Patient Comprehension of Trigger Finger Concepts Based on Distribution Format: A Randomized Controlled Trial of Handout Versus Video

Background: Patient comprehension is an essential part of optimizing medical outcomes. It is unknown which format is most effective in delivering this information. In addition to a face-to-face conversation, a paper handout is often given as an educational supplement at the conclusion of a visit. Secondary to advances in technology and the ubiquity of the Internet, medical videos have gained popularity. The purpose of this randomized controlled trial was to determine whether the educational material format (paper handout vs video) resulted in a difference in either comprehension of the condition or satisfaction with the delivery of the information. Methods: Patients aged ≥18 years with a diagnosis of trigger finger were prospectively enrolled and randomized to receive either a paper handout or video link with information regarding the pathophysiology, diagnosis, and treatment of trigger finger. Survey assessments were then distributed, consisting of 7 questions related to trigger finger and 1 question related to patient satisfaction. Continuous data were compared using 2-sample t tests, and categorical data were compared with χ2 tests. Alpha was 0.05. Results: Seventy-one patients were enrolled, and 60 completed their survey (response rate: 85%). The video group had significantly higher comprehension scores (82% vs 71%, P = .04) and significantly higher satisfaction scores (9.4 vs 8.6, P = .02). Conclusions: Those who received their educational material in a video format had greater comprehension of their condition and higher satisfaction compared with those receiving a paper handout. Medical providers should consider using video formats to provide supplemental educational materials to their patients.

Patient understanding and experience of non-invasive imaging diagnostic techniques and the liver patient pathway

Background Clinical and patient-reported outcomes are positively affected when efforts to increase patient understanding of underlying diseases and foster patient participation are part of care pathways. The prevalence of liver diseases is increasing globally, and successful communication of results from liver diagnostic tests will be important for physicians to ensure patient engagement and encourage adherence to lifestyle changes and therapy. Here, we aimed to explore the impact of non-invasive liver tests on patient experience and patient comprehension of liver disease in chronic liver disease diagnostic pathways typically managed with liver biopsies. Results 101 participants diagnosed with a range of liver disease aetiologies (90 patients, 11 caregivers) underwent a multiparametric magnetic resonance imaging (MRI) test. A subset of 33 participants was subjected to transient elastography (TE) with FibroScan® in addition to multiparametric MRI. MRI results were analysed using LiverMultiScan™. Participants received results on their liver-health status followed by a semi-structured interview to assess the scan procedure experience, comprehension of the results, and experiences of liver disease. A subset of participants (N = 5) was also engaged in the design, execution, and thematic analysis of the interview transcripts of the study. Analysis of semi-structured interviews revealed: (1) Presentation and discussion of the LiverMultiScan visual report by a physician was an effective contributor to better patient experience and increased comprehension of liver disease. (2) Patients demonstrated preference for non-invasive tests over biopsy for management of liver disease. (3) Patients reported positive experiences with the MRI test during the path for liver disease management. Conclusions Patients presented with visual reports of liver test results developed increased understanding of liver disease care which may have contributed to an overall more positive experience. Patients reported that clinical information obtained through non-invasive methods and transmitted through visual reports contributed to clarity, understanding and overall increased satisfaction. We conclude that a shift toward non-invasive testing and visual reporting of clinical information (e.g. picture of liver with visual scale) when possible are likely to contribute to improved physician engagement with patients and lead to better outcomes in the management of chronic liver diseases. Plain English summary Evidence suggests that patient experience and understanding can affect several aspects of clinical care and patient well-being. In this study, 101 patients and patient caregivers affected by liver diseases were recruited to determine how patient experiences of liver disease were affected with the introduction of non-invasive evaluation of the liver with an MRI or ultrasound-based elastography. All 101 participants received an MRI followed by a LiverMultiScan report. 33 participants received an additional FibroScan and report. Following the reports, participants were interviewed and asked to reflect on factors which affected their experience of the procedure and the understanding of their results. We focused on factors related to the layout of the standardised report and the delivery of its results. The interviews were transcribed and analysed for common themes and patterns. Patients and patient advocacy groups were involved in the design and conduct of the study, and analysis of the interview transcripts. Here, we report the perception of patients and patient caregivers on the quality of care and diagnostic experience. Trial registration ClinicalTrials.gov identifier—NCT02877602.

