Teach-back: Interactive Module Slides

Slide 1: Teach-Back

Improving Patient Safety by Engaging Patients and Families in Effective Clinician-Patient Communication

Slide 2: AHRQ

Sponsored by the Agency for Healthcare Research and Quality (AHRQ), this teach-back learning module is designed to inform clinicians about the teach-back method and provide effective strategies to implement teach-back. Teach-back engages patients (and families) and ensures their clear understanding of what they need to know for improved patient safety and outcomes.

Slide 3: Introduction

At its core, teach-back is about communicating with patients. We're going to start by reviewing two conversations between patients and clinicians.

• Examine the scenarios over the next series of screens and consider the difference between Scenario 1 and Scenario 2.
• What did the clinician in the scenarios do to produce those differences?

Slide 4: Scenario 1, Part 1

Clinician: "I am prescribing an antibiotic called amoxicillin for Anna's ear infection. It needs to be given 3 times a day – at breakfast, lunch and dinner. Most children like the taste of this antibiotic, which is important because Anna will need to take this medication for 10 days. Do you have any questions?"

Patient's Mother Speaking: "No."

Slide 5: Scenario 1, Part 2

Clinician: "If Anna develops a rash or does not feel better, please give our office a call. We want to make sure that she gets better soon. Okay?"

Patient's Mother Speaking: "Okay."

Slide 6: Scenario 2, Part 1

Clinician: "I am prescribing an antibiotic called Amoxicillin for Anna's ear infection. It needs to be given 3 times a day – at breakfast, lunch, and dinner. Most children like the taste of this antibiotic, which is important because Anna will need to take this medication for 10 days. I want to make sure I am being clear and to answer any questions you may have. In your own words, can you tell me what you need to do at home for Anna's ear infection?"

Patient's Mother: "You want me to give antibiotics to Anna at every meal for 10 days. But Anna is at school during the day, and they don't like to give medications. Does she have to take it at lunch time?"

Slide 7: Scenario 2, Part 2

Clinician: "I'm glad you told me that. I can adjust the dose so that Anna only takes the antibiotic at breakfast and dinner. Now if Anna develops any red spots on her body, continues to have a fever, or is not acting like herself, please call me. Even if you are not certain if you should call, call me any time! As a final safety check, when is it important for you to call me?"

Patient's Mother: "If Anna is not feeling better, she gets a rash, or I am concerned, I should call you."

Slide 8: Scenario 1 Reflection

Now that you've had the opportunity to explore both scenarios again, consider the differences between Scenario 1 and Scenario 2 and ask yourself:

• What did the clinician in the scenarios do to produce those differences?

Slide 9: Learning Objectives

By the end of this lesson you should be able to:

• Understand and describe the steps of the teach-back process.
• Describe the role and value of teach-back in improving patient safety.
• Identify strategies for implementing the teach-back process.

Slide 10: Pathway Menu

Teach-Back

• Oval 1: What is teach-back?
• Oval 2: Why should I use teach-back?
• Oval 3: When should I use teach-back?
• Oval 4: How is teach-back different?
• Oval 5: What are some teach-back examples?
• Oval 6: How can I make teach-back successful?
• Oval 7: Which patients benefit from teach-back?
• Oval 8: Are there other considerations?
• Oval 9: Are there other important tips?

Slide 11: What Is Teach-Back?

A method of ensuring that patients understand what you’ve told them.

During teach-back, you ask patients to explain in their own words what they need to know or do to take care of their health. You ask them to teach back to you what you have told them.

Slide 12: Why Should I Use Teach-Back?

• Info Point 1: Research shows that clinicians underestimate patients' needs for information, and overestimate their own ability to convey information effectively.^2,3,4,5,7
• Info Point 2: Studies have shown that up to 80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect.^1,8
• Info Point 3: Low health literacy can affect patient adherence and ultimately patient health outcomes.¹⁰
• Info Point 4: There is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well.¹¹

Effective communication in medical care positively correlates with better patient adherence.

