Patient and physician factors predict patients’ comprehension of health information

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Abstract

While patients frequently do not comprehend health information, little is known about patient and physician factors that influence lack of comprehension. To assess effectiveness of health information exchange, 19 physicians and 145 patients were given post-encounter questionnaires to evaluate the preceding visit. We analyzed differences in beliefs between patients who comprehended health information and patients who did not, and whether physicians’ attitudes and self-assessment of their educational abilities influenced this comprehension. Patients with insufficient comprehension were more likely to have schooling below college and cited language as a barrier. Physicians who believed health information delivery to be important had fewer patients with comprehension difficulties, while physicians who assessed themselves as very effective educators had significantly more patients with lack of comprehension, compared with physicians who did not feel as effective. Patients’ comprehension of health information was associated not only with patient factors but also with physicians’ attitude and self-assessment.

Introduction

A hallmark of the successful doctor–patient relationship is effective communication. In a typical clinical encounter, this communication is a two-way street: the patient needs to describe his symptoms while the doctor must listen. Then the doctor needs to explain effectively a diagnostic, treatment or prevention plan, and the patient must understand and endorse this plan. The first part of this communication is essential for the physician to obtain accurate information and to understand the patient’s predicament and desires; the second part is needed to provide patient education and counseling, and to ensure adherence with the proposed diagnostic tests, lifestyle modifications or medical treatments [1]. Doctors must be able to provide health information to patients and ensure patients’ understanding, even though this information may be complex.

Although medical schools have paid increasing attention to the importance of teaching communication skills to future physicians, there has been little research on how effective this health information exchange is in clinical practice. Physicians usually develop their own individualized approaches in the absence of critical feedback, based on their own personal values, styles, beliefs and biases [2]. If some feedback is provided, it is usually from a senior physician educator, rather than from the patients themselves [3], [4]. While a colleague or physician educator can determine whether the doctor’s style meets certain criteria or is consistent with the observer’s preferred approach, only patients themselves can determine if the given medical information was understood.

This study was performed to assess effectiveness of doctor–patient health information exchange as assessed by patients and physicians following a routine clinical encounter in a general medicine practice. Paired assessments of physicians and patients were obtained by questionnaires distributed immediately after these encounters. We sought to determine the prevalence of self-assessed lack of comprehension among patients to determine whether physicians recognize difficulties with understanding when it is present and to identify factors predictive of insufficient comprehension.

Section snippets

Methods

This study was a descriptive, correlation design that used a questionnaire survey administered to physicians and patients in an urban, academic, primary care outpatient practice at New York Hospital in New York City. The medical office served approximately 60,000 patients staffed by private and academically-based primary care providers, interns and residents. On three consecutive days, 22 physicians, met by the investigator during regular clinic hours, were asked to participate and enrolled in

Results

Twenty-two physicians, including attendings (84%) and housestaff (16%), were asked to participate and all agreed. Out of 302 patients, 61 were ineligible for the study, mostly because of an inability to speak English. Of the 241 eligible patients, 41 patients refused and 47 did not return a completed questionnaire, leaving 153 patients for evaluation. Physicians returned the post-encounter questionnaires in 95% of cases resulting in eight more unmatched pairs. Thus, 145 matched post-encounter

Discussion

It has been shown that appropriate access to health information can influence many aspects of medical care, such as patient satisfaction, adherence, health outcomes, malpractice suits and health care costs [8], [9], [10], [11]. Clearly, these potential benefits will be lost if that information is not understood by patients. This has been confirmed through research that focused on specific conditions. For instance, it has been shown that early management of myocardial infarction improves

Acknowledgements

This research was conducted during a fellowship in General Internal Medicine at Cornell Medical Center, New York Hospital. We are grateful to Dr. Judith Hall for her unsolicited, valuable critique and encouraging words that lead to this final version of this paper.

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