It comes as no surprise to any health professional that one of the most important, time consuming and arguably, most rewarding aspects of our practice is providing ‘advice and education’ to our patients. This may include discussing their concerns, teaching skills and in many cases re-educating unhelpful beliefs and behaviours.
What I found very quickly in my PhD journey into patient education is that we often pride ourselves on our ability teach patients and we often consider these skills to come naturally with experience [1]. Research however paints a vastly different picture. Most educational approaches adopted by health professionals tend to be didactic and clinician-centred and often don’t marry up with patient expectations [2,3]. Research also suggests similar levels of patient education competence between novice and experienced professionals [4]. A major reason for this is health professionals receive minimal training in patient education skills [5] and ongoing professional development activities are rarely delivered in this area [3].
Within the last two decades, healthcare literature has strongly supported a patient-centered approach to how we should provide education [6]. A patient-centered or ‘tailored’ approach has been shown to have positive effects on patient motivation, retention of information and health outcomes [7]. Such an approach has also been recognised by both patients and health professionals as the most important characteristic of an effective educator [7]. But what does patient-centred education mean to the clinician in day to day practice? And how can we assess and measure these skills?
Part of our research in this area was to define the specific skills that physiotherapists should possess to be competent in providing effective patient-centred education [8]. A Delphi study with two rounds using a panel of specialist physiotherapists within Australia was undertaken. These final 21 competencies were then contrasted to evidence based patient education practice in other fields for similarity in competencies. A major theme consistent with our research and other literature in the area was the spread of competencies throughout and across the patient consultation; assessing the patient’s learning needs, tailoring education and evaluating learning.
Assessing the educational needs of the patient
Assessment of the patient’s educational needs, often during the interview, is critical for determining how education should be tailored and structured [9]. Furthermore, clinicians who are unaware of their patients’ educational needs and readiness to learn have the potential to inadvertently contribute to poor patient outcomes [10].
Specific skills we determined in this area for clinicians include:
- Actively seeking out the patient’s main concerns
- Seeking patient perceptions using appropriate questioning
- Exploring patient’s existing knowledge, perceptions or beliefs about their condition or presentation
- Seeking from the patient their expectations relating to their management, including expectations of their own role
Providing tailored education to the patient
Skills identified included:
- Effectively explaining the patient’s condition
- Providing content that is in the best interest of the patient
- Using communication styles, language and materials that are tailored to the patient
- Providing self-management education and reinforcing the patient’s ability to manage
- Consistently and regularly reviewing progress of patient learning
- Recognizing and managing barriers to effective education
Evaluating
Evaluation is considered the last phase of patient-centred education to appraise patient learning and progress the educational process [11], however it receives little attention in health professional training [12]. The teach-back approach was one of the key competencies that had high levels of expert agreement. This approach checks for lapses in recall but can also uncover health beliefs, reinforce and tailor health messages, and generate dialogue between the patient and health professional for the professional to correct misunderstandings [11].
Other explicit evaluation approaches included:
- Effectively summarising information
- Identifying when educational needs have been met
- Seeking return demonstrations
- Communicating with the patient’s family or other health care providers to seek patient progress
- Providing the patient with a hypothetical scenario to assess their problem solving
Our research has provided a common language in the field of physiotherapy training for educators and faculty to have a shared understanding of outcomes for professional practice standards and assessment. The results of this research has implications for informing existing curricula or the potential for targeted training related to patient education. In light of the need for patient-centred education skills of health professionals, it should also be recognised that we must endeavour to provide our future professionals with the means to effectively incorporate these skills into practice.
About Roma Forbes
Dr Roma Forbes is a Musculoskeletal Physiotherapist and Lecturer at The University of Queensland. She completed a PhD in the area of patient education practice which developed training methods for teaching these skills to health professional students. Her research is in the area of teaching and learning; particularly in improving new-graduate readiness for practice. Twitter: @RomaForbesPT
References
[1] Rindflesch, A B. (2009). A grounded-theory investigation of patient education in physical therapy practice. Physiotherapy Theory and Practice, 25(3), 193-202.
[2] Trede, F.V. (2000). Physiotherapists’ approaches to low back pain education. Physiotherapy, 86(8), 427-433.
[3] Bergh, A.L., Persson, E., Karlsson, J. & Friberg, F. (2014). Registered nurses’ perceptions of conditions for patient education–focusing on aspects of competence. Scandinavian Journal of Caring Sciences, 28(3), 523-536.
[4] Wouda, J.C. & van de Wiel, H.B. (2015). Supervisors’ and residents’ patient-education competency in challenging outpatient consultations. Patient Education and Counseling, 98(9), 1084-1091.
[5] Svavarsdottir, M.H., Sigueoardottir, A.K. & Steinsbekk, A. (2015). How to become an expert educator: a qualitative study on the view of health professionals with experience in patient education. Bio Med Central Medical Education, 15(1), 1-9.
[6] Coulter, A. & Ellins, J. (2007). Effectiveness of strategies for informing, educating, and involving patients. BMJ. 335(7609), 24-27.
[7] Hyrkas, K. & Wiggins, M. (2014). A comparison of usual care, a patient‐centred education intervention and motivational interviewing to improve medication adherence and readmissions of adults in an acute‐care setting. Journal of Nursing Management, 22(3), 350-361.
[8] Forbes, R., Mandrusiak, A., Smith, M. & Russell, T. (2017). Identification of competencies for patient education in physical therapy using a Delphi approach. Physiotherapy, 104 (2), 232-238.
[9] Smith, S., Mitchell, C. & Bowler, S. (2007). Patient-centered education: applying learner-centered concepts to asthma education. Journal of Asthma, 44(10), 799-804.
[10] Needleman, J. (2013). Increasing acuity, increasing technology, and the changing demands on nurses. Nursing Economics, 31(4), 200-202.
[11] Friberg, F., Granum, V. & Bergh, A.L. (2012). Nurses’ patient-education work: conditional factors; an integrative review. Journal of Nursing Management, 20(2), 170-186.
[12] Forbes, R., Mandrusiak, A., Smith, M. & Russell, T. Training physiotherapy students to educate patients; a randomised controlled trial. Patient Education and Counseling, 101(2), 295-303