The healthcare environment can oftentimes be a complex, challenging setting for patients. Medications have complicated names that can be easily forgotten, treatments and other aspects of care are sometimes explained using language outside a typical person’s vocabulary, and instructions for what is required of a patient after discharge may be rushed or not fully explained. As a result, patients may leave the hospital without a clear understanding of the care they just received or what they have been instructed to do—a factor which plays a large role in causing preventable errors and readmissions.
While many providers frequently ask patients whether they understand the instructions being given, patients do not always feel comfortable admitting their lack of comprehension. Patients will commonly tell providers that they understand instructions or hide confusion by using a number of coping strategies. In order to overcome this hesitance and ensure that care instructions are being both clearly conveyed by the provider and accurately understood by the patient, many providers across all care settings employ the teach-back style of communication.
Teach-back communication centers around the idea of engaging patients in a two-way discussion of the directions given to them by care providers. Because patients will commonly default to saying “yes” when asked if they understand the care directions they are given, this one-way style of communication is not very effective in gauging comprehension. Rather than asking a “yes” or “no” question, providers using the teach-back style instead ask patients to explain or demonstrate the instructions they have just been given. In this way, providers can more precisely assess whether or not patients are comprehending what they are being told based on the accuracy of the patient’s explanation.
When using the teach-back method, there are a number of important tactics that can help support success. For example, breaking apart instructions into smaller segments that are reviewed over the course of the visit can be much easier for patients to remember and understand than one large block of information presented at the end of the appointment. Using plain language and varying the explanatory approach after discovering mistakes can also be helpful in ensuring that the information is conveyed to the patient in a way that they understand. Furthermore, asking patients to physically demonstrate the procedure of using a device or counting out the correct amount of medication can be of great assistance in reinforcing the verbal explanation.
Effectively incorporating the teach-back method can take a level of practice before it becomes a natural part of providers’ routines when speaking with patients. Because of this, many healthcare professionals recommend that providers begin integrating the technique slowly. For example, a nurse may try it out with the last patient being seen in the day or during an appointment that does not have an immediate commitment following it. Doing so will give providers more time for practice and will minimize its impact on other appointments and clinical responsibilities.
The teach-back method has been widely recommended by a number of organizations as a helpful method for improving patient comprehension across care settings. This broad support is backed up by a number of studies demonstrating the method’s efficacy. Studies performed with patients with chronic obstructive pulmonary disease found that demonstrating correct inhaler usage with the teach-back methodology resulted in a significant increase in patients being able to correctly utilize their inhalers. Further studies among patients with chronic diseases including heart failure and diabetes showed improvements in patients’ self-management behaviors after receiving teach-back education.
One randomized, controlled study measuring the method’s impact on patients leaving the emergency department found that while patients reported no change in satisfaction or perceived understanding of discharge instructions, they showed improved comprehension and knowledge of self-care, medications, and post-ED care resources. What these findings demonstrate is that, even though patients may not perceive its benefits, the teach-back method still has a measurable impact on improving their understanding.
With the increasing importance placed upon patient engagement and readmission reductions, particularly among patients with chronic diseases, the need for effective techniques to improve communication and education is growing. One of the key factors driving value and supporting long-term positive health outcomes is communication between providers and patients. With successful communication, providers are better able to understand patients’ needs and concerns, and patients are better able to understand care instructions and what is required of them to stay healthy.
The teach-back method exists as a tool to assist providers in building successful communication with patients. By moving away from the traditional monologue of providers reciting large amounts of information at once, which often leaves the patient confused and overwhelmed, the dialogue can open up into a transparent conversation. By doing so, patients may feel more encouraged to ask questions and raise any concerns they may have, and providers are given an opportunity to more accurately gauge comprehension. For organizations looking to improve patient outcomes at the foundational level of communication, integrating the teach-back method may provide a valuable first step.