The competent patient in a paediatric Stem cell Transplant Unit (SCT) and the ethical value of ensuring therapeutic compliance in adolescents

The Barrows Cards method was originally used to test decision-making skills and critical thinking in medical students and which can be adapted, to assess the skills of competent patients. There is evidence that adolescents... [ view full abstract ]

The Barrows Cards method was originally used to test decision-making skills and critical thinking in medical students and which can be adapted, to assess the skills of competent patients.
There is evidence that adolescents tend to have poor levels of compliance with prescribed treatments, so we used the Barrows Cards to stimulate compliance in adolescents affected by blood cancer and help them to autonomously and safely manage their drug therapy.
The aim of the study is to improve compliance with therapeutic education in adolescents undergone to allogeneic SCT.

The Barrows Cards method starts with a card that proposes an issue followed by pack of at least 15 cards each illustrating a possible decision. The front side of each card describes a particular behaviour, which could be either right or wrong. Instead, on the back of each card it says whether the behaviour chosen is right or wrong, and why. Adolescents are supported by a specifically-trained nurse, who explains them how to use the tool correctly and answers to their questions. Patients and their family members will then evaluate the tool by answering a short questionnaire on their level of satisfaction and on the Therapeutic Self Care Paediatric Scale before and after the intervention.

This tool has been successfully tested on 15 adolescents and all the indications that emerged from the test have been applied in corrective terms and an updated version is currently being tested. In addition, we are validating an English version of the method to facilitate therapeutic education with foreign patients

This tool aroused in adolescents a good level of interest and compliance, consequently contributing to a higher level of self-care educational efficacy. It would be unethical to simply accept that adolescents are an inherently non-compliant population.