This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Understanding and managing your health care plan as a person with bronchiectasis and/or NTM lung disease can be very challenging. In my experience, I have found that those that leave the hospital after a stay can be confused about the instructions they have been given. Often, patients do not recognize that they did not understand the instructions when they received them. As a result, a large amount of health care information is forgotten immediately after leaving a doctor’s appointment or being discharged from the hospital.

Health literacy is the “ability to find, process, and understand basic health information and services needed to make appropriate health care decisions.”¹ When people with lung conditions do not understand the health information they have been given, it can lead to an increased burden of your lung condition, worsening outcomes, and increased health system use and costs.¹

Health literacy is an important goal of patient education. It can be defined as having the skills and understanding to apply information to make valuable decisions about your health and healthcare.

How health care teams give information to those with lung conditions, like bronchiectasis and NTM lung disease, can make a big difference in how much someone understands their diagnosis.It may also help someone who has a lung condition manage it better. “Teach-back” can be a wonderful patient education tool to help patients understand information about their health. It can help those with health conditions become involved in their care and may lead to better quality and safer care.¹

Good communication between health care practitioners (HCPs) and patients is important for safe, quality care. There is a high cost to misunderstanding. The cost of a lack of education and patient misunderstanding of medical information is estimated at $73 billion a year.² This means that many people leave doctors’ offices without fully understanding their diagnosis and the necessary treatments to lessen their symptoms.

Crowded areas in health care facilities, noise, and lack of privacy are often barriers to effective learning. Interruptions, lack of time, and poor HCP teaching skills may contribute to a patient’s difficulty understanding health information.²

A possible solution

“Teach-back” helps HCPs test whether their teaching methods are working by allowing them to find out whether their patients understand. Open-ended questions enable the health care professional to see whether a person understands what she/ he has just been taught. Close-ended questions such as “Do you have any questions?” only frequently produce a yes or no response. Asking “yes” or “no” questions does not help with continued discussion and may make patients feel ashamed to say they do not understand the information.

Unfortunately, many people with lung conditions may be too embarrassed to ask questions (or do not know what to ask). Additionally, some patients may say they understand everything when they do not in hopes that they do not appear uneducated. Self-advocacy is so important throughout the healthcare learning curve.

I recommend that the next time a new treatment or procedure is prescribed for you that you do not leave the doctor’s office or health care facility until you can demonstrate how to perform the specific procedure or treatment prescribed. An example would be how to use a new inhaler. Your HCP can assure you that you are doing a particular treatment correctly. Otherwise, you may not get the full benefit of the treatment. Results showed that the “teach-back” method positively affected patient satisfaction. Patients also improved with perceptions, readmissions, managing their condition, and quality of life.³

In one study, results showed that people with asthma who repeated respiratory inhaler instructions with “teach-back” during discharge education had less misuse of inhalers and lower 30-day readmission rates than those who received only one set of oral and written instructions. This demonstrated that “teach-back” can be used to improve patient self-care and education. ¹

Authors note:

Please keep this “teach-back” tool in mind the next time you are in a hospital or other health care setting. Use helpful materials such as pamphlets and audio-visual media to improve your education. Make sure you fully understand your discharge plan before leaving the hospital or health care setting.

Be assertive, be your own advocate. Understanding and health care literacy for your lung condition is thenumberonegoal for your health care action plan to be most effective. Let your health care plan WIN! Your health is your wealth. Please keep us posted on your use of this tool on the BronchandNTM360social activity feed.

References:

1. Yen, P, FNP-BC, DNP and Leasure, A.R, Ph.D., RN, CCRN, CNS Use and Effectiveness of the Teach-Back Method in Patient Education and Health Outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590951 Accessed August 1, 2022.
2. Denault, D MSN, BSN, RN; Wilcox, S MSN, BS, RN; Breda, K Ph.D., RN; Duhamel, K, DNP, MSHCE, RN; and Eichar, S EdD, APRN Teach-back: An underutilized tool https://www.myamericannurse.com/teach-back-an-underutilized-tool/ Accessed August 1, 2022.
3. Dorrah, T, MD, MPH, PX: Everything We Say and Do. Use the Teach-Back Method to Confirm Patient Understanding. https://www.the-hospitalist.org/hospitalist/article/121632/use-teach-back-method-confirm-patient-understanding Accessed August 1, 2022.