L’effet de Halo : quand les patients éduqués éduquent à leur tour leurs aidants

Introduction According to the WHO, therapeutic patient education (TPE) addresses the patient and his family, but in the majority of cases, it is the patient who benefits the most from the educational program. However, it is likely that patients in turn transmit knowledge and/or competencies to their caregivers. According to this hypothesis, a “Halo effect” would result from the therapeutic patient education. The objectives of this study were: (1) to highlight, with educated patients and their caregivers, the existence of this Halo effect; (2) to describe the consequences of the halo effect, both on patients and their caregivers; (3) to identify the knowledge/competencies transmited which had the greatest impact for both partners. Method Patients, who participated in 15 TPE programs organized by the Montpellier University Hospital in 2020 as well as their caregivers, were submitted to two separate questionnaires to be completed online via Google form. All analyzes were performed at 5% alpha risk using R software version 4.0.4 (The R Foundation, 1020 Vienna, Austria). The analyzes are descriptive and analytical using parametric tests or their equivalent when their performance conditions were not met. The socio-demographic characteristics and statements concerning the use of TPE of patients were compared with those of their caregivers. Results One hundred fifty-seven patients (62.7% women, mean age: 53) and 59 caregivers (57.6% women, mean age: 54, mostly wifes) answered the questionnaires. 84.9% of patients (p) recognize having transmitted knowledge/competencies to their caregivers (a) and the latter confirm (86.2%), i.e. a p-value of 0.98. These would encourage caregivers to better understand the disease (p = 69.9%; a = 83.1%) with a p < 0.001, and are considered, on both sides, useful in helping the patient to cope with emergencies (p = 68.3%; a = 74.6%), to better manage his illness (p = 61.6%; a = 64.4%) and his diet (p = 78.4%; a = 81.4%) daily, to provide him a better psychological support (p = 56.6%; a = 64.4%). The Halo effect seems to be less effective in terms of stress management, quality of sleep and of interpersonal and social relationships. Patients and caregivers express non-contradictory opinions, although the responses of the latter are consistently of a higher percentage than those of the patients. Finally, patients want their caregivers to participate in the TPE program, but only to a part of it (p = 49.3%; a = 60%). Discussion and conclusion A Halo effect exists. Patients who in turn educate their caregiver can benefit from useful daily help, thanks to a better understanding of the disease by the latter. As a result, the caregiver better participates in the management of the patient’s therapy. The Halo effect, therefore, not only affects the caregiver’s empowerment, but more generally contributes to the spread of health skills which should be taken into account when considering the economy of TPE as well as the future of TPE programs which should involve more the caregivers.