Posts Tagged ‘patient literature’

Teach Back as an Effective Patient Education Tool

June 26, 2014

PatientTeachBack

by Edward Leigh, MA

A patient tells you they understand everything you said about their treatment plan.  You feel good about this patient visit and are ready to close the meeting.  The patient stated they understood, but did they really?

Problem with “Do you understand?” question

There are serious issues associated with the question, “Do you understand?”  Just because the patient says, “Yes,” does not mean they truly understand.  How can you be sure they understand? Use the powerful “teach back” method.

Teach back is a powerful communication tool to assess a patient’s understanding. After the professional shares new medical information with the patient, the patient is asked to “teach back” what they just heard, verbally or in the form of a demonstration. This allows the professional to correct misunderstandings and provide additional information, if necessary. (In some cases, the patient’s caregiver may be the person “teaching back” the information.)

Factors to consider

If the teach back strategy is not properly set up it could actually backfire leading to a worse patient experience.

Patients may feel you are questioning their intellectual abilities. I have interviewed thousands of patients regarding their experiences with healthcare professionals.  For example, I asked one patient if she was familiar with teach back. She stated she was not familiar with the strategy. She also asked, “Is that for people with learning disabilities?” Upon further discussion, she said if a healthcare professional asked her to repeat back what she heard, she would feel that they think of her as dumb. This example illustrates that the set up to the discussion is critical.  It is vital that patients know the strategy is useful for everyone.

This strategy is not a like a pop quiz you had in school. Don’t simply tell a patient, “Repeat back what I just said!”  This comment will put them on the spot and cause anxiety.  They will feel like a school kid who was just told to clear their desk for an unannounced pop quiz.

To avoid these potential issues, ask the patient certain types of questions. View sample questions in the next section.

Sample of open-ended questions to assess understanding

There are many ways to assess patient understanding via teach back. The questions below provide a friendly and comfortable manner to assess understanding.

Focus on “I” Language. It is important to remember teach back is a way to test our abilities at explaining. In other words, we are actually testing ourselves, not the patients. Using “I” language takes the stress off the patient.

  • “I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?”
  • “Please show me how you will use the device, so I can be sure I have given you clear instructions.”

Focus on how they would tell other people in their lives.

  • “How would you describe your health condition to a friend?”
  • “When you get home and your spouse asks about your treatment plan – what will say?”

Possible reasons for patients not being able to teach back

If the patient is not able to repeat back their medical situation this may be an indication the professional needs to rework their teaching approaches. There could be several factors reducing the ability of a patient to teach back.

Excessive use of medical jargon. If patients do not understand what professionals are saying, they will not be able to repeat back what was said to them. Use everyday language.  For example, do not say, “NPO after midnight.” Rather, state, “Do not eat or drink anything after midnight.”

Too much information presented too quickly.  The “chunk & check” strategy is a tool to avoid this scenario. Provide a “chunk” of information and then “check” with the patient for understanding.

Patient anxiety.  Regardless of how skilled the professional is at explaining to the patient their medical situation, if the patient is very tense, the material will not be absorbed.  In this case, use empathy. Mention that you understand their feelings of anxiety.  You may want to engage in brief deep breathing exercises with the patient to help them feel calmer so they are better able to take in the information.  The exhale should be longer to achieve maximum relaxation. For example, inhale on a count of four and exhale on a count of six. A few deep breathes goes a long way!

If the patient was not able to repeat back, do not repeat – re-phrase.

Benefits of teach back

Improves outcomes. According to the Joint Commission, research indicates that the teach back technique is effective, not just for improving patients’ understanding, but also for improving outcomes. For example, patients with diabetes whose physicians assess their comprehension and recall with the teach back technique have significantly better diabetes control than patients whose physicians do not use the technique. (Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.)

Can ultimately save time. Professionals often feel they have no time for the teach back method.  It actually does not take very long to assess a patient’s understanding.  Think of how much time it will take if the patient has to call back or visit again.

Enhances patient safety. If a patient does not understand their medical issue, they are at risk. A patient’s medical situation is not nice-to-know information, it is need-to-know information!

Unity Point Health, Des Moines University and other organizations collaborated to develop an excellent Teach Back Toolkit.  Click on the link for more information on this very helpful toolkit.

http://www.teachbacktraining.org/

After giving it – be sure they get it!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in late 2014.  http://www.CommunicatingWithPatients.com or 1-800-677-3256

My Mother’s Recent Hospitalization Experiences: The Good, the Bad and the Ugly!

November 18, 2009

About a month ago, my mother was crossing the street with her friend. Just as she stepped on the sidewalk she started feeling faint and began to feel sick.  An ambulance was immediately contacted and my mother was taken to the ER.  My mother’s friend accompanied her to the hospital — she called us from the hospital and told us to come right over.

My brother and I entered the hospital’s ER to find my Mom awake and alert. An ER nurse told us that my mother’s EKG was abnormal and that she had a condition known as Atrial Fibrillation and would need to take the medication, Coumadin.

A few hours later, my mother was admitted to the hospital.  The physician on the unit determined the underlying medical issue, dehydration.  We thought my mother was drinking enough fluids — obviously not.  My mother was in the hospital for four days.  Upon proper hydration, she was feeling fine and looking forward to returning home.

These are my observations regarding my mother’s recent hospitalization.  I base the observations on my PIE Model of Patient Communication.
P  Psychosocial (providing emotional support)
I  Interviewing (getting information)
E  Educating (giving information)

Psychosocial Dimension

Everyone was very friendly and kind.  I found the healthcare professionals to be very caring and treated my mother quite well.  However, what I did not find was any direct empathic responses.  I was waiting for someone to make a statement such as, “I know this must be difficult for you.”  Every medical center and practice always mention that empathy is an important component of their work.  In reality, empathy is rarely displayed.  This is due to the fact that healthcare professionals are not educated on how to convey empathy.

