Introduction
Patient education is often viewed as the availability of fact sheets, brochures, or videos that explain specific conditions or treatments. These documents are either printed from the electronic health record, playing on a loop in a waiting room, or housed in a neatly arranged displays throughout the office. While this information is helpful, it cannot be relied upon to address all patient education needs. These materials are most effective when used to guide or support a conversation or as a follow-up to an initial conversation.
However, there are several things to consider about your patient population before developing a patient education strategy.
Considerations
Education Tactics
There is often a fine line between patient education and coaching because specific skills are used in both. In an education setting, however, the focus is on providing information to the patient in a way that makes it easier for them to understand and accept. In a coaching setting, the conversation may start with education and then progress to goal setting and assessing the patient’s desire to change behavior and their confidence in being successful.
Common Skills Include...
Open-ended questioning
Open-ended questioning forces the individual to think about their response rather than provide a reactive “yes”, “no”, or “I don’t know” response. For instance, instead of asking a patient newly diagnosed with a specific condition, “Do you understand what the provider told you about (chronic condition)?” or “Do you have any questions about what the provider told you?”, you could ask “What do you know about (chronic condition)?” or “What questions to you have?”
Tips for Open-ended Questioning:
- Begin questions with “What”, “What do you know about diabetes?” or “How”, “How do you feel about this new diagnosis?”
- Do not begin questions with “Why”; why can be interpreted as judgmental or leading.
- Use prompts like, “Tell me more” and “What else” to encourage the patient to continue.
Active listening
Active listening combines mindfulness and listening to ensure the focus is on the patient, what they are saying, what they are not saying, and their body language. It may sound complicated or difficult and in some ways, it is. In a busy environment, it’s often difficult to truly block out the noise and the activity surrounding you. It takes practice and it takes intention.
Tips for Active Listening:
- Take a few minutes before each patient meeting to focus your attention and clear your thoughts.
- Visualize a way to “brush away” the noise and distractions.
Reflections
Reflections are a way to communicate to the patient that you hear and understand their concerns. A simple reflection will simply paraphrase what they’ve expressed to confirm understanding. A complex reflection connects emotion to what the patient has expressed. Simple reflections are general sufficient in an education discussion.
Tips for Reflecting:
- Practice simple reflections with your family members and team members.
- Be sure to express your reflections as a statement rather than a question.
- Paraphrase rather repeat what they say
Ask-Tell-Ask or Elicit-Provide-Elicit
(Health Sciences Institute Chronic Care Professional (CCP) Health Coaching Certification Manual)
The Ask-Tell-Ask approach to educating patients begins by asking what the patient knows or understands about a topic. This provides the educator with the opportunity to affirm or correct the patient’s knowledge, fill in any gaps and provide additional information.
Steps:
- Ask patient an open-ended question to assess what they understand about their condition or treatment
- Affirm or correct what the patient knows
- Fill in any gaps in knowledge the patient has related to your first question
- Repeat this process to introduce small chunks of information
Teach Back Technique
Teach Back Technique is a way to “close the loop” when teaching a new concept. However, Teach Back is not about checking the patient’s understanding, but the speaker’s clarity in explaining new information, instructions
Steps:
- Speak calmly, display comfortable body language, and make eye contact
- Explain the condition or treatment in small chunks of information
- Use plain language and avoid medical jargon or acronyms
-
Ask the patient to tell you what they understood you to say in their own words.
- “I want to make sure I explained that correctly. Can you tell me how you will take your medication?”
- Make corrections as needed to ensure fully understands the information
Shared Decision-Making:
- Create shared decision making tools, educational material, which discusses the options of different treatments or testing; including the pros and cons, benefits, risks, costs, overview of procedure in terms the patient will understand
- Give patients contemplating treatment or testing the shared decision making tool to review
- Once the patient has had time to review the tool, have a conversation with the patient regarding the tool, asking them if they have additional questions or concerns you can address.
- Empower the patient to make their own choice on their treatment or test
Regardless of the intent of your interaction with the patient, family member, or caregiver, make sure your communication style is effective for any level of health literacy. In addition to the education tactics listed previously:
- Always make appropriate eye contact with the individual you are speaking with and give them a warm, friendly greeting.
- Remember to use plain language and avoid medical terminology.
- Present information in small chunks, focusing on the most important 3 to 5 points at a time.
- Repeat these key points to ensure understanding.
- Speak at a moderate pace and utilize pictures, illustrations, 3-D models, or other visuals, whenever possible.
