Conveying Best Evidence to
Patients
Anne Beschnett, MLIS
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
http://healthliteracymn.org/downloads/Health-Literacy-101-presentation.ppt
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). http://nces.ed.gov/naal/health.asp
AMA (2007). Health literacy and patient safety: Help patients understand
Empowering Evidence 2014
Who is most at risk?
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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
http://healthliteracymn.org/downloads/Health-Literacy-101-presentation.ppt
Empowering Evidence 2014
Health Literacy in the U.S.
• Low health literacy is associated with
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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: 23126607
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
http://sphhs.gwu.edu/departments/healthpolicy/CHPR/downloads/LowhealthLiteracyReport10_4_07.pdf
Empowering Evidence 2014
Communicating the Evidence:
Informed Medical Decisions
Medical
Evidence
Clinician
Expertise
Institute of Medicine (2012) Communicating with Patients on
Health Care Evidence. goo.gl/v5XqGc
Empowering Evidence 2014
Patient
Values
Informed
Medical Decisions
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/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/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/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/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/v5XqGc
Empowering Evidence 2014
How Can I Help My Patients
Understand?
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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
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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. http://goo.gl/d4Xphc
Empowering Evidence 2014
Tips for Communicating
Numeracy: Visuals
FDA (2011) Communicating Risks and Benefits: An Evidence-Based User’s Guide. http://goo.gl/d4Xphc
AHRQ (2010) ACE Inhibitors and ARBs to Protect Your Heart? http://goo.gl/hfAuyj
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 patientprovider communication
Empowering Evidence 2014