Slide 13: When Should I Use Teach-Back?

Use teach-back whenever explaining important concepts to patients about their health care such as:

• New diagnosis.
• Medication.
• Home care instructions.
• Treatment plan.
• Recommended behavior changes.
• Use of a new device.
• Treatment options.
• Next steps.

Slide 14: How Is Teach-Back Different?

If you ask patients whether they have any questions, they will often say they don’t, even if they don’t really understand what you’ve told them. They may be embarrassed or intimidated, or they may think they understand.

Using teach-back helps you more accurately determine your patient’s level of understanding so you can adapt your communication as needed.

Slide 15: What Are Some Examples of Teach-Back?

• Info Point 1: "Just to be safe, I want to make sure we are on the same page. Can you tell me..."
• Info Point 2: "Your inhaler is important for your health. Can you show me how you would use it at home?"
• Info Point 3: "I want to make sure that I explained things clearly. Can you explain to me…"
• Info Point 4: "We have discussed some important information about your medication. As a safety check, can you tell me warning signs to look for with this medication?"

There are many ways to approach teach-back with your patients and their families.

Slide 16: How Can I Make Teach-Back Successful?

• Info Point 1: Use teach-back on ALL patients.
• Info Point 2: Focus on 2 to 4 key points for that visit.
• Info Point 3: Start with the most important message.
• Info Point 4: Use plain language. Most patients do not understand medical jargon. Using plain language may take some practice.
• Info Point 5: If your patient teaches back incorrectly, always assume your teaching was not sufficient. Repeating the same message is not effective. Rephrase your message until your patient has a clear understanding.
• Info Point 6: Use patient materials and underline or circle the most important points during teach-back.
• Info Point 7: Use pictures or draw diagrams to support your teaching.
• Info Point 8: Foster an office culture around teach-back that helps patients and their families feel supported and engaged as important members of their care team.

Slide 17: Which Patients Benefit From Teach-Back?

All patients benefit from teach-back, especially any patient presented with a new diagnosis.

Slide 18: Are There Other Considerations When Using Teach-Back?

With certain patient populations, there are additional considerations when using teach-back.

Older Adults

When using teach-back with older adults, consider the following:

• Mild or moderate hearing impairments often occur with age:
  • Use a lower voice pitch.
  • Speak naturally and distinctly.
  • Minimize background noise.
• Information processing speed declines with age:
  • Limit the amount of new information delivered during each visit.
  • Slow down the rate of delivery.

Children

When using teach-back with children, consider the following:

• The conversation with the child should be age and developmentally appropriate.
• Both the patient and the caregiver should understand the information being shared.
• Visual aids can support communication of new diagnoses and new therapies (such as the use of an inhaler).

Language Diversity

When using teach-back with patients who speak a different first language, consider the following:

• Medical translation services are beneficial if available.
• Both verbal and nonverbal cues can help with communication.
• Visual aids can support communication.

Slide 19: What Are Other Important Tips For Teach-Back?

• Info Point 1: It is important to be approachable, making your patient and his or her family members feel confident when engaging in teach-back.
• Info Point 2: Emphasize to your patient and his or her family that teach-back is a part of a safety check to ensure that you are communicating clearly.
• Info Point 3: Do not appear rushed. It is important for your patient and his or her family to understand your instructions clearly so that they can adhere and be safe.
• Info Point 4: Remove physical barriers between you and the patient (e.g., desk, computer, crossed arms), and position yourself at your patient’s eye level.
• Info Point 5: This is not a patient quiz but an opportunity for you to identify gaps in your teaching.

Your tone and attitude are important.

Slide 20: Scenario 2 Review, Part 1

Clinician: “ I am prescribing an antibiotic called Amoxicillin for Anna's ear infection. It needs to be given 3 times a day – at breakfast, lunch, and dinner. Most children like the taste of this antibiotic, which is important because Anna will need to take this medication for 10 days. I want to make sure I am being clear and to answer any questions you may have. In your own words, can you tell me what you need to do at home for Anna's ear infection?”

