L16: Patient Education

Question 1

What are 7 benefits of an educated patient?

Answer 1

1. Is better informed about how to manage their condition
2. Takes a more active role in their care
3. Has reduced anxiety and fear
4. Has increased satisfaction of care
5. Has increased compliance
6. Has improved outcomes (pain, function)
7. Has less healthcare utilization

Question 2

We need to assess the educational needs of the patient DURING the ______.

Answer 2

subjective

Question 3

Existing knowledge and ____ should be explored

Answer 3

beliefs

Question 4

Patient education needs to be relevant and linked to ______ examples and experiences

Answer 4

meaningful

Question 5

Patient must be engaged and respected as _____ for their own management

Answer 5

responsible

Question 6

Adherence and satisfaction is significantly ______ (improved/declined) when we consider their concerns/take them seriously and address them

Answer 6

improved

” Do you have any concerns about what’s happening with your back? “

Question 7

____ is now a part of treatment/

Answer 7

Patient education

Question 8

What are 8 common road blocks to patient education?

Answer 8

1. Not getting the patient’s perspective
2. Alerting or using scare tactics
3. Ignoring or making light of patients concerns
4. Not identifying or making use of ‘teachable moments’
5. Failure to scaffold or build on patient learning
6. Assuming the patient’s current level of knowledge or what they want to know
7. Assuming that learning has occurred without checking
   
   • What have you been told about your pain in the past? Have you read anything that you think is related?
8. The belief that simply providing information impacts adherence or outcomes
   
   • Need to build up confidence and self-efficacy –> not scare tactics

Question 9

What are 2 important strategies for patient education?

Answer 9

1. Assessing educational needs
2. Tailoring education

Question 10

How can we assess the patient’s educational needs during the interview?

Answer 10

• We need to find out what the needs of the learner are so that we can tailor our education
• By assessing patient understanding, concerns and expectations

Question 11

What are 3 questions to ask to explore the patient’s understanding?

Answer 11

1. Can you tell me about what you know or understand about your condition or what might be happening?
2. What have you previously been told?
3. Why do you think it started/not improved/has not gone away?

Question 12

What are 2 questions to ask to explore the patient’s concerns?

Answer 12

1. Is there anything particular or specific that you were concerned about?
2. Do you have any particular concerns that you want to discuss today?

Question 13

What is one question to ask to explore the patient’s expectations?

Answer 13

What are you hoping to find out about today?

Question 14

What are the 6 steps in assessing the educational needs of a patient?

Answer 14

1. Finding out what the patient understands
2. Finding out about their concerns
3. Exploring if the patient can identify issues in their recovery
4. Clarifying with questions
5. Seeing if the patient can identify a solution on their own
6. Indicating a plan for the education

Question 15

What are 8 things that are important when tailoring the education for patients?

Answer 15

1. Addressing the patients concerns
2. Effectively explaining the patients condition in a way they understand and is evidence based, without causing alarm
3. Giving prognostic information
   
   • After manual assessment –>Credible but doesn’t sound scary
4. Providing information that is prioritised as important
5. Outlining the management plan
6. Outlining the role of the patient
7. Providing skills or tools to self-manage
8. Providing only a few key concepts to learn at one time

Question 16

Physiotherapists explaining pain from a purely structural cause in LBP goes against evidence based practice and more likely to give _______ advice. This ‘labelling’ can influence the _____of the patient. The result of this has been called “_____” where ‘treatment’ can actually make the problem worse

Answer 16

fear avoidant; pain experience; iatrogenic disability

Question 17

What are 3 examples of Inappropriate language and conditioning?

Answer 17

1. Focussing on pain and frequently asking about it (focus on function and goals instead)
2. Strongly advising activity around presence or avoidance of pain (avoiding activity is associated with poor coping and poor outcomes)
3. Using inflammatory or threat-appraisal language

Question 18

Patho-anatomical words and diagnostic labels are commonly used and instead of helping patients, in fact, increase ____ and ____.

Answer 18

fear; anxiety

Question 19

What are 6 things you can tell your patient about their back?

Answer 19

1. The segment*
2. They have not sustained a major injury (we can rule this out or any other serious causes)
3. Our findings from the physical – contributing factors
4. Why they may be getting pain/continuing to get pain
5. The good outcomes that are expected
6. What they can do

We can be more specific…OR we can (but not necessary) tell the patient that being able to determine the exact tissue structure beyond the segment is not possible and does not help/change what we do

Question 20

Can I tell the patient they’ve injured a disc? Is this still okay as it’s not an in-depth patho-anatomical explanation?

Answer 20

Yes –> If you deem the patient will not change their behaviour in a negative way because of it AND you explain it within this context

As long as you tell them:

• Good prognosis
• Same recovery
  
  • full recovery in 4-6 weeks)
  • Significcant recovery in 1-2 weeks

Question 21

What are 4 things to say if you say to your patient: “You’ve injured a disc”?

Answer 21

Question 22

When should you never tell a patient that they have injured a disc?

Answer 22

Only done in someone that is not fear avoidant

• Have a negative effect
• Especially in persistent pain

Question 23

Why is this not okay to say to a patient?

Answer 23

Nothing to support it

Question 24

Why is this not okay to say to a patient?

Answer 24

Do not to use injury labels if they have long term

Is a result of nervous system

Not that patient keeps injuring it

Question 25

Why is this not okay to say to a patient?

Answer 25

Will start protecting their body –> not moving

Question 26

Why is this not okay to say to a patient?

Answer 26

• Do not make the patient feel that they need to protect their back • Do not tell them to avoid activities

Question 27

What are 2 recommendations for current LBP?

Answer 27

1. Reassure and play down the severity of the problem: to ‘de-medicalise’ LBP
   
   • Eg. like headaches or colds –> everyone gets one. if stressed, run down…etc)
2. Do not motivate health behaviour based upon threat appraisal and apparent severity of the condition

Question 28

What are 8 education examples that should be priorities on day 1?

Answer 28

1. Establish patient’s ability to cope, their understanding of their condition and use psychosocial screening tools if appropriate.
   
   • Give positive feedback –> encouraging them fabout steps that they have done well
2. Address patients concerns
3. Provide reassurance
4. Give prognostic information – evidence based and reassuring
   
   • The more active, returning to work –> better outcomes
5. Identify and encourage activities that they enjoy and find comfortable, including relieving positions.
6. Demonstrate, practice and encourage unguarded movements and postures
7. Help patient re-appraise their ability to cope with pain: challenging negative thoughts and how to return to normal functioning.
8. Develop an appropriate exercise plan that includes return to functional activities and improves tolerance to movement
   
   • Make sure this is reinforced throughout the session

Question 29

What are 8 things that should be done in patient interview for education

Answer 29

1. Outlining plan
2. Seeking existing knowledge
3. Giving evidence based prognosis
4. Providing positive reinforcement about what patient is doing well
5. Providing reassurance
6. Keeping open to potential changes
7. Relating plan to patients functional tasks
8. Using appropriate non-threatening language

Question 30

What are 6 features of effective education?

Answer 30

1. Appropriate education is THE priority on day one
2. Limited time – consider what is most important for patient to know
3. Finding out what their concerns are and what they want to know = efficient use of time
4. CARE needed with use of language – working out what the patient already understands can help
5. Consider alternative ways of explaining symptoms and recovery rather than a tissue injury model
6. Be direct and honest with the patient