Readability of the American, Canadian, and British Otolaryngology–Head and Neck Surgery Societies’ Patient Materials

Objective Patient education materials across 3 national English otolaryngology–head and neck surgery (OHNS) societies: the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), the Canadian Society of Otolaryngology–Head and Neck Surgery (CSOHNS), and Ear, Nose, and Throat United Kingdom (ENT UK) were examined to determine whether they are written at a level suitable for patient comprehension. Study Design Cross-sectional study. Setting Online patient materials presented through OHNS national societies. Methods Readability was calculated using the Flesch-Kincaid Grade Level, Flesch-Kincaid Reading Ease Score, and Simple Measure of Gobbledygook Index. All public patient education materials available through the CSOHNS, AAO-HNS, and ENT UK websites were assessed. Patient education materials were grouped into categories by subspecialty. Results In total, 128 patient materials from the 3 societies were included in the study. All 3 societies required a minimum grade 9 reading comprehension level to understand their online materials. According to Flesch-Kincaid Grade Level, the CSOHNS required a significantly higher reading grade level to comprehend the materials presented when compared to AAO-HNS (11.3 vs 9.9; 95% CI, 0.5-2.4; P < .01) and ENT UK (11.3 vs 9.4; 95% CI, 0.9-2.9; P < .01). Patient education materials related to rhinology were the least readable among all 3 societies. Conclusion This study suggests that the reading level of the current patient materials presented through 3 national OHNS societies are written at a level that exceeds current recommendations. Promisingly, it highlights an improvement for the readability of patient materials presented through the AAO-HNS.

Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample

ObjectivesTo develop a programme theory for the intervention of patients receiving discharge letters.DesignWe used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed programme theory. General practitioner (GP), patient and hospital clinician views of a single discharge event in which they were all involved were collected using semi-structured interviews and surveys. These were then triangulated to match the corresponding discharge letter. Data were qualitatively synthesised and compared in meta-matrices before interrogation with realist logic of analysis to develop the programme theory that maps out how patients receiving discharge letters works in specific contexts.Setting14 GP practices and four hospital trusts in West Midlands, UK.Participants10 complete matched cases (GP, patient and hospital practitioner), and a further 26 cases in which a letter was matched with two out of the three participants.ResultsWe identified seven context mechanism outcome configurations not found through literature searching. These related to the broad concepts of: patient preference for receiving letters, patient comprehension of letters, patient-directed letters, patient harm and clinician views on patients receiving letters. ‘Patient choice’ was important to the success (or not) of the intervention. Other important contexts for positive effects included: letters written in plain English, lay explanations for jargon, verbal information also provided, no new information in letter and patient choice acknowledged. Three key findings were: patient understanding is perhaps greater than clinicians perceive, clinician attitudes are a barrier to patients receiving letters and that, negative outcomes more commonly manifested when patients had not received letters, rather than when they had.ConclusionsWe suggest how patients receiving discharge letters could be improved to enhance patient outcomes. Our programme theory has potential for use in different healthcare contexts and as a framework for policy development relating to patient discharge.

Dissemination of validated health literacy videos: A tailored approach.

e18505 Background: Previously, we showed that chemotherapy and precision medicine terminology are remarkably difficult for patients to understand. Therefore, we developed short, animated videos explaining key terminology and demonstrated that they significantly improved understanding. These videos, though effective and published, including freely downloadable, will only be helpful if appropriately disseminated. In the past, even after a video-based educational tool for prostate cancer was proven effective for improving patient comprehension, no dissemination plan was implemented due to copyright issues. Therefore, in order to propel these validated health literacy videos from the academic community into clinic workflow, we aimed to determine the best dissemination method at two different hospitals with disparate populations just six miles apart: an underserved, inner-city hospital and a higher SES hospital. Methods: The dissemination interview was developed in collaboration with an expert Intervention Development, Dissemination, and Implementation team. The draft was cognitively tested with physicians and staff who were not oncologists and finalized. With consent, interviews were conducted with both Winship Cancer Institute and Grady Memorial Hospital providers (GMH). All interviews were audio recorded, transcribed and analyzed using a semantic content analysis method. Results: Eleven providers at GMH and 22 providers at Winship were interviewed, reaching saturation of themes. 72% (n = 8) of the GMH providers felt that the best place for patients to view the videos was in the clinic, compared to 27% (n = 6) of the Winship providers. 68% (n = 15) of the Winship providers stated an app would be the most useful format, compared to 27% (n = 3) at GMH. All agreed that it would be useful for the patient’s family or caregiver to view the videos (GMH = 100%, Winship = 72%), that translation of the videos to Spanish would be beneficial (GMH = 90%, Winship = 63%), and that a nurse would be best to introduce the videos (GMH = 81%, Winship = 68%). Conclusions: Educational materials explaining complicated oncology treatment terminology enhance patient-centered care, yet without proper dissemination these crucial educational tools may never reach the intended patient population. The hospitals examined in this study served significantly different patient populations and the dissemination recommendations were quite different. Providers believed that the underserved patients needed the videos accessible in the clinic whereas providers serving higher SES patients thought that a web-based app, requiring a smart device or internet access, was more appropriate. Our study shows that it is crucial to ensure that educational materials are accessible to all populations, not just those with more means. Without a location-specific dissemination plan, educational tools may only further exacerbate disparities, rather than alleviate them.

