The instrument has been tested in large samples and its five-factor structure has been supported by - fitness-of-good test and factor analyses. The data were analyzed statistically using the SAS 9. Frequencies, percentages, means, standard deviations and medians were used as descriptive statistics. Background characteristics between intervention and control groups were compared by chi-square test or Fisher's exact probability test. Normality of the sum variables was studied by Shapiro-Wilk test. In case of normal distribution t-test was used for comparisons between the groups, otherwise Wilcoxon signed-rank test were used.
Small sample sizes prohibited any multivariate analyses. P-values less than 0. The informants in the intervention and control groups were not exactly the same individuals for the baseline M1 and follow-up data collections M2, M3 but there were no significant differences between the groups with regard to age, gender, marital status, educational background, cancer diagnosis and cancer treatment Table 1.
For all data combined, the informants were near the pensionable age the mean age was 65 years in the intervention group and The information searching, decision-making and information control preferences of the informants were assessed at the three measurement points. When all data sets M1-M3 were analyzed together Table 2 , there were significant differences between the intervention group and control group in the statements concerning information searching preferences in favor of the intervention group: No other significant differences were found.
When the different data sets were analyzed separately, the informants in the intervention group perceived themselves as knowing better p 0. As to the decision-making and information control preferences, both groups wanted as much as possible to participate in the decision-making concerning their cancer management, wanted to know how effective the cancer management was in their situation, and trusted in their own skills to take care of themselves between the cancer management visits.
The patients in the intervention group perceived themselves as knowing the duration of their illness trajectory better than the patients in the control group p 0. The patients in the intervention group also seemed to perceive slightly fewer symptoms due to their illness than the patients in the control group.
However, this was not a statistically significant difference between groups. Changes in physiological, social, emotional and functional well-being were also explored at three time points. There was only one statistically significant difference between the intervention and control groups at the different measurements Table 4. The emotional well-being of the informants in the intervention group seemed to be higher than in the control group p 0. The other areas of well-being over the preceding seven days did not differ between the groups and only marginally within each group: Physiological well-being seemed to be slightly poorer in both groups at the second measurement, which was probably due to the active cancer management period.
Social and functional well-being were perceived as good in both groups during the whole illness trajectory. The posttraumatic growth of the informants was assessed only once, at the time when the informants were at the outpatient clinic for the final cancer management visit Table 5. In the intervention group, the informants perceived appreciation of life p 0.watch
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The aim of the study was to describe the empowering outcomes of a patient education intervention in the form of a self-report workbook with focus on patients' self-perceived knowledge expectations. If empowerment is considered as a process of reciprocal patient activation and self-efficacy, our intervention had measurable empowering outcomes. This was seen at all measurements M1-M3 p 0. This suggests that our personalized patient activation intervention [ 17 ] may lead to better self-efficacy in terms of cancer patients' knowledge.
With self-efficacy defined as skills and confidence to manage own health and health care [ 15 ] and belief in one's own ability to complete a future task or solve a future problem [ 16 ], the patients in both the intervention group and the control group trusted in their own skills to take care of themselves between cancer management visits, and wanted to look for information about their cancer independently. However, it seems that the informants in the intervention group had higher desire for independent information searching already at the baseline measurement p 0.
Furthermore, the patients in the intervention group also had a greater desire to get as much information as possible about their cancer p 0. These patient activity and self-efficacy differences between the groups may be a result of our intervention, that is, the acknowledgment that one is belonging to a patient education group or the self-report workbook as such. If empowerment is considered as an outcome, such as beliefs that allow for greater control in education process [ 11 , 19 ], there was only one statistically significant difference between the groups in terms of measured illness perception [ 28 ].
The patients' contextual self-understanding and comprehension of the illness differed between the groups: The patients in the control group perceived that they did not know the duration of their illness trajectory to the same extent as the patients in the intervention group did p 0. This difference between the intervention and control groups might be related to the individually tailored, continuous patient education [ 1 ] based on the intervention.
