Making the Case for Personalized Patient Education, Communication

April 26, 2023 - Imagine getting a new diagnosis of a chronic illness, and being mostly left with a pile of patient education packets and one-size-fits-all patient-provider communication.

Sure, you might be getting great information about your illness, and maybe even some health advice, but you likely won’t feel confident to act on it or implement a new self-management regimen.

But that’s all too often the situation, according to Caroline E. Ortiz, MSN, MPH, RN, NC-BC, an associate professor at Pacific College of Health and Science, who focuses on patient-provider communication and patient education.

Most healthcare experts would agree that quality patient education is paramount. An educated patient is an activated patient, one who is willing and able to do chronic disease self-management that can keep adverse, acute healthcare events at bay. Comprehensive patient education has been linked to quality outcomes like lower hospital readmissions and patient experience.

But that comprehensive patient education is often out-of-reach. A February 2023 survey showed that 94 percent of patients want better patient education, but a third don’t feel like they get it.

According to Ortiz, that’s because the healthcare industry isn’t built to help providers offer that patient education.

“We don't have a system that offers enough time, sufficient time, and that pressures both the clinician and it pressures the patient to get a lot done in a very short period,” she told PatientEngagementHIT in an interview.

“Second to that is, and I know this from having interviewed multiple healthcare consumers, is the quality of the communication, the quality of the interaction,” Ortiz continued. “If I am the clinician and I hold this information and I hold the knowledge, it is my job to convey that to the patient or the recipient's understanding.”

While it certainly is hard to actually check patient understanding, Ortiz said providers need the tools to still meet unique patient needs and preferences. Offering patient education in multiple languages is a very clear start to meeting variable literacy levels, and most providers are starting to create workarounds for using too much medical jargon that could be confusing to patients.

But meeting patient needs also requires some nuanced information about the patient, like whether the patient is an auditory or visual learner. And notably, it requires the context of the patient’s everyday life. Personalizing healthcare communication and knowing about other social determinants of health the patient faces makes that communication more actionable.

That level of personalization is crucial, particularly during the transition of care, Ortiz added.

“The transition of care is an area where something like a nurse coach could be supremely helpful,” Ortiz suggested. “They are supporting the patient not just on things that they need to know, but also on how they can start actually taking action toward the health goals that now they've been told that they would need to heal optimally or to get the most out of their treatments.”

And to get there, patients need personalization and context. Take a patient newly diagnosed with diabetes. That patient doesn’t only need information about what diabetes is, related health risks, and the healthy behaviors needed to achieve good outcomes. They also need information about how all of that fits into their lives.

“Yes, knowledge is a big part of it. You need to have an idea or know what resources to get an idea of what it is that you need to do,” Ortiz acknowledged. “But then, how do you start?”

That’s usually where healthcare leaves off, Ortiz indicated. Healthcare often provides high-quality health information, and provider offices usually have a slew of patient education materials readily available.

But those tools are rarely personalized, and they don’t take the context of a patient’s everyday life into account. That’s because, as Ortiz mentioned, providers don’t have the time or the resources to improve the quality of their patient education.

So, that leaves patients—overwhelmed and concerned about a new chronic illness diagnosis—to navigate the breadth of new healthcare information presented to them on their own. They must learn what this new diagnosis means and what new lifestyle behaviors they must adopt to live well.

And if the patient doesn’t have proficient health literacy, speak English, or come from a culture that accommodates a lot of that healthy behavior advice, that process can feel a lot like drinking from a fire hose. It can feel nearly impossible to know where to start, Ortiz says, if the patient even starts at all.

And, ultimately, that’s where generic patient education and engagement can lead to health inequities, she added. While there are many systemic injustices at the root of health inequity, the lack of personalized patient engagement and education is also at play.

“And that's unfair because often that can affect certain segments of the population, those that perhaps don't have many resources, those that perhaps don't dominate the language that well, those that perhaps have three jobs and they don't really have time to sit with all of these pamphlets,” Ortiz explained. “It disadvantages large pockets of patients.”

Healthcare providers are likely finding themselves with their hands tied, Ortiz acknowledged. They simply don’t have the time or resources for the ideal, contextualized patient education that could help close inequities. While the transition to value-based care is putting an emphasis on health equity and patient engagement, the amount of value-based payment that’s happening has plateaued in recent years.

So, some providers might find themselves stuck in reimbursement models that prevent them from digging deeply with their patients.

But there are some opportunities for change, Ortiz added. For one thing, diversifying the medical workforce will help bring different cultural contexts into patient engagement. Right now, those who are not racially or ethnically part of the dominant culture might be left out of healthcare; empowering healthcare leaders from traditionally minoritized cultures could help ameliorate that issue.

“How do we create a more humanistic environment for these interactions where both the patient feels like they are listened to and so they listen and the provider feels like they are listening and in a reciprocal way now being listened to?” Ortiz queried.
That is easier by having a more diverse workforce.”

“There is value in having a diverse culturally, linguistically, ethnically diverse healthcare culture, the value that adds in the language in what is appropriate communication or just that feeling of connection,” she concluded.