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Journal Article•DOI•

Improving patient recall of information: Harnessing the power of structure

Wolf Langewitz1, Selina Ackermann1, Anette Heierle1, Ralph Hertwig2, Leyla Ghanim3, Roland Bingisser1 •
University Hospital of Basel1, Max Planck Society2, University of Graz3
01 Jun 2015-Patient Education and Counseling (Elsevier Science)-Vol. 98, Iss: 6, pp 716-721
TL;DR: The amount of medical information laypeople recall, investigate the impact of structured presentation on recall and recommend the physician to friends to improve recall are assessed.
About: This article is published in Patient Education and Counseling.The article was published on 2015-06-01 and is currently open access. It has received 56 citations till now. The article focuses on the topics: Recall test & Recall.

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  • Citation for final published version: Wirth, Thomas 2017.
  • Changes made as a result of publishing processes such as copy-editing, formatting and page numbers may not be reflected in this version, also known as Please note.
  • The availability of commercial equipment to carry out small and medium scale reactions in the laboratory has clearly triggered lots of the current research.

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Journal Article•DOI•
Communication and patient participation influencing patient recall of treatment discussions.

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Claude Richard, Emma Glaser1, Marie-Thérèse Lussier1•
Université de Montréal1
01 Aug 2017-Health Expectations
TL;DR: Patient recall of treatment information is a key variable towards chronic disease (CD) management but it is unclear what communication and patient participation characteristics predict recall.
Abstract: Context Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. Objectives To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. Design Observational study within a RCT. Setting & participants Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. Main variables Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. Main outcome measures Recall of CD, lifestyle treatment and medication information. Results Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. Discussion Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. Conclusion Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.

124 citations

Journal Article•DOI•
Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology.

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M. Barton Laws1, Yoojin Lee1, Tatiana Taubin1, William H. Rogers2, Ira B. Wilson1 •
Brown University1, Tufts Medical Center2
01 Feb 2018-PLOS ONE
TL;DR: In a multivariate model, the total number of items to be recalled per visit, and percentage of utterances in decision-making processes by the provider (“verbal dominance”), were significant predictors of poorer recall.
Abstract: While some studies have assessed patient recall of important information from ambulatory care visits, none has done so recently. Furthermore, little is known about features of clinical interactions which are associated with patient understanding and recall, without which shared decision making, a widely shared ideal for patient care, cannot occur. Our objective was to evaluate characteristics of patients and outpatient encounters associated with patient recall of information after one week, along with observation of elements of shared decision making. This was an observational study based on coded transcripts of 189 outpatient encounters, and post-visit interviews with patients 1 week later. Coding used three previously validated systems, adopted for this study. Forty-nine percent of decisions and recommendations were recalled accurately without prompting; 36% recalled with a prompt; 15% recalled erroneously or not at all. Provider behaviors hypothesized to be associated with patient recall, such as open-questioning and "teach back," were rare. Patients with less than high school education recalled 38% of items freely and accurately, while patients with a college degree recalled 65% (p < .0001). In a multivariate model, the total number of items to be recalled per visit, and percentage of utterances in decision-making processes by the provider ("verbal dominance"), were significant predictors of poorer recall. The item count was associated with poorer recall for lower, but not higher, educated patients.

43 citations

Journal Article•DOI•
Oncologist recommendation matters!-Predictors of psycho-oncological service uptake in oncology outpatients.

[...]

Antje Frey Nascimento1, Theresa Tondorf1, Theresa Tondorf2, Sacha I. Rothschild2, Michael T. Koller2, Christoph Rochlitz2, Alexander Kiss2, Rainer Schaefert2, Rainer Schaefert1, Gunther Meinlschmidt, Sabina Hunziker2, Sabina Hunziker1, Jens Gaab1, Diana Zwahlen2 •
University of Basel1, University Hospital of Basel2
01 Feb 2019-Psycho-oncology
TL;DR: The link between patient‐oncologist communication (ie, talking about psychosocial distress, providing detailed information, and recommending POS) and POS uptake is examined.
Abstract: Objective Highly distressed cancer patients often do not use psycho-oncological services (POS). Research on predictors of POS uptake has mainly focused on patient-related variables and less on communication variables, so we examined the link between patient-oncologist communication (ie, talking about psychosocial distress, providing detailed information, and recommending POS) and POS uptake. Methods We conducted a prospective, observational study in an Oncology Outpatient Clinic in Switzerland. Predictors (ie, patient-related variables and patient's reports of the patient-oncologist communication) were assessed via semistructured interviews, and information on outpatient POS uptake was assessed after 4 months. For statistical analysis, a multivariate logistic regression was performed. Results Of 333 participants (mean age 61 years; 55% male; 54% distress thermometer ≥5), 77 (23%) had used POS during a 4-month period. Patients who reported an oncologist-recommended POS (odds ratio [OR] = 6.27, 95% confidence interval [CI] = 3.14-12.85) and those who were not sure if they had received a recommendation (OR = 4.64, 95% CI = 1.83-11.97) were more likely to attend POS than those who reported receiving no recommendation. Talking about psychosocial distress (OR = 0.74, 95% CI = 0.38-1.46) and providing detailed information about POS did not predict POS uptake (OR = 1.06, 95% CI = 0.46-2.38). Conclusions Oncologists' expert recommendations to attend POS were strongly associated with patients' uptake of POS. The central role played by oncologists should be accounted for in stepped psycho-oncological care when POS referral pathways are defined.

