AHRQ’s Health Literacy Universal Precautions Toolkit Guides Practice Changes in Mayo Clinic's Transplant Center

The Mayo Clinic Transplant Center in Rochester, Minnesota, uses AHRQ's Health Literacy Universal Precautions Toolkit to help improve understanding among transplant candidates who are required to undergo an intensive evaluation. Many patients travel from out of town to visit the Transplant Center for evaluation. To minimize disruption to their lives, the Transplant Center schedules multiple appointments within a single visit spanning several consecutive days.

"With patients experiencing a series of medical tests and consultations within a short period of time, we recognize this is a challenging situation that often overwhelms their capacity to process all of the information they receive," notes Kathleen J. Yost, Ph.D., a Mayo Clinic health sciences researcher.

The AHRQ health literacy toolkit offers medical practices a way to assess their services for health literacy considerations, raise awareness among the entire staff, and work on specific areas needing improvement.

"We view the [AHRQ] health literacy toolkit as a practical guide that addresses the challenge of aligning the skills and abilities of transplant patients and caregivers with the strenuous demands and complexity of transplant health care," Dr. Yost says.

Mayo Clinic is implementing the toolkit incrementally, having used "Assess Your Practice" (Tool 2), "The Teach-Back Method" (Tool 5), and "Get Patient Feedback" (Tool 17).

"The teach-back method helps to improve patients' and caregivers' understanding of the medical and procedural information received, both before and following a transplant," explains Rachel F. Carroll, M.A., a Mayo Clinic patient education specialist.

With teach-back, a Mayo Clinic nurse coordinator asks the patient and caregiver to repeat back information as a way to assess whether they understood what was said. It is important to use teach-back with caregivers because patients rely heavily on them to understand information and for help with complex self-management issues, such as medications or special diets.

A patient and caregiver survey conducted following the evaluation period identified the need for more teach-back and audio/visual materials to improve understanding of information presented. It also suggested that patients and caregivers should be encouraged to write down questions while waiting for appointments.

Patient and caregiver survey feedback indicated that nearly 30 percent of patient/caregiver pairs may have inadequate health literacy, which puts patients at risk for poor outcomes. "The Transplant Center is also assessing whether to offer a personalized, 30-minute education session to patients and caregivers who could benefit most from the additional assistance," Dr. Yost notes.

A health literacy self-assessment among program staff—on topics such as spoken and written communication and patient empowerment—indicated the need for enhancing the teach-back method, using clear oral communication techniques, and assessing non-medical barriers.

"Increasing program staff awareness of the importance of health literacy and how it impacts patients is the topic of the next [AHRQ health literacy] toolkit module that we plan to implement," Dr. Yost says.

To learn more about the toolkit, visit AHRQ Health Literacy Universal Precautions Toolkit.