{'fraction_non_alphanumeric': 0.019242155121373596, 'fraction_numerical': 0.0005920663114268798, 'mean_word_length': 5.09927797833935, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is education enough to improve quality of life in people with chronic inflammatory skin conditions?

It is well established that people living with inflammatory skin conditions experience both reduced quality of life and high levels of distress and these aspects are probably linked. The level of distress is not proportional to the severity of the skin condition and, in the way we can’t guess a patient’s blood pressure or cholesterol level, we cannot guess which patients are more distressed. Whether there is a link between patients’ reduced quality of life and poor understanding of a condition is not known. One fundamental component of patient care is the provision of information, and nurses are trained and well placed to provide patient education about the condition. However, in the busy clinical setting, information-giving trumps real ‘education’ and may not increase patient understanding or improve their quality of life. In this issue of the BJD, Pickett et al. systematically review the role of education in improving quality of life and found evidence lacking in terms of the quality of research available and, therefore, no clear findings to support the assertion. So where should clinicians go from here? One option is to throw the baby out with the bathwater and claim that no clear evidence means we should not be educating patients. Another, more reasonable approach, is to accept that education is more than simply giving information and is an intervention, like any other, that requires well-tested effective components plus skilled people to deliver it. Most education interventions are complex in that they are multifaceted and often contain both information and skill components. This makes replicating educational interventions difficult. Information should be given routinely to all patients; education-based interventions need better-quality trials to determine their efficacy and allow replication. The average reading age of the U.K. population is 9 years, but most patient information sources are not designed for 9year-olds; therefore, important information may not be understood. Pickett and colleagues did not consider the reading age of the studies in their review. Furthermore, health information has weighted meaning and it has the capacity to induce anxiety; when people are worried they do not absorb or recall information well. If the intention is to educate people about their condition for the purposes of informed consent or shared decision-making, then best practice suggests the need to tailor messages to the recipient and check they have understood, not assume they have. Understanding may be a necessary but not sufficient condition for improvement in quality of life. When patients set goals to improve their quality of life, they need more than information/understanding; they also need motivational support and the skills to be able to do this. We have well-established evidence-based approaches for how to help people reach goals; we now need the will to implement them in clinical practice. This systematic review has drawn attention to the need for studies on educational interventions and their impact on quality of life and, of course, any studies likely to impact on quality of life should conform to the same scientific standards in design and evaluation, whether they are pharmacological, educational or behavioural.