The Effect of Educational Intervention on Adherence to Treatment Recommendations and Quality of Life in Patients With Liver Cirrhosis

TL;DR

Teaching patients with liver cirrhosis improves their treatment adherence and quality of life over six months.

Contribution

Demonstrates that a single educational session improves long-term treatment adherence and quality of life in cirrhosis patients.

Findings

Educational intervention significantly improved treatment adherence for six months.

Quality of life improved significantly in the intervention group compared to the control group.

The intervention reduced hospital readmissions among cirrhosis patients.

Abstract

Introduction

Liver cirrhosis (LC) is a chronic disease with serious complications affecting adversely patients' quality of life (QoL), leading to a significant burden on the healthcare system. Effective management of LC involves both treating the underlying etiology to delay disease progression and addressing long-term complications. Insufficient adherence of patients to treatment recommendations is considered a major factor of ineffective disease management.

Methods

This is a controlled interventional prospective study, involving cirrhotic patients who were followed up at the outpatient hepatology department of a general hospital in Athens from January 2015 to September 2018. The educational intervention consisted of one session supported by a nurse along with a specific information leaflet. Data were collected at patients’ initial evaluation and subsequently at thee and six months. Adherence was estimated by the A-14 scale and QoL by the Chronic Liver Disease Questionnaire (CLDQ). Statistical analysis was performed by the use of the SPSS 22.0 statistical program (IBM Corp., Armonk, NY, USA). The level of statistical significance was set at 0.05.

Results

A total of 125 patients participated in the study of whom 65 (52%) were included in the intervention group and 60 (48%) in the control group. Patients’ mean ± standard deviation age was 66.5±11.8 and 64.2±13.7 years in the intervention and control group, respectively. The educational intervention led to a statistically significant improvement in adherence to treatment recommendations, and this effect was maintained during the 6-month follow-up period (p<0.001). Additionally, the educational intervention improved the overall QoL (p<0.001) and reduced the proportion of patients with at least one readmission as well as the total number of readmissions (p<0.001) during the 6-month follow-up period. Multivariate analysis showed that the effect of the educational intervention on patients’ adherence to treatment recommendations and QoL, was independent of patients’ demographic and clinical characteristics.

Conclusions

Ongoing education is an important nursing intervention for improving both LC patients' adherence to treatment recommendations and their QoL.

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