- Patients only remember about 49 percent of the information their doctors give them without prompting, highlighting shortcomings with patient recall that can negatively impact patient activation, shows a study out of Brown University School of Public Health.
Healthcare professionals rely on a key set of patient engagement strategies to create better patient activation in care. Shared decision-making and other techniques help integrate the patient as a member of the care team, creates patient ownership of care, and can yield higher patient satisfaction rates.
But patients cannot meaningfully participate in shared decision-making if they cannot remember the medical information their providers share with them, the researchers said.
“While many factors affect whether decision making is shared and informed, and affect adherence to medication regimens and other medical advice, people who do not properly understand and remember instructions have no chance to be adherent,” the researchers explained. “Nor can patients who do not correctly understand the information provided by their physician legitimately be said to have shared in decision making.”
“While various models of shared decision making have been proposed, they have been found to share the requirement that providers inform the patient about the nature of the decision and available options; elicit patient preferences; and integrate those preferences into a decision making process,” the team continued.
Previous studies have looked at the rate at which patients recall healthcare information following an appointment, but such studies have not taken place in some time, the team explained. Likewise, few studies have tested how different patient engagement strategies impact patient recall.
An analysis of patient recall at three outpatient clinics showed that patients are remembering some health information better than previously observed. Patients can recall 85 percent of information correctly with or without prompting the team found.
However, the fact that patients still cannot remember 15 percent of medical information is problematic, the team noted.
“Despite our finding of a relatively high percentage of accurate recall, the 15 percent of items that are not remembered may be consequential,” the researchers said. “In our sample, they include, for example, instructions to reduce salt intake, to change medication dosages, and to seek medical attention if certain symptoms occur. Better understanding of the prevalence of risk and harm to patients from inaccurate recall is needed.”
Additionally, patients could only remember 49 percent of decisions and recommendations without any prompting. This creates an issue when the patient does not encounter an organic prompt in their daily lives.
Patients only recalled 36 percent of information without a prompt.
Furthermore, some of the provider behaviors associated with better patient recall – patient teach-back, summarizing, and open questioning – were uncommon.
“We also found that recall-promoting behaviors by providers are rare, as are elements of shared decision making,” the researchers said. “We must note, however, that with an average of nearly eight decision items per visit, it would probably not be feasible to have a substantial shared decision process for all of them; nor would patients necessarily expect or want this.”
Care encounters during which providers maintained verbal dominance – spoke more than the patient did – also yielded a lower patient recall rate. This trend was especially pressing for patients with lower educational attainment. Additionally, this trend confirmed that basic patient education techniques involving the patient are essential for creating better patient recall.
Although the researchers confirmed that meaningful patient engagement and education strategies could improve patient recall, they also acknowledged barriers for providers. Calling for better patient engagement is not necessarily the answer to patient recall issues because most providers believe in patient engagement strategies are important.
“The consensus of the symposium participants was that physicians generally want to practice more patient-centered medicine, but that time pressure is a major obstacle,” the researchers said. “Agenda setting, teach back, discussion of multiple options, and open questions encouraging more patient talk are all perceived as taking up scarce time. The conclusion was that simply training physicians to use these techniques is unlikely to produce major change.”
Instead, industry leaders must focus on restructuring healthcare in a way that would allow providers to engage in patient education techniques.
“What is needed is reform and reorganization of the medical enterprise to create more room within the precious time of the physician-patient encounter to adequately process a limited number of therapeutic decisions,” the researchers continued. “Systems for pre-visit planning, putting more medical education and counseling responsibilities on non-physician providers, using technology to facilitate exchange of information and recall, were all among the proposals.”
Ultimately, patients would remember more of their office visits if their providers used more patient-centered care techniques. However, the healthcare industry must create systems that give providers the time to engage in those strategies more effectively.
“Findings suggest that patient recall could be enhanced if providers were to use more of the techniques to encourage patient engagement, such as open questioning, agenda setting, and teach-back; and limit the amount of information to be remembered in a single visit based on an assessment of patients’ ability to recall,” the researchers concluded.