Implementation of Educational Videos in Mohs Micrographic Surgery for Improved Patient Satisfaction and Comprehension

Background: Patients are reported to understand less than half of the information communicated to them by physicians. In an effort to better promote patient education, instructional videos have been implemented in surgical specialties, with demonstrable improvement in patient satisfaction and knowledge. In Mohs micrographic surgery (MMS), Mohs surgeons have begun to implement educational videos to supplement the traditional informed consent discussion and wound care demonstration. Objective: To review published literature to determine if video education in MMS can improve patient satisfaction and comprehension of their procedure. Methods: A review of literature was performed using the PubMed database from 2000 to 2020. The articles selected focused on the implementation of educational videos in Mohs surgery for the improvement of the informed consent process, post-surgical wound care instructions, and overall patient satisfaction and comprehension. Results: A total of seven articles met the criteria for review. The videos were noted to improve certain aspects of the informed consent discussion, including patients knowledge on the procedural risks. In regard to wound care education, some patients preferred video education to surgeon instruction. While patient comprehension was similar between the intervention and control groups, most studies demonstrated overall patient satisfaction. In addition, the results noted that most patients who watched a video would recommend it to a peer undergoing MMS. Conclusion: Educational videos have demonstrated promise for patient education in MMS and patients are receptive to learn from them.

Design and preliminary evaluation of a newly designed patient-friendly discharge letter – a randomized, controlled participant-blind trial

Background Low health literacy has been associated with poor health outcome and impaired use of healthcare services. The hospital discharge letter represents a key source of medical information for patients and can be used to address the problem of low health literacy. The aim of this project was to develop and evaluate a new, patient-directed, version of the discharge letter. Methods Based upon two conventional discharge letters (CDL; one surgical and one medical letter), two new, patient-friendly discharge letters (PFDL) were designed following 5 key principles: short sentences, few abbreviations, large font size, avoidance of technical terms and no more than 4 pages length. Medical undergraduates were randomized into two blinded groups (CDL, PFDL) and asked to assess the assigned letter for the 3 domains structure, content and patient-friendliness. Subsections were rated on a 6-point Likert scale (1 = completely agree, 6 = completely disagree), the results of the survey were compared using the Mann-Whitney-U-Test with a p < 0.05 being the level of significance. Results In total, 74 undergraduates participated in this study. PFDL (35 participants) were rated significantly better than CDL (39 participants) regarding structure (median 1 vs. 2, p = 0.005), content (1 vs. 3, p < 0.001) and patient-friendliness (2 vs. 6, p < 0.001). Of all 17 subsections, PFDL were rated significantly better in 12 cases, and never worse than CDL. Conclusions PFDL were rated significantly better than their CDL counterparts. Medical undergraduates were considered the ideal cohort, not being medical lays and yet unbiased regarding everyday clinical practice procedures. Further tests evaluating the impact of the PFDL on patient comprehension and health literacy are necessary.

Patients with complex proximal tibial fractures overestimate the prognosis of their injury

Purpose To investigate, if patients with complex proximal tibial fracture have realistic expectations on open reduction and internal fixation. Methods 114 patients (mean 49 years, SD ± 13) with closed AO-type B and C proximal tibial fracture were grouped (group B, respectively C). Prior to surgery expectations concerning knee function, pain, return to work/sports, and the risk for osteoarthritis was assessed with the Hospital for Special Surgery-Knee Surgery Expectations Survey (HFSS-KSE) and a non-validated ten-item survey. Results 92% of patients expected at least an almost natural knee postoperatively. All items regarding restoring knee function were ranked to be at least important in both groups. 65% in group B and 47% in group C expected at most occasional pain. 83% in group B and 67% in group C expected full return to work without any limitations. Patients with low physical work intensity expected significantly shorter incapacity to work in both groups (7.8, respectively 8.9 weeks). 71% in group B and 60% in group C expected to return to sports with at most small limitations. 33% in group B and 22% in group C assumed risk for osteoarthritis will be prevented by surgery. Conclusion Expectations on surgery for complex proximal tibial fracture are high regardless of fracture type. The prognosis of many health and lifestyle domains was overestimated. The risk for osteoarthritis was underestimated. This study should sensitize surgeons to discuss realistic expectations. This may help to improve patient comprehension what leads to sensible expectations, resulting in improved patients´ satisfaction. Level of evidence IV. Trial registration number 14104, Date of registration: 06/2015.