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Developing Patient Teach-Back to Improve Patient Education

Simply delivering patient education is not enough; patient teach-back allows providers to assess patient understanding and cement information in patients' memories.

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As healthcare costs continue to skyrocket, medical professionals know that a well-informed patient is a more engaged, healthier, and less costly patient. Critical to supplementing those efforts is ensuring patients understand a care concept. Patient teach-back has emerged as a key strategy for supporting patient education.

Clinicians are encountering patient populations who largely don’t remember much of what their providers discuss with them during healthcare encounters. A landmark study published in the Journal of the Royal Society of Medicine found that patients usually forget between 40 and 80 percent of the information communicated during an appointment.  And almost half of what patients remember is incorrect.

In times of stress, such as when a negative diagnosis is delivered, this effect may be magnified even further.

Poor understanding of information can put patients on the defensive, reduce satisfaction, and erode trust between patients and their care providers.

The inability to remember healthcare advice is also driving up industry spending. According to the Center for Health Care Strategies (CHCS), low health literacy and insufficient patient education can cost up to $236 billion every year.

To ensure that patients are retaining information that can keep them healthier, providers need to go beyond the basics of discussing concepts and self-management techniques.  Checking for understanding through patient teach-back methods can cement information in the consumer’s mind and raise the chances of adherence to recommended care.

What is patient teach-back, how does it help improve education, and how can providers implement this strategy effectively at the point of care?

What is the patient teach-back strategy?

Patient teach-back is a patient-provider communication strategy during which providers ask patients to repeat information back to them. This allows providers to assess how well they explained healthcare information to the patient.

According to the Agency for Healthcare Research and Quality (AHRQ), healthcare professionals should use the teach-back method to improve patient understanding of and adherence to care instructions.  The strategy may also decrease clinic calls and improve patient satisfaction and outcomes.

“Regardless of a patient's health literacy level, it is important that staff ensure that patients understand the information they have been given,” AHRQ says. “The teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health.”

Nurses are primarily in charge of patient education and therefore use patient teach-back more than other clinicians. However, doctors, social workers, care coordinators, and other healthcare personnel may also use patient teach-back.

Clinicians can use teach-back when communicating one-on-one with patients, and with patients’ family members or caregivers, too.

How do providers carry out patient teach-back?

Patient teach-back is a key part of patient-provider interactions that should be used toward the end of an appointment or after introducing a new healthcare concept.

Generally, patient teach-back can be broken down into a handful of steps, according to AHRQ:

  • Summarize patient information in clear, plain language (say “high blood pressure” instead of “hypertension” or “walk” instead of “ambulate”). Using high-level medical vocabulary will not be helpful for layperson patients.
  • Ask the patient to repeat the information back in their own words.
  • Assess patient understanding. Was their response accurate? Are there areas the patient still doesn’t seem to understand?
  • Ask the patient where you can explain better, and then clarify misunderstood information.

When eliciting a patient’s response, providers should make clear that teach-back is not a test, according to the Institute for Healthcare Improvement (IHI). There is not necessarily a wrong answer, but rather information the provider needs to clarify.

AHRQ recommends providers explain that the responsibility for the patient to understand is on the provider, not the patient.

Providers should also avoid using simple “yes” or “no” questions, IHI and AHRQ both say. Open-ended questions will reveal more information to the provider and allow the provider to assess whether the patient truly understands a healthcare concept. A “yes” or “no” question will allow a patient who may not understand a concept to leave the clinic without receiving a full and satisfactory explanation.

Instead of asking, “do you have any questions?” clinicians can try saying:

  • “I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?”
  • “What will you tell your husband about the changes we made to your medicines today?”
  • “We’ve gone over a lot of information. In your own words, please review with me what we talked about.”

Providers should also consider their body language during this process. Being engaged, perhaps sitting at the same level as the patient instead of standing over them, will make the patient feel comfortable reiterating information. Using a caring and empathetic tone of voice instead of shaming or lecturing the patient is also important to a positive patient interaction.

Where applicable, providers should also engage a family member or caregiver who has joined the patient for the appointment, AHRQ advises. Experts assert that family engagement helps patients adhere to their care plans. Thus, ensuring family members or caregivers understand key healthcare concepts and techniques will help the patient after she has left the clinic or hospital.

Not all patients consent to their family members being present for healthcare appointments. In these instances, providers can encourage patients to share their experience with a loved one at home.

