Developing and Validating a Tool to Improve Self-Management of Antineoplastic Therapy at Home

Sunday, 30 July 2017

Annamaria Bagnasco, PhD, MSN
Department of Health Sciences (DISSAL),, University of Genoa, Genoa, Italy


To develop and validate an educational tool consisting of a deck of cards for lung cancer patients to educate them to autonomously and safely manage their biological antineoplastic oral therapy at home. This process could increase patients’ self-confidence and adherence to treatment.


We started from the definition of ‘self-management’ coined by Corbin & Strauss (1988): ‘Self-management aims at helping patients to maintain a wellness in their foreground perspective’ (Lorig & Holman 2003, p. 1). Therefore, self-management is based on the perception patients have about problems linked to their conditions. This led us to choose a method based on the theory of problem-based learning, such as the Barrows Cards (Barrows & Tamblyn, 1977), and applied it to patients with the purpose of improving self-management through therapeutic education.

The Barrows Cards were originally used to test decision-making skills and critical thinking in medical students. This method—also known as the ‘Portable Patient Problem Pack’ or simply P4 System—uses a situational card that describes a complex problem and learners can choose from a deck of at least 15 cards each of which describes a possible solution to that problem with the support of a picture.The setting was the Oncology Day Hospital of our Teaching Hospital. The participants were 14 adult lung cancer patients taking antineoplastic oral therapy at home.

The instrument development and validation process included the following steps: 1) A review of the literature to retrieve scientific evidence to support the purpose of our study; 2) Obtaining support and advice from cancer experts; 3) Checking the nursing records of the 14 patients under treatment; 4) Using a short questionnaire, feedback from patients on the clarity of the statement provided on each card and on the appropriateness of the picture that illustrates the statement was obtained.


At the end of this study, all of the 14 patients were very satisfied with the deck of 15 cards, plus a situational card initially developed with the support of our cancer experts. Through the active participation of patients, we ensured that the cards were actually appropriate for the purpose of educating them to safely self-manage their biological antineoplastic oral therapy at home. This qualitative process enabled to validate the cards initially developed by our experts.


Despite the great number benefits provided by new antineoplastic drugs, there are still some important issues linked to the incorrect management of oral antineoplastic therapy when patients are at home. The most common issue was found to be the lack of adherence to therapy, which reduces the effectiveness of therapeutic treatment. Therapeutic patient education performed by nurses based on a validated structured model such as the Barrows Cards, can significantly promote adherence to treatment and in achieving better health outcomes also in vulnerable populations, such as cancer patients.