According to Vaartio-Rajalin, et al. This sense of control is prominent in empowerment: In improving the quality of one's life and in making rational decisions about how to manage the illness [ 2 ]. Considering self-determination and informed consent as empowerment outcomes, patients in both the intervention and control group wanted to know how effective the cancer management was in their situation so that they would be empowered to make rational decisions about how to manage their illness [ 2 ].
Both groups also wanted as much as possible to participate in decision-making concerning their cancer management in order to have sufficient control and resources to implement their decisions [ 3 ]. However, the changes in physiological, social, emotional and functional well-being over the past seven days before the measurement might have affected empowerment outcomes, such as self-determination preferences [ 20 ]. The emotional well-being of the informants in the intervention group seemed to be higher than in control group p 0.
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The other areas of well-being did not differ between the groups and only marginally within each group: Physiological well-being seemed to be slightly poorer in both groups at the second measurement, which is probably due to the active cancer management period. Social and functional well-being was perceived as good in both groups during the whole illness trajectory. The difference in emotional well-being between the groups may be a result of our intervention, the willingness to participate in a specific patient education group with personalized patient education, and being an active part thereof.
Emotional well-being can both be a part of the process and an outcome of empowerment defined as the process of recognizing, promoting and enhancing one's abilities to meet own needs, solve own problems and mobilize the necessary resources to feel in control [ 4 ]. The posttraumatic growth of informants in terms of, e. In our data, the informants in the intervention group appreciated life p 0.
This may be taken as an indicator of growth in the sense of self [ 4 , 17 ] due to increased self-confidence, self-efficacy, perceived control and emotional well-being as a result of our patient-centered patient education intervention. On the basis of our study, the patient-centered patient education intervention in the form of a self-report workbook resulted in empowering outcomes among oncologic patients during their illness trajectory.
The informants in the intervention group experienced better self-confidence and self-efficacy in terms of information searching preferences, but there were no differences between the intervention group and the control group as regards decision-making and information control preferences during the illness trajectory. The informants in the intervention group also perceived more contextual self-understanding in relation to the duration of their illness trajectory, and positive emotional well-being as compared with the informants in the control group.
Furthermore, their personal growth in terms of appreciation of life and personal strength at the end of illness trajectory was higher than in the control group. These findings indicate individual empowerment outcomes through the process of acknowledging that one is asked to participate in a patient education group, belonging to that group, and the use of the self-report workbook, i.
This is in accordance with Gibson's [ 4 ] definition of empowerment as the process of recognizing, promoting and enhancing one's abilities to meet own needs, solve own problems and mobilize the necessary resources to feel in control. This study has certain limitations. First, the data sets were collected from one single hospital. However, this university hospital is one of the largest hospitals in Finland and has a reputation of excellence in clinical cancer management, and it is responsible for the care and treatment of thousands of cancer patients annually.
Second, the informants in the intervention group and in the control group were not the exactly the same individuals for the baseline M1 and follow-up data collections M2, M3. Nevertheless, there were no significant differences between the groups regarding age, gender, marital status, educational background, and cancer diagnosis and cancer treatment. Third, the instruments applied in this study may have been too loading, thus resulting in relatively small sample sizes and missing data.
Fourth, we do not know when the informants completed the questionnaires, whether it was directly after receiving them or just before their next visit to the outpatient clinic, and we did not record how the self-report workbook affected the patient education. However, the findings are based on the patients' individual perceptions of their own information searching, decision-making and information control preferences, illness perceptions and functional capacity during the cancer trajectory as well as posttraumatic growth at the end thereof. Background variables in intervention group and in control group.
Information seeking and decision making preferences in the intervention group and in the control group during the critial moments of patient education. Illness perception in the intervention and control group when the measurements M1, M2 and M3 are combined.
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Functional well-being in the intervention and control groups. Empowered Workbook Randy Clark. View More by This Author.
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