title: Investigating the use of Barrows Cards to improve self-management and reduce healthcare costs in adolescents with blood cancer: a pilot study.
abstract: OBJECTIVE
  To test if the Barrows Cards method improves adherence to immunosuppressive therapy self-management following hematopoietic stem-cell transplantation in adolescents affected by blood cancer and reduce costs.
  
  
  BACKGROUND
  Chronically ill adolescents need to be helped to improve self-management, make sure they can confidently and safely manage therapy at home and reduce readmissions and costs. We identified the Barrows Cards method, originally used to test decision-making skills and critical thinking in medical students. In this pilot study, we tested the efficacy of the Barrows Cards Method in improving adhesion to immunosuppressive therapy in a group of adolescents following hematopoietic stem-cell transplantation and analysed its cost-effectiveness.
  
  
  METHODS
  A mixed-method study.
  
  
  METHODS
  The Barrows Cards method is an educational intervention based on the theory of problem-based learning that uses at least 15 cards specially designed to teach participants how to manage a specific problem. We piloted the Barrows cards method in terms of adherence to immunosuppressive therapy and self-management in a group of 17 adolescents affected by blood cancer before being discharged. Participants were enrolled between 2013-2015. Activity Based Costing was used to analyse the cost-effectiveness.
  
  
  RESULTS
  The Barrows Cards method significantly improved adherence to immunosuppressive therapy in blood cancer adolescents and reduced readmissions. We also showed how this method could significantly reduce healthcare costs.
  
  
  CONCLUSIONS
  Further research is required, but the Barrows Cards method could be effectively used by nurses to improve self-management in chronic patients and reduce health costs.
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Bagnasco
authors.affiliation: Blood Cancer Department, G. Gaslini Children's Hospital, Genoa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Calza
authors.affiliation: G. Gaslini Children's Hospital, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Petralia
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aleo
authors.affiliation: Centre of International Studies and Education "G. Gaslini", Genoa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fornoni
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Sasso
mesh_terms: D000293:Adolescent; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003657:Decision Making; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000191:economics / Q000451:nursing*; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D055118:Medication Adherence; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D010865:Pilot Projects; D012648:Self Care / Q000191:economics / Q000592:standards*
chemical_list: D007166:Immunosuppressive Agents
keywords: barrows cards; chronic illness; costs; nursing; patient education; problem-based learning; safety; self-management