Providers can also employ patient education aids to assist in patient teach-back. Printouts can reinforce education during and after the clinic visit.

Additionally, patient education technology can help streamline the patient teach-back process. Patient education technology includes videos or digital modules that teach patients about certain healthcare issues. Some organizations have started using patient education technology to streamline provider workflows and ensure continuity of education throughout the entire hospital or clinic stay.

After using the patient education technology, providers can circle back with patients to check patient understanding. Using the same open-ended questions, providers can elicit patient feedback on the patient education technology, ensuring patient understanding.

How can organizations introduce teach-back to clinicians?

Patient teach-back is a key patient-provider communication strategy. If an organization implements a patient teach-back program throughout the clinic or hospital, it may be a significant workflow change. After all, providers already struggle to make enough time for patient relationship-building between their clinical and documenting duties.

Implementing patient teach-back as a patient education strategy will require strong provider buy-in. To achieve a high level of engagement from staff, organization leaders will need to communicate with their providers.

AHRQ recommends organizations begin by electing a provider champion for the teach-back strategy campaign. This champion can serve as a liaison between providers and leadership, help educate colleagues, and address other problems clinicians have with the workflow change. These advocates may also be able to negotiate room in provider schedules to allow for the workflow shift where necessary, AHRQ says.

Next, organizations should train all members on the teach-back method as outlined above. This will require leaders to determine how and when teach-back will be implemented. It may be difficult to squeeze the new communication strategy into all patient interactions immediately. Instead, AHRQ suggests a more incremental approach.

For example, providers might try implementing patient teach-back with the last patient of the day until clinicians become comfortable with the strategy. This way, if teach-back causes the appointment to last longer than normal, it will not impact the entire day’s schedule. This should help providers gauge the pacing of their appointments going forward.

Organizations should also inform patients and family caregivers about teach-back and why they use it. AHRQ recommends organizations use handouts and office signage to help patients understand this new communication method. This can help make clear why and how the strategy is implemented and that it is not a test for patients.

Once teach-back has been implemented organization-wide, leaders should evaluate and refine their strategies. Organization leaders can survey providers about the effectiveness of the strategy or areas where they need more support. This will help all providers become more comfortable with the communication method and ensure it is seamlessly integrated into patient communications.

IHI offers similar strategies. Organization leaders must approach new workflow changes with empathy for their provider staff and consistently acknowledge the work that goes into adopting a new patient-provider communication strategy.

IHI recommends leaders:

  • Build motivation by highlighting the proven efficacy of teach-back
  • Show an understanding of already time-strapped clinician working conditions
  • Be sure to confront the problem, not the person when encountering issues
  • Promote skills development
  • Build provider confidence in skills

Organization leaders should acknowledge that workflow changes are often difficult and take time. By demonstrating this understanding to providers and implementing teach-back with patience and empathy, they can more effectively support providers.

How effective is patient teach-back?

Increasingly, providers regard patient teach-back as a standard patient-provider communication strategy. In recent years, more evidence has emerged to support that viewpoint.

A 2015 article published in the Journal of Communication in Healthcare found that teach-back improves patient comprehension of post-discharge care instructions among patients with limited health literacy.

The researchers compared an intervention and control group of patients and found that patients had better comprehension of their post-discharge care instructions after experiencing teach-back. However, teach-back did not have a statistically significant impact on patient satisfaction or whether the patient believed she understood her post-discharge care instructions.

A 2016 literature review of patient teach-back studies found that the method improved patient self-care habits, increased adherence to self-management, and enhanced disease-specific knowledge for patients with a chronic illness.

Although researchers have largely found that patient teach-back can empower patients with more knowledge about their health, the data on teach-back and patient satisfaction is less conclusive.

The above-mentioned studies indicate that teach-back has little statistically significant impact on patient satisfaction or HCAHPS scores.

Other studies, such one presented at the Sigma Theta Tau International Honors Society for Nursing 2018 conference, found that scores for the medication education questions on HCAHPS improved, but scores for few other questions improved.

Nonetheless, organizations advocate for the communication strategy because it can improve patient understanding of a condition and empower patients in self-management. According to research cited by AHRQ, patients prefer the teach-back method to supplement provider communication and better understand their own health.

As the healthcare industry continues to tackle the issue of chronic disease management and patient empowerment, they must ensure patients understand health information. Supplementing patient education efforts with patient teach-back allows providers to determine patient understanding and enhance education in key areas.

This article was originally published on November 9, 2018.

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