Interviewing Dimension

The questioning techniques employed were sufficient to gather information from my mother and I.  There was the usual issue of asking too many closed questions in succession and not allowing the patient sufficient time to discuss their medical issues.

The biggest issue was closing the interview with this question, “Do you have any questions?”  That is a closed question.  To encourage patients to ask questions, we should rephrase the question as an open question, “What questions do you have?”

Educational Dimension

Brace yourself and fasten your seat belt!  This was by far the weakest area.  Upon discharge, the unit nurse reviewed the discharge instructions, which were disjointed at best.  There were so many issues, I almost did not know where to begin my evaluation.  These are the problem areas and suggestions for improvement:

Excessive use of medical jargon:  The discharge instructions used the terms presyncope and mixed hyperlipidemia.  I am in the healthcare field and know what the terms mean, but what if I wasn’t in the field and didn’t know what the words meant?  Use patient-friendly language.

Ultimate diagnosis not mentioned. My mother initially fainted, but was ultimately diagnosed with dehydration by the attending physician.  Dehydration was never mentioned in the discharge report. This is a perfect of example of how poor handoffs lead to medical errors. At the time of discharge, I asked about the dehydration and how much fluid my mother should consume.  The nurse said, “About 3-4 glasses a day, I guess.” (Having a solid healthcare background, I researched the topic and developed a daily fluid intake plan for my mother.)
Vague comments. The discharge form states, “Will order Influenza vaccine.” Was it ever administered to my mother?  I called the hospital and was first sent to the Medical Records Department — they had no idea.  The Medical Records Department sent me to the unit, who also had no idea.  The unit nurse did say this, “Your Mom most likely did get the flu shot.  We usually give it to people 50 or over.”  Why didn’t the report state, “Patient was given a flu shot?”

No educational materials / resources.  In spite of the fact my mother was diagnosed with dehydration, no information was provided.  A brochure, website or organization to contact would have been helpful.

Overall, the healthcare professionals who took care of my mother were kind and skilled at their jobs.  There were some issues with the interviewing questions and empathic responding, however the biggest concern was the poor patient education component.  If patients do not comprehend their medical situation, they are at risk.

I signed the form for my mother (I have Power of Attorney).  By signing the form, I indicated I understand the discharge papers.  I actually did understand them — I have been in healthcare over 20 years.  My biggest concern is that most people will sign the form stating they understand, but they really do not.

Hospitals need to do a better job at educating patients.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com / 1-800-677-3256

New “Readability Toolkit” Helps Develop Understandable Patients Forms and Educational Materials

July 9, 2009

PatientFormsClipboard

The Group Health Center for Health Studies recently created an excellent report, the “Readability Toolkit.”  The Toolkit is designed to show research teams how to create consent forms and other participant materials in plain language.  Overall, the Toolkit has excellent information to create patient-friendly forms and educational literature.

The Toolkit contains these sections:

What You Should Know Before Using this Toolkit – Background information on health literacy, plain language, and why both are important in the research context.

The Principles of Plain Language – An explanation of the components of plain language, as well as concrete strategies that support plain language writing.

How to Determine Reading Level – Information and advice about using readability formulas to rate the approximate reading level of your materials.

Quick Reference Guide for Improving Readability – An at-a-glance summary of plain language principles and strategies, plus other formatting, editing, and proofreading tips.

Editing Checklist for Participant Materials – A companion to the Quick Reference Guide that guides users through a systematic process to improve readability, identify unclear concepts, and eliminate proofreading errors.

Resources for Informed Consent Documents – Readability advice and resources specifically for consent forms, including a list of common pitfalls, links to helpful consent templates and guidelines, and a selection of easy-to-read template language for common consent topics, such as randomization and voluntary participation.

Resources for HIPAA Authorization Documents – Links to helpful HIPAA templates and guidelines, along with a brief selection of easy-to-read HIPAA language.

Alternative wording suggestions – A list of plain language alternatives for hundreds of words typically used in medical and research settings and links to online resources that define medical and research jargon.

Examples of improved readability– Before and after “snapshots” of plain language revisions to original text taken from actual participant materials.

Examples of improved formatting – Techniques for improving readability through
formatting changes are illustrated with three before and after examples: an advance letter, a consent form, and a study information sheet. While the focus is on improved formatting, all three examples also illustrate other plain language techniques.

Repository of readability resources and references – A clearinghouse of Web-based resources focused on health literacy, readability, plain language, and informed consent, plus a short bibliography of articles related to literacy and readability in health research.

Download the complimentary Toolkit here:  http://www.centerforhealthstudies.org/capabilities/readability/ghchs_readability_toolkit.pdf

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

What Grade Level are Your Patient Education Materials?

May 29, 2009

PatientReading

The average adult in the United States reads at an eighth-grade level yet most patient education materials are written on a high-school or college reading level. It is unlikely patients will admit the information is “over their heads.”  It therefore important to determine reading levels of patient education materials.

In 1969, G. Harry McLaughlin developed the popular SMOG Readability Formula.  (SMOG stands for “Simple Measure of Gobbledygook.”)  Before computers, people would have to determine by hand (or with a calculator), the actual grade level of the materials.  Thanks to computers, it is now very easy!  Put your information into this website and within seconds you will have important data to determine readability level.  (In addition to SMOG, this website has other formulas to determine readability levels.)

http://www.wordscount.info/

With materials written at the appropriate grade levels, patients are more likely to review the information and follow instructions.  It’s all about patient safety.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256