Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program.

Abstract

The growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context. This study used qualitative data from the French "ONCORAL" program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions. Analysis highlighted that TPE specifically helps patients' functional health, revealed the medical expectations and social norms that shape the patient's role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE. TPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence. Dedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.