Checking For Understanding
You’ve taken the history made the diagnosis and come up with the management. You’re on the home straight.
All that’s left is to make sure your patient is able to follow the treatment plan.
Here is where it can all fall apart.
Explanation and planning is a pivotal part of our clinical conversations.
Done poorly, at best this causes a minor misunderstanding and delay to care, but at worst we risk serious medical errors, healthcare harms and loss of the patient’s trust in their clinicians.
Medication errors and incorrect use are just one of the risks of poor explanation of a treatment plan
We know that up to 80% of health information is forgotten immediately and 50% of recalled information is incorrect.(1) There is often a mismatch between what clinicians think they have discussed and what patients have taken away.
There are many reasons why there may be a gap between the treatment that is recommended and what actually happens.
However there are crucial things we can do to make this a lot less likely to happen, and they are supported by evidence.
Teach-back technique
You may have heard of this method of making sure your patients know the plan, but did you know just how effective it is?
What are the benefits of Teach-back?
Teach-back technique has been found to have the following benefits
Better recall and knowledge
Better chronic disease management
Less medication errors after discharge
Reduced heart failure readmissions and better heart failure self management
Ok, how do you do it?
Teach-back involves asking the patient to explain the management plan in their own words, importantly this is to make sure your explanation has landed for them, rather than test their comprehension skills.
You might start with:-
“I’ve shared quite a bit of information, so I can check that I am explaining things clearly would you be able to tell me what you understand about…(specific plan or issue)?”
or
”Your (relative) is likely to have questions, what will you tell them about (the plan) from today?”
The 5 steps of Teach-back (2)
The 5Ts of Teach-back
Another way to remember the steps is to consider the 5Ts of Teach-back (2).
Triage: choose one topic, keep it simple
Tools: pictures or written information aligning with your patient’s preferred way to receive information
Take responsibility: acknowledge complexity and be clear that you are checking your own explanation, not testing them
Tell me: “Tell me in your own words…” Be clear about what information you want them to focus on
Try again: if necessary, adjusting the message as needed
Important to know
Teach-back may feel repetitive but does not take much longer and has proven results in better patient outcomes.
Always remember the power is unequal in the room, let patients know you are here to support them get the best care and are checking you the clinician have got your messaging right - this is not a test for them
When using interpreters it is important they know you are using teach-back and interpret your words accurately so you can check for understanding and change the message if necessary
Teach-back may not work for everyone - adjust your approach and consider other options if it is not working
Other strategies
These are well known but bear repeating and remembering.
Gather information before giving - always even with just one question, is best to start with what your patient already knows.
Avoid jargon - and if you do need to use a medical term, explain it in simple terms straight away.
Ask permission to discuss the plan and involve carers if this is their preference. They may know of limitations to their understanding and may prefer a carer to be part of the discussion.
Chunk and check - after 1-3 pieces of information, pause, check in with the person for verbal and non-verbal cues that they are following. If they are not stop and check where the issue is.
Check the plan is feasible - consider asking “Is there anything you can see that might get in the way, or might make it hard to do this?” Life events, travel, transport limitations or other issues may necessitate some adjustments to the plan.
Communication strategies that help with checking for understanding
Given that there are many factors affecting health literacy and engagement, its important that we maximise our role in making sure patients receive the right care.
So, next time you need to check your patient is across the treatment plan, try Teach-back and the other strategies suggested here, and give your patients the best chance of the best outcomes.
References
Patients’ memory for medical information Kessels RPC. J R Soc Med 2003;96:219–222
Teach-back [Internet]. Sydney, NSW: South Eastern Sydney Local Health District, Deakin University and University of Melbourne; 2018. Available from: https://teachback.org/
This site has further explanations, resources a learning module and example videos on how to use teach-back
The 5Ts for Teach Back: An Operational Definition for Teach-Back Training. Anderson et al., HLRP: Health Literacy Research and Practice. 2020;4(2):94-103.