• Key Teach-Back Strategy 1: Starts with most important message.
• Key Teach-Back Strategy 2: Gives an additional key point.
• Key Teach-Back Strategy 3: Gives a third key point. Key Teach-Back Strategy 4: Explains that she is trying to make sure her message is clear so the patient doesn’t feel quizzed.
• Key Teach-Back Strategy 5: Engages the family/patient.
• Key Teach-Back Strategy 6: Uses an effective teach-back phrase to ensure the message was clearly understood.

Patient's Mother: "You want me to give antibiotics to Anna at every meal for 10 days. But Anna is at school during the day, and they don't like to give medications. Does she have to take it at lunch time?"

• Key Teach-Back Strategy 7: Shows understanding – teach-back was effective.
• Key Teach-Back Strategy 8: Patient is able to identify a potential barrier to adherence.

Slide 21: Scenario 2 Review, Part 2

Clinician: “I'm glad you told me that. I can adjust the dose so that Anna only takes the antibiotic at breakfast and dinner. Now if Anna develops any red spots on her body, continues to have a fever, or is not acting like herself, please call me. Even if you are not certain if you should call, call me any time! As a final safety check, when is it important for you to call me?”

• Key Teach-Back Strategy 1: The clinician is able to adapt her recommendation to better suit the patient’s needs and constraints.
• Key Teach-Back Strategy 2: Gives a key point.
• Key Teach-Back Strategy 3: Uses an effective teach-back phrase.

Patient's Mother: “If Anna is not feeling better, she gets a rash, or I am concerned, I should call you.”

• Key Teach-Back Strategy 4: Demonstrates understanding.

Slide 22: What Is the Most Important Rationale for Using Teach-Back?

Slide 23: Question: Using Plain Language

Using plain language is a critical component of the teach-back method.

Here are examples of medical jargon and their plain language alternatives.

Slide 24: Question: Expectations of Teach-Back

Through teach-back clinicians can expect which of the following (choose all that apply).

Slide 25: Question: Effective Teach-Back Phrases

Which of these are effective teach-back phrases?

Remember, effective teach-back uses open-ended questions that encourage patients to explain their understanding in their own words.

Slide 26: Congratulations!

You have completed the teach-back training.

"Tell me and I forget, teach me and I may remember, involve me and I learn."
                                                                                              —Benjamin Franklin

Slide 27: References

1. Anderson JL, Dodman S, Kopelman M, et al. Patient information recall in a rheumatology clinic. Rheumatology 1979 18(1):18-22.
2. Britten N, Stevenson FA, Barry CA, et al. Misunderstandings in prescribing decisions in general practice: qualitative study. BMJ 2000 Feb 19;320(7233):484-8.
3. Calkins DR, Davis RB, Reiley P, et al. Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment plan. Arch Intern Med 1997 May 12;157(9):1026-30.
4. Coran JJ, Koropeckyj-Cox T, Arnold CL. Are physicians and patients in agreement? Exploring dyadic concordance. Health Educ Behav 2013 40(5):603-611.
5. Hancock K, Clayton JM, Parker SM, et al. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manag 2007 Aug 31;34(2):190- 200.
6. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 2009 Aug;47(8):826.
7. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff 2013 Feb 1;32(2):207- 14.
8. Keulers BJ, Scheltinga MR, Houterman S, et al. Surgeons underestimate their patients' desire for preoperative information. World J Surg 2008 Jun 1;32(6):964-70.
9. Kessels RP. Patients' memory for medical information. J Roy Soc Med 2003 May 1;96(5):219-22.
10. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J of Gen Intern Med 2006 Aug 1;21(8):888-90.
11. Lagay F. Reducing the effects of low health literacy. Virtual Mentor 2003 Jun 1;5(6).
12. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009 Aug;47(8):826.