Why Patient Education Fails So Often

The number of Canadians living with chronic disease is at an all-time high. Many chronically-ill people manage their conditions at home, where they don’t have direct access to medical expertise. As a result, patient education has never been so important.

Living independently is great. But in many cases, it requires a lot from those who have to keep track of their health statuses and lifestyle changes. For these patients, retaining critical information is key.

If you’re a nurse, physician, or specialist, you almost certainly act as an educator, at least some of the time. On many occasions, you’ve probably also had the realization that the information and advice you’ve dispensed has gone to waste.

It could be the woman with heart disease, who doesn’t adhere to dietary restrictions. It might be the man with COPD, who hasn’t been doing his exercises. No matter how many times a health care practitioner sees patients who don’t comply, it’s always disappointing.

So why do patient education efforts fail so often? And what can educators – from the home care nurse to the discharging doctor – do to ensure they succeed?

No Shortage of Challenges

On average, how long do you spend with patients? The answer, of course, will depend on your role and area of practice. But whether you’re a home care nurse or an oncologist, the answer is probably, “not enough”.

There’s rarely enough time to provide the thorough, in-person education that many chronic patients need. A one-time explanation probably won’t cut it, nor will a leaflet. Education is about understanding. It’s a process.

Even so, the small window of time that a frontline practitioner has with her patient presents an opportunity. Finding the right way to communicate crucial information can have a huge, ongoing influence on the listener’s behaviour.

It goes without saying that environment and context are important considerations. A patient who’s about to be discharged may not absorb verbal instructions due to exhaustion, grogginess, or medication use.

Even family caregivers are apt to forget important care-related tasks for their loved ones – such as administering medication, or applying dressing to a simple wound. None of us have a perfect memory. And when the stakes are high, we often second guess ourselves.

Consider this: approximately 50% of those who are chronically ill don’t take their medication as prescribed. While abuse sometimes occurs, it’s fair to assume that in most of these incidences, patients and their family members simply misremember what they’ve been told.

It’s easy to incorrectly assess a patient’s mental state or comprehension level, especially during a hectic shift.

In many cases, stress and inadequate time also prevent health care professionals from recognizing a patient’s progress or development. This is especially true in home care, where practitioners have little control over a client’s environment. As a result, education plans can quickly become out-of-date.

For doctor’s and specialists, time is also a limiting factor. Patients may only have a few minutes to speak to an expert – if they’re able to make it in to the office at all.

These are just a handful of the obstacles that prevent patients from reaping the full benefits of relevant educational plans.

The True Value of Patient Education

The value of high-quality patient education is undeniable.To state the obvious, it’s important for patients to know what they need to do to in order to prevent negative health outcomes. And increased compliance is one of the clearest (and most significant) benefits of complete patient understanding.

In COPD patients,the right education can make a real difference. Innovative solutions, like the Canadian INSPIRED program, are vastly improving quality of life for many people.

When it comes to certain conditions, ongoing clarification is especially important. COPD is a great example; for those dealing with the disease, the correct courses of action may seem counter intuitive. For example, physical activity is extremely important. Common sense might dictate that a patient suffering from shortness of breath should stop exercising. But that conclusion would almost certainly be wrong.

The benefits of good patient education go far beyond adherence. In general, studies show that engaged patients are, on the whole, healthier than their less informed counterparts.

Improved patient satisfaction is another benefit, and it’s often overlooked. Obviously, better health is frequently linked to a better state of mind. But as any frontline professional knows, there’s more to it than that.

Recall a time that a patient met or surpassed one of his goals. He likely had a clear sense of accomplishment, which led to a more positive attitude moving forward. And we’re all aware of the tangible benefits that can come with the right attitude.

Positive, incremental changes to health and wellbeing are important. But there may be other significant benefits, too. For example, a patient who has absorbed relevant information is far more likely to recognize critical signs and symptoms – including those that could signal emergency.

And of course, well-informed patients are less likely to be rehosptialized for complications. Ultimately, patient education is good for those who are chronically ill, as well as for the health care system.

Educational Content for Better Health Outcomes

Whether it’s anxiety, forgetfulness, or fear of making a mistake, patients often forget what they know about self care the moment they’re away from health care professionals. The same can be said of family caregivers – even those who try their best to listen diligently.

There are many things frontline workers can do to ensure patients are listening actively to instructions. First and foremost, carrying out a realistic assessment – one that takes into consideration all of the factors that might be affecting a patient’s state of mind – is key.

In many cases, a patient may appear receptive and attentive, when actually she’s distracted. Simply asking if she understands what she’s heard will rarely provide accurate information. One method for testing information absorption involves getting the patient to demonstrate her knowledge. Asking her to verbally explain a procedure to a family member is one way to do this.

Many nurses and doctors are aware of these tests, but they’re far too busy to implement them in every case. But consider this: ensuring that a patient understands the actions they have to take will often cut down on phone calls and unnecessary follow-up.

After you leave the hospital room or the patient’s home, the need for clear reminders in the form of educational content begins.

Think about the importance of inhaler technique for people with COPD. The truth is, most patients use their inhalers incorrectly. It goes without saying that a clear, step-by-step illustration can help in these cases. And patients should be able to refer to this illustration at any time.

It’s surprising how heavily people rely on instructional text, diagrams, slide shows, and videos to illustrate points they’ve already heard. For this reason, choosing the right content is key.

Considerations go beyond ensuring materials come from authoritative sources. For a practitioner who’s creating a patient’s education plan, it’s best to combine straightforward instructions for tasks and procedures with more general lifestyle guidelines and advice. Timeline and level of detail should be guided by patient attitudes, learning capacities, and preferences.

Putting it All Together

Once the right plan has been designed and explained, the health care practitioner’s job is far from complete. In order to ensure positive outcomes, it’s important that someone is measuring results, reevaluating plans, and performing any necessary tweaking.

At the heart of all effective patient education plan is an understanding of the patient. Building a relationship based on trust isn’t always possible given the pace at which many practitioners move. But it’s important that learning objectives and related patient progress is relevant and up-to-date. Providing professional care should always involve ensuring patients and their family members are fully informed.

Feature image courtesy of Dr. Farouk

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