Children with cancer may experience considerable psychological and physiological complications. The aim of patient therapeutic education is to improve quality of life, through developing knowledge and management skills, for both the child and the parents.
To determine the best available evidence related to the use of patient therapeutic education, in which at least one nurse has been involved in the intervention, for children with cancer and their families.
Types of participants
Children diagnosed with cancer aged 0 to 21 years and their families, parents (or guardian) and siblings.
Types of intervention
The review focused on various forms of therapeutic educational intervention that included one or more of the following dimensions: 1.Cognitive 2.Perceptive 3.Infra-cognitive 4.Meta-cognitive and 5.Emotional/affective.
Types of studies
Randomised controlled trials and quasi-randomised controlled trials.
Types of outcomes
Self-efficacy, coping and psychological assessment, health-related quality of life, health care utilisation, symptom management, adverse effects, adherence, biological markers, and family functioning in children diagnosed with cancer and their families.
A systematic search was conducted across 13 databases to identify published and unpublished studies in English and French between the years 1980-2010.
Critical appraisal was undertaken by two independent reviewers using the Joanna Briggs Institute critical appraisal checklist.
Data were extracted using standardised data extraction forms provided by the Joanna Briggs Institute.
Meta-analysis was performed with two studies. Regarding all other studies, pooling of the results was not possible due to the diversity of interventions and outcomes. Hence, the study findings are reported in narrative form.
Six studies were included in the final review, providing a total of 244 patients. Five out of the six studies were randomised controlled trials and one was a pseudo-randomised controlled trial. The effectiveness of therapeutic education using an interactive CD-ROM on health locus of control was not statistically significant (overall effect size = 0.37, [95% CI -0.04-0.78]). The effectiveness of therapeutic education on quality of life, coping style, cancer knowledge and task-specific self-efficacy was not statistically significant. Therapeutic education reduced pain intensity (-0.65, p < .001) and oral mucositis (-1.85, p<.001) in patients, who were instructed on protocolised mouth wash utilisation. One study assessed the effectiveness of two behavioural interventions, matched with two coping styles during invasive procedures. The results showed a significant difference in anticipatory heart rate when not divided by coping style for the information group. One study reporting results of an educational intervention designated to facilitate self-care coping demonstrated no effect on hopefulness, self-esteem, general self-efficacy and treatment toxicity.
No experimental or quasi-experimental studies involving therapeutic education targeted to both the child and one of their parents were found.
Although the review aimed to investigate the effectiveness of patient therapeutic education on both children and parents, no studies with parent-related outcomes could be included.
This review identified six studies that tested therapeutic education on health locus of control, quality of life, coping, cancer knowledge, task-specific self-efficacy, pain, and rate of mucositis. It revealed that therapeutic education has a positive effect on the reduction of pain and mucositis, only. This review also highlighted the paucity of high level evidence research in patient therapeutic education in the nursing field.
Implication for practice
Teaching self-care is crucial for appropriate symptom management of cancer and cancer treatment. It is recommended that the role of nurses delivering patient therapeutic education is clarified to inform nursing practice and education.
Implication for research
Further research is warranted before it is possible to show the effect of patient therapeutic education as a nursing intervention. There is a need to define the core measures to test the effect of patient therapeutic education in children and parents.