Increasing Effective Communications with Patients

Diane C. Moyer, MS, RN Associate Director

Health System Patient Education

Health Literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Healthy People 2010

Health Literacy

Slightly more than half of the adults in the US had intermediate health literacy, while 36% were at basic or below basic health literacy About 1 in 12 people are proficient to be

able to obtain, process and act on health information.

Results from 2003 National Assessment of Adult Literacy (NAAL)

Cost is great

Personal costs – poor outcomes, poor health,

shame, frustration and embarrassment Cost of low health literacy to the U.S. economy in the

range of $106 billion to $238 billion annually Low Health Literacy: Implications for National Health Policy http://publichealth.gwu.edu/departments/healthpolicy/CHPR/downloads/LowHealthLiteracyReport10_4_07.pdf

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Why does health literacy matter? Patient Engagement Actions people must take to obtain the greatest

benefit from the health care services available to them. (Center for Advancing Health)

Cornerstone for Accountable Care Organizations and Patient-centered Medical Homes - Relies on health literacy (Affordable Care Act)

High risk groups for health literacy issues People over 65 years of age Racial and ethnic minorities Limited English proficiency (LEP) Chronic health conditions Low income and those with < high school education or

GED

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No matter what job you have in life, your success with be determined 5% by your academic credentials, 15% by your professional experiences, and 80% by your communication skills. Stephen Wang

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Factors that Impact Health Literacy

Communication skills Knowledge of health topics Culture Demands of the health systems Demands of the situation and context

From both Provider and Patient Perspectives

Barriers to Communication

Limited and brief visits • Get them in and out quickly • Multiple demands on time for both patients and

providers • Give them a stack of papers as they come in and

when they leave

Lack of trust Raises anxiety level “I’m not going to tell him about that!” “I don’t want to let him know I don’t know what that

means!”

Barriers to Communication

Differences in Patient’s and Provider’s agenda Complexity of identifying symptoms Competing clinical problems

Barriers to Communication

Language Jargon --Medical, nursing, pharmacy,

insurance, cultural, slang……… Spoken, print and non-verbal messages Foreign language speakers Mistaken pronunciation of words

(medicine names, body parts, diseases)

Barriers to Communication

Culture Adversarial, impersonal Scary or “out of My control” Can the patient and provider respect

each others differences?

Cultural Humility

Enables and doesn’t block a “patient’s telling his or her own illness or wellness story…Patient is encouraged to communicate how much or how little culture has to do with that particular clinical encounter” Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Undeserved, 9, 117-125.

Practice Cultural Humility

Cultural Competency

Cultural Humility

Knowledge of other cultures

Endpoint “I am the expert” Can lead to

stereotyping Clinician instituted

interviewing

See and acknowledge own biases-Can truly only know self Lifelong process “You are the expert” Helps to balance power Patient focused

interviewing Enhances partnerships

Cultural Humility

Asking questions Listening and hearing More attainable More respectful Acknowledging we can never be experts on someone else’s life.

J. Nutik Zitter, 2017, Extreme Measures, page 154

Kleinman’s Questions

What do you call your illness or problem? What do you think caused this problem? Why do you think this problem started and when did it start? What do you think this problem does inside your body? How

does it work? How severe is this problem? Will it have a short or long

course? What kind of treatment do you think you should receive? What are the most important results you hope to receive from

this treatment? What are the chief problems this illness has caused? What do you fear most about the illness/problem?

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Why Engagement Matters

Increased satisfaction of Patient/Family Improved outcomes and quality of life Decreased patient anxiety Reduce complications Ensures continuity of care Promotes adherence to treatment plan Energizes and empowers consumers to actively be

involved in planning their care

Create an environment that is shame free

Stress and anxiety limit a person’s ability to listen, learn and remember. Navigating the system is complex. Simplify registration process and paperwork. Offer help to patients who need to fill out forms. All forms should be easy to read and use plain

language. Referrals Easy to follow instructions that are clear and concise. Provide directions and number to call for scheduling

or questions.

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Encourage Patient and Family Participation

If okay with patient, invite family member/support person to stay in room Encourage questions – “What questions do you have

for me?” Provide opportunities for guided practice Involve them in decision making about treatment Help them feel empowered

Be On the Same Level

Sit down if the patient is sitting Towering over the person can be very intimidating Helps remove some of the perceived power May help ease the rushed feeling

Be respectful

Address them by title and last name unless they request you use their first name Focus attention on patient, not on computer or other

tasks Smile and use a warm, friendly tone Let them know what to expect and be sure you invite

them to ask questions Clarify with patient to be sure you understand what

he/she means

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Listen, and Listen Well

Let the patient talk without interruptions Key in on the words the patient uses and the body

language What they are not telling you may be as important as

what they are telling you Improving your listening skills can help your ability to

communicate

Assess Your Patient

What questions do you have for me? Tell me how you have been treating this at home. What is the most important thing for you to get from

this visit?

What does the patient already know, and what does he want or need to know?

Speak Slowly

Many providers tend to rush their words because they may give the same message over and over Use living room language - Simple words and

sentences Limit message to 2 or 3 key points

Show, as well as Tell

Use pictures, posters, models, etc. Demonstrate and return demonstrate Use simple drawings rather than complex anatomical

images

More is not always better

What do they already know and what is their most burning question today? Give the person the option to ask for more

information if they have other questions. Don’t overwhelm the person with your vast collection

of resources.

Check patient’s understanding (aka – Teach back)

Time well spent Don’t ask, “Do you have any questions?” -- Sets the

person up to lie so he/she doesn’t feel stupid Have the person share with you so you know if

he/she got it – teach back Tell me about . . . Show me how you would . . . What would you do if. . .? Who are you going to call if. . .?

Be a Detective and a Guide Helping people ask and answer questions

is a large part of dealing with health literacy. Invite your patients/families to ask

questions Provide resources for patient to learn more Good sources online or in community Phone numbers

Resources to Learn More

AHRQ Health Literacy Universal Precautions Toolkit – Primary Care -http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

The Joint Commission, “What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety - http://www.jointcommission.org/What_Did_the_Doctor_Say/

US Department of Health & Human Services, National Action Plan to Improve Health Literacy - http://www.health.gov/communication/hlactionplan/

Centers for Disease Control and Prevention, Health Literacy - http://www.cdc.gov/healthliteracy/

American Medical Association, Health Literacy - http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program.page

National Institutes of Health, Clear Communication – Health Literacy - http://www.nih.gov/clearcommunication/healthliteracy.htm

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