Systematic review
The effects of group education on patients and their next of kin
Systematic review
|Updated
The Norwegian Knowledge Centre for the Health Services has summarized available research on the effect of group education to patients and their next of kin.
Key message
Patient education is increasingly being used as part of the treatment course and is one of four of the specialist health care’s statutory responsibilities in Norway. Group education is commonly used by the learning and activity centres.
The Norwegian Knowledge Centre for the Health Services has summarized available research on the effect of group education to patients and their next of kin. We included 15 systematic reviews that compared group education with individual lessons, nothing or placebo, treatment as usual, treatment as usual or waiting list or no treatment, self-help, or other treatment. The reviews included people with type 2 diabetes, schizophrenia, rheumatism, cancer, back and neck pain, smoking cessation, birth preparation and a mixed group of patients with different chronic conditions.
Most comparisons were of low or very low quality and often the documentation necessary was lacking. However, based on the comparisons of high to low quality, group education was found to be:
- Group education generally appears to have a positive effect on psychosocial outcomes such as mental health, coping, relations and knowledge about own illness.
- For people with type 2 diabetes, group education improves long term blood glucose and possibly leads to better skills, knowledge and patient satisfaction compared with usual care, waiting list or no intervention. No effect on quality of life or health behaviour were detected compared with no treatment or placebo
- For people with acute back pain , group education may possibly decrease pain duration work absence compared with no treatment or placebo. No statistical differences were detected compared with physical activity
- For people with schizophrenia, group education may possibly improve mental health and knowledge about own illness compared with usual care
- For people with various cancers, group education probably impacts positively on depression, anxiety, quality of life, skills and relations with partner compared with usual care. No statistical differences were detected compared with no treatment or placebo.
- Group education probably increases the number of people who stop smoking compared with both self help groups and no intervention. No statistical differences were detected compared with nicotine replacement.
Summary
Background
Patient and next of kin education is increasingly being used as part of the treatment course and is one of the specialist health service's four main statutory duties. In Norway, such training can often occur at the individual departments at the hospitals and at the learning and activity centers (LMS). Group-based learning provision is a widespread activity and includes many patients. Although there has been some research on the effect of patient and next of kin education, there was no overview of systematic reviews that have looked at the effects of using the group as a method of patient and next of kin education.
Methods
We searched for systematic reviews in medical databases. The search was done in October and November 2009. Two people independently assessed all of the titles and summaries. Potentially relevant reviews were retrieved in full text and considered for inclusion or exclusion. All systematic reviews encompassing patients and their next of kin who received group education were included. The quality of the included reviews was assessed with checklists. The quality of the documentation for each outcome was assessed using GRADE. We reviewed the effects and quality of the documentation for the following outcomes where data were available: health outcomes (such as blood sugar control, pain), quality of life, knowledge, coping, health behaviors, patient satisfaction and health care utilization / costs.
Results
Of the 1229 hits that the search generated, we included 15 systematic reviews of high quality, which all together had 27 comparisons across eight diagnosis and other target groups including: diabetes, schizophrenia, rheumatism, cancer, back /neck, smoking cessation, birth preparation and a mixed group of patients with chronic conditions. Group education was mainly given in addition to conventional treatment or follow-up.
For people with type 2 diabetes, group education may possibly improve long term blood glucose compared with individual education. Group education compared with usual care, waiting list or no intervention probably improves long term blood glucose, and possibly improves knowledge, skills and patient satisfaction. No statistical differences were detected comparing intensive (short-term) group education with standard group education.
For people with schizophrenia, the results vary. Brief group education probably improves mental health, knowledge about own illness, more appropriate drug use and reduced use of health care services compared to usual care. It is uncertain if group based cognitive-behavioural therapy affects drug use and health services use (relapse and readmission) compared with treatment as usual or waiting lists.
Group based cognitive-behavioural therapy for people with rheumatism possibly do not affect the perception of social support. Group education led by lay people for people with arthritis may possibly improve self-efficacy and communication with health personnel and may possibly decrease depression. It is uncertain if pain, disability/ impared function or use of health services (GP visits) is affected.
Group education for patients with various types of cancer probably provides less depression and anxiety, improves coping, quality of life and relationship with partner, but it is uncertain if it affects survival compared to treatment as usual. Groups based psychological interventions for women with metastatic breast cancer may possibly reduce pain, but it is uncertain if it changes quality of life and survival compared with treatment as usual. Group education for patients with cancer-related fatigue probably reduces fatigue, but it is uncertain if it changes quality of life (vigor) compared with no treatment.
Group education for patients with acute low back pain may possibly decrease the duration of pain and sick leave, but it is uncertain if it affects pain intensity and functional status compared with no treatment / placebo. Additionally, it is uncertain if group education for patients with acute back pain has any effect on duration and intensity of pain compared with other treatment. Group instruction for patients with chronic back pain compared with other treatments (body gymnastics) is possibly less effective with respect to spinal mobility.
Group education probably leads to more people quitting smoking compared with both self-help groups and no intervention. It is uncertain if group education including nicotine replacement compared with nicotine alone, and group education compared to individual education, makes a difference for smoking cessation or not.
Group education led by lay people for a mixed group of people with different types of chronic conditions may possibly improve self-efficacy, reduce disability/ impaired functioning, less health distress and more exercise as well as less pain and possible improved communication with health professionals.
There is considerable uncertainty regarding the estimates and difficult to conclude due to the low quality of documentation in terms of a) group education (normal length) for patients with schizophrenia compared with treatment as usual, b) self-help based, cognitive-behavioral, and support based group education for patients with rheumatism, c) group education (with focus on coping with pain and stress) for patients with neck pain compared with treatment as usual and group education for patients with neck pain compared with no treatment, d) group education compared with no treatment / placebo for patients with chronic back pain, and e) birth preparation group education for pregnant women compared with the treatment as usual.
Discussion
The available knowledge for this report covers a broad spectrum, and the results vary in direction and strength for a number of outcomes such as health, health behavior and quality of life. Such variation may be explained by several factors: the content and quality of teaching, the quality of the studies and the suitability of group-based educational initiatives relative to the target group which may be dependent on variables such as severity of illness and disease duration, and other contextual factors.
The target groups and interventions covered in the included systematic reviews vary considerably. Unfortunately, the available evidence does not provide sufficient information in order to make meaningful comparisons across these dimensions. Only one systematic review provides enough information with good enough quality to be able to conclude on intervention specific differences. The review compares standard length group education with intensive (short length) group education and no probable differences between groups was found.
Group education is not necessarily better (or worse) than other treatments. Two reviews included in this report compared group education to other treatments (back pain and smoking cessation), and found that group education can probably be as good as or less effective compared with certain other treatments.
Conclusion
The included systematic reviews show that group education generally seem to have a positive effect on psychosocial outcomes such as mental health, coping, and relationships, but also on knowledge. Group education also seems beneficial when it comes to patient satisfaction (diabetes type 2) and to reduce sick leave (acute back pain). For other health outcomes, health-related behavior such as drug use and quality of life, the results vary across groups and interventions. Group education is not necessarily better than other treatments. None of the reviews reported effects on costs.
There is a need for more research on the effects of group education on health outcomes, patient satisfaction and health care utilization / costs. Other relevant outcomes may be to examine the effects on relationships between patients and health professionals, as well as effects on the patient's participation in employment or in other meaningful activities. Further research should aim to describe the content, execution and intensity of interventions to facilitate better comparisons and to better inform practice.