancer patients will continue to increase,with a near doubling by the year 2001. It is estimatedthat medical technology will advanceto the point where at least two of three cancerpatients will be cured by the beginning of the 21st Century, giving us a growing pool of cancer survivors. By the year 2001, 1 in every 1,000 young adults entering the job market will be a survivor of childhood cancer.’ With an increasing number of patients, we will need to find new ways of providing education and information to them and their families. We will also need to be more in touch with the ongoing

From the Yale Comprehensive Cancer Center. Yale School of Medicine, New Haven, CT. Marion E. Morra, MA: Associate Director, Yale Comprehensive Cancer Center. Address reprint requests to Marion E. Morra, Yale Comprehensive Cancer Center, WWW 204, PO Box 3333, New Haven. CT 06510. Copyright 0 1991 by W.B. Saunders Company 0749-208119110702-0010$5.0010

Seminars in Oncology Nursing, Vol 7, No 2 (May), 1991: pp W-145

143

MARION

problems of the growing group of cancer survivors, being more sensitive to their needs and concerns and finding means to help them solve their problems. Another challenge will be how to counsel patients about preventive actions. The typical officebasedpractice has contact with over 700 patients eachyear: 290 of them smoke,and 180are aged50 and over and needmammographyreferrals.’ If every smoking patient was routinely counselled to stop smoking, at least 1 million Americans might stop smoking in 1 year. If every office had a system for routine referrals for mammograms, our breast cancer statistics would change radically. Nurses can play a pivotal role in this important effort. There will be more membersof many of the minority groups and more people who are disadvantaged. The major growth in the population and the workplace will come from the ranks of minority groups during the next 10 years. It is estimated that one of every four people in the US will be a member of a racial or ethnic minority in the year 2001, and minorities will be majorities in 53 of the largest 100 cities.’ Hispanics, growing at five times the national rate, will increaseto nearly 29 million by the year 2001.lo There are presently 38 million Americans living in poverty. ‘i Minorities and disadvantagedpeople constitute two different groups. Only one third of the disadvantagedare minorities, but a larger percentage of minorities fall into the disadvantaged category. Disadvantaged Americans come from many different cultural and ethnic groups, including millions of poor white people. Minorities and the disadvantagedare not reaping the benefits of advancesin cancer prevention, detection, and treatment. Mainstream health education activities often fail to reach thesepopulations. Generally, they are not information seekers;they have lesser communication skills and an inadequate foundation of knowledge on which to expand. We will need to be more sensitive to their differences and their needs. We must put our energies, our resources, our imaginations and our skills into finding new and better ways to communicate with these populations and to find ways of providing medical and nursing care. There will be more people with literacy problems. Today, there are 23 million American adults who are functionally illiterate: 20% of our

E. MORRA

population read at a fifth grade level or lower. I2 That meansthat every fifth person we are presently dealing with is likely to be without enough fluency to make good use of written materials-someone to whom we must communicate mostly with pictures. Another 33% of our population are only marginally competent in reading. Yet one needs to read at a sixth grade level to understanda driver’s manual, at an eighth grade level to follow directions on a frozen dinner package, and at a 10th grade level to read the instructions on an aspirin bottle. A recent study found that fewer than 50% of young adults can understand a newspaperarticle. Too many of us in the health field are continuing to produce mainly written materials and materials that are increasingly difficult to understand. We will needto experiment with more visual meansin order to reach these people. We will need to use new technologies, many of which are already available, to provide information for this target population. The expansion of the video market for entertainmentprovides us with evidence of the potential for this media. We need to find effective ways of using new vehicles for health education, for information, and for individualized instructions to reach patients of all levels of sophistication. The health care systemwill look very diflerent from the one we know today. What the health care system will be by the turn of the century is anybody’s guess. What we do know is that there will be major changes. Those pushing for these changes include big corporations, organized labor, consumer groups and the government, to namea few. Add to this the aging population, a looming physician surplus, the continued nursing shortage, increasing technological advances,and the trend toward large national proprietary companies with more and more care being moved to outpatient settings. These changes in the health care system will mean that our ways of reaching and communicating to patients and their families will changedrastically. We have already seen some changes. For instance, many breast cancer patients now go home from the hospital in 2 to 3 days insteadof the former week. That meanswe can no longer do our teaching in the hospitals. Breast care patients go home with their drains still in. That means they must, once they are home, be able to do things we

FUTURE TRENDS

IN PATIENT

EDUCATION

145

once did for them in the hospital, such as measuring their own amountsof drainageand taking care of their own incisions. Our communication problems will continue to be expanded and compounded. We will need to make more adjustments as the health care systemcontinues to take on different forms. A critical aspectimportant to shaping this health system will be the analysis of nursing care needs to produce specific outcomes. This analysis restson accurate,completeand valid documentation of nursing care, including patient edu-

cation and information. As computerized information systemsfor nursing care are implemented, this documentationwill becomemore accessibleto all. These trends will require us to make broad changesin the way we offer patient education and information in the next 10 years. Attention must be given to the expanding fields of information technology, to computer applications, to the shifting trends in usesof media, and to the growing issues of consumerismif we are to be effective educators of cancer patients and their families.

REFERENCES 1. American Cancer Society: Cancer Facts and Figures1991 (Pub1 No. 5008.91 LE). Atlanta, GA, ACS, 1991 2. Von der Leyen K: Welcome to the ’90s. Vogue 1:165177, 1988 3. Centron MJ: Class of 2ooO: The good news and the bad news. The Futurist 11:9-15, 1988 4. Henderson C: Old glory: America comes of age. The Futurist 3:36-40, 1988 5. Walsh SJ, Begg CB, Carbone PB: Cancer chemotherapy in the elderly. Semin Oncol 16:66-75, 1989 6. Kick E: Patient teaching for elders. Nurs Cl North Am 24:681-686, 1989

7. Silbemer J: First you beat the cancer. U.S. News and World Report 11:97-99, 1989 8. Sullivan LW: Sounding board, Healthy people 2000. N Engl J Med 323:1065-1067, 1990 9. Kumpfer A: Managing now for the 1990s. Fortune 9:4496, 1988 10. Flores A: Hispanic marketing special report. PR Week 9:6-10, 1988 11. American Cancer Society: Cancer and the Poor: A Report to the Nation (Pub1 No. 0216). Atlanta, GA, 1989. 12. Doak CC, Doak LG, Root JH: Teaching patients with low literacy skills. Philadelphia, PA, Lippincott, 1985

Future trends in patient education.

The many changes expected in the future will create challenges and opportunities in the field of patient education. The aging population, increased nu...
273KB Sizes 0 Downloads 0 Views