Best practices: Approaches to educating and engaging patients on VTE prevention Judy Phillips, DNP, FNP-BC, AOCN Cancer Care of Western North Carolina Lenoir- Rhyne University

Evidence: Patient knowledge is often lacking Additional education for patients and practice teams can lead to growth in patient knowledge. Education programs should be standardized, focusing on patient safety. Patients should be educated more than once, if a satisfactory level of patient knowledge is maintained. Patient education needs must be complete and understandable, especially in the elderly population. Anxiety management, regarding the diagnosis and possible treatment side effects, is necessary to improve patients’ outcomes. Educational materials, and patient involvement are vital to success of anticoagulation.

Who is at high risk? Elderly Inability to read Multiple medications Inability to hear Lower intelligence levels High co-morbidities Inability to see Overly anxious

Learning Disabilities: 10 to 15% of the are overall US population are learning disabled. Evidence supports that adults do not outgrown learning disabilities. These people may have problems with: Memory, Language, Motor functioning, and/or Information processing. Things we CAN do to help: 1.Tape Recorders, 2.Use hand signs when giving verbal directions, 3.Use hands-on experience, 4. Use a computer, 5. Appeal to all senses: auditory, visual, and tactile.

Case Management is necessary: Groups working together. Involvement of systematically monitoring patients, encouragement to continue the treatment and action in the case of non-adherence or no improvement has been successful in chronic conditions for other medications such as: osteoarthritis, heart failure, and depression.

Patient knowledge Indication for oral anticoagulation Awareness of the risk of being treated with anticoagulation Duration of treatment known? Checking frequency known? Target INR range known? Foods which contain Vitamin K in large amounts known? Diet related recommendations known? Safest analgesic available over the counter known? What to do when you have missed a medication? Interactions with medications known? Recognition of emergencies. Do they know when it is important to inform others of oral anticoagulation therapy?

Education Maintain a satisfactory level of patient knowledge. Refreshers periodically are necessary. Practice-based case management and additional patient education can effectively raise knowledge. Written information helps Self-management can lead to increased patient knowledge, empower the patients who are able. Practice based case management with additional patient education can help. Return verbalization of what is being taught, can the patient do this?

Educating patients: Get on their level. Talk in their language. Listen Explain WHY this is necessary. Be Engaged. Are they able to read and write? If not what can they do? Interventions to relieve anxiety surrounding the diagnosis and possible treatment side effects. Patient involvement is absolute. Use shared decision making regarding everything. Which drugs to use. Give them information, then let them be involved in the decisions. Shared decisions are necessary, the patient needs to adapt their lifestyle and conform in order for success of treatment.

Education Tips: Speak in Laymen’s terms Provide an explanation of the known causes and consequences of thrombosis and drugs Teach necessary changes in diet. Relaxation techniques, such as breathing. Use a calm approach. Set memory aids, the potential to develop a memory aid app for mobile phones and tablets. Link to social support networks online and or face to face.

Main themes: Understand the diagnosis: Cause: Why is this necessary. Support/information Distress

The challenges of living with anticoagulation. Adherence Side effects (including anxiety) INR maintenance

Patient recommendations: Social Support Information Delivery Illness specific information Relaxation Techniques Memory Aids

References: Maikranz et al. BMC Family Practice (2017) 18:15 Clarkesmith, D., Lip, G., Lane, D., Patients’ experiences of atrial fibrillation and non-vitamin K antagonist oral anticoagulants, and their educations needs: A qualitative study (2017) Thrombosis Research. Elsevier. Bastable, S. Essentials of Patient Education, 2006, Jones and Bartlett: Boston.