Conveying Best Evidence to Patients Anne Beschnett, MLIS

Empowering Evidence 2014 Health Literacy “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Source: Ratzan and Parker, 2000 / Healthy People 2010

Empowering Evidence 2014 Health Literacy A patient's ability to obtain, understand and act on health information A provider’s capacity to communicate clearly, educate about health and empower their patients Source: Minnesota Health Literacy Partnership: Health Literacy 101

Empowering Evidence 2014 Health Literacy in the U.S. 1/3 of adult English speaking Americans have only basic or below basic health literacy skills –May have difficulties following directions on prescription bottle, following self-care directions, etc. Only 12% have proficient health literacy skills Health literacy is the greatest predictor of an individual’s health status – more than age, race or socioeconomic status Sources: National Assessment of Adult Literacy (2006). AMA (2007). Health literacy and patient safety: Help patients understand

Empowering Evidence 2014 Who is most at risk? Elderly Ethnic and racial minorities Immigrants with limited education People with low socioeconomic status People with chronic disease Source: Minnesota Health Literacy Partnership: Health Literacy 101

Empowering Evidence 2014 Health Literacy in the U.S. Low health literacy is associated with –Increased hospitalizations –Greater emergency care use –Lower use of preventive services –Reduced ability to demonstrate taking medications appropriately –Reduced ability to interpret labels and health messages –Poorer overall health status and higher mortality among seniors –Higher healthcare costs Source: Berkman et al (2011). Health literacy interventions and outcomes: an updated systematic review. PMID:

Empowering Evidence 2014 Cost of Low Health Literacy in the U.S. A 2007 study from the University of Connecticut estimates the cost of low health literacy in the U.S. ranges from $106 billion to $238 billion annually This represents 7%-17% of all personal health care expenditures Source: Vernon et al. (2007) Low Health Literacy: Implications for National Health Policy

Empowering Evidence 2014 Communicating the Evidence: Informed Medical Decisions Medical Evidence Patient Values Clinician Expertise Informed Medical Decisions Institute of Medicine (2012) Communicating with Patients on Health Care Evidence. goo.gl/v5XqGcgoo.gl/v5XqGc

Empowering Evidence 2014 Communicating the Evidence “Providing patients with clearly presented evidence has been shown to impact choices, resulting in better understanding of treatment options and screening recommendations, higher satisfaction, and choices resulting in lower costs. Simply stated, engaging patients in their own medical decisions leads to better health outcomes.” Institute of Medicine (2012) Communicating with Patients on Health Care Evidence. goo.gl/v5XqGcgoo.gl/v5XqGc

Empowering Evidence 2014 IOM Findings People desire a patient experience that includes deep engagement in shared decision making –8 in 10 people want their provider to listen to them –8 in 10 people want to hear the full truth about their diagnosis –7 in 10 people want to understand the risks of treatments. Institute of Medicine (2012) Communicating with Patients on Health Care Evidence. goo.gl/v5XqGcgoo.gl/v5XqGc

Empowering Evidence 2014 IOM Findings There is a gap between what people want and what they get regarding engagement in health care –8 in 10 people want their health care provider to listen to them, but just 6 in 10 say it actually happens. –Less than half of people say their provider asks about their goals and concerns for their health and health care. –9 in 10 people want their providers to work together as a team, but just 4 in 10 say it actually happens. Institute of Medicine (2012) Communicating with Patients on Health Care Evidence. goo.gl/v5XqGcgoo.gl/v5XqGc

Empowering Evidence 2014 IOM Findings People who are more engaged in health care report a better experience –Patients whose providers listen to them, elicit goals and concerns, and explain all the options, among other things, are 3 to 5 times more satisfied with their providers Institute of Medicine (2012) Communicating with Patients on Health Care Evidence. goo.gl/v5XqGcgoo.gl/v5XqGc

Empowering Evidence 2014 IOM Findings People have clear preferences for evidence communication. –Medical evidence, the clinician’s expertise, and the patient’s goals and concerns are all critical to making medical decisions. –To describe medical evidence, people prefer the phrases “what is proven to work best” and “the most up-to-date medical evidence, including information about the risks and benefits.” Institute of Medicine (2012) Communicating with Patients on Health Care Evidence. goo.gl/v5XqGcgoo.gl/v5XqGc

Empowering Evidence 2014 How Can I Help My Patients Understand? Slow down Use plain, nonmedical language Show or draw pictures Limit the amount of information provided and repeat it Use the “teach-back” technique Create a shame-free environment by encouraging questions Source: AMA (2007). Health literacy and patient safety: Help patients understand

Empowering Evidence 2014 Numeracy As an element of health literacy, numeracy comprises basic math skills needed for health-related activities (timing, dosing, etc). Numeric concepts also include higher level tasks like estimation, probability, and risk assessment. Apter et al. (2008) Numeracy and Communication with Patients: They Are Counting on Us. J Gen Intern Med.

Empowering Evidence 2014 Improve Comprehension of Numerical Information Provide numeric likelihoods of risks and benefits Provide absolute risks, not just relative risks Keep denominators constant for comparisons Use visual aids when possible Reduce the amount of information shown as much as possible Provide both positive and negative frames Make the differences between baseline and treatment risks and benefits clear. Apter et al. (2008) Numeracy and Communication with Patients: They Are Counting on Us. J Gen Intern Med.

Empowering Evidence 2014 Tips for Communicating Numeracy: Visuals FDA (2011) Communicating Risks and Benefits: An Evidence-Based User’s Guide.

Empowering Evidence 2014 Tips for Communicating Numeracy: Visuals FDA (2011) Communicating Risks and Benefits: An Evidence-Based User’s Guide. AHRQ (2010) ACE Inhibitors and ARBs to Protect Your Heart?

Empowering Evidence 2014 What’s Your Experience Discuss at your table: –A patient encounter where patient-provider communication was either exceptionally bad or exceptionally good (and why) –Any tips or tricks you find helpful in patient- provider communication