31 citations

Cites background from "Improving patient recall of informa..."

  • ...Again, oncologists and patients might have different views of what detailed information about POS means, and the stressful situation may have affected patients' ability to process and recall this information.(33,34) Probably, the complexity of the information did not meet the situational need of the patient and patients may be more likely to remember detailed information about POS if it was disseminated in a later appointment....

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Journal Article•DOI•
Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM).

[...]

Nicole Ernstmann1, Sarah Halbach1, Christoph Kowalski, Holger Pfaff2, Lena Ansmann2 •
University Hospital Bonn1, University of Cologne2
01 Apr 2017-Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
TL;DR: HL-COM was found to impact patient enablement, mediated through the support by physicians, and will have to test these associations in the context of other diseases or institutions.

28 citations

Journal Article•DOI•
Women's experiences of abnormal Pap smear results : a qualitative study

[...]

Marie Rask1, Katarina Swahnberg1, Gunnel Lindell2, Marie Oscarsson1•
Linnaeus University1, Karolinska Institutet2
01 Jun 2017-Sexual & Reproductive Healthcare
TL;DR: In general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results and need oral information, based on the individual women's situation, and delivered at the time the women receive the test result.

24 citations

References
More filters
Journal Article•DOI•
The measurement of observer agreement for categorical data

[...]

J. R. Landis1, Gary G. Koch•
University of Michigan1
01 Mar 1977-Biometrics
TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.

64,109 citations

"Improving patient recall of informa..." refers background in this paper

  • ...74, indicating substantial interrater reliability according to Landis and Koch [34]....

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  • ...Analyses of the agreement between the two raters resulted in a Cohen’s kappa of 0.74, indicating substantial interrater reliability according to Landis and Koch [34]....

    [...]

Book•DOI•
Thought and choice in chess

[...]

Adrianus Dingeman de Groot
01 Jun 1966-American Journal of Psychology
TL;DR: In this article, the authors did an experimental study in 1938, to which famous chessmasters participated (Alekhine, Max Euwe and Flohr), and the results showed that a chessmaster is highly organized and uses methods and strategies to solve his problem of choice.
Abstract: What does a chessmaster think when he prepartes his next move? How are his thoughts organized? Which methods and strategies does he use by solving his problem of choice? To answer these questions, the author did an experimental study in 1938, to which famous chessmasters participated (Alekhine, Max Euwe and Flohr). This book is still usefull for everybody who studies cognition and artificial intelligence.

2,160 citations

Journal Article•DOI•
Patients' memory for medical information.

[...]

Roy P. C. Kessels1•
Utrecht University1
01 May 2003-Journal of the Royal Society of Medicine
TL;DR: Empirical evidence is examined concerning the obstacles to memory for medical information and some suggestions for overcoming them as a prerequisite for good adherence to recommended treatment are offered.
Abstract: When important decisions are to be made, the patient must receive detailed information on the illness, treatment options and prognosis. The shortening of hospital stays and the trend towards outpatient care enhance the need of patients and their families for specific information.1 Practitioners are responding to these demands, yet the amount of information correctly recalled by patients is strikingly small.2 In this review I examine empirical evidence concerning the obstacles to memory for medical information and offer some suggestions for overcoming them. Clearly, memory for medical information is a prerequisite for good adherence to recommended treatment. Ley's3 model on effective communication in medical practice (see Figure 1) stresses the importance of memory next to factors such as the understanding of information and satisfaction with the treatment. 40-80% of medical information provided by healthcare practitioners is forgotten immediately. The greater the amount of information presented, the lower the proportion correctly recalled;4 furthermore, almost half of the information that is remembered is incorrect.5 For the forgetting of information there are three basic types of explanation—first, factors related to the clinician, such as use of difficult medical terminology; second, the mode of information (e.g. spoken versus written); and, third, factors related to the patient, such as low education or specific expectations.6 Here, I discuss only the second and third, since the communication skills of clinicians have been thoroughly reviewed elsewhere.7,8 Figure 1 Overview of Ley's model on the interactions between patient-related factors and therapy adherence (see Ref. 3)

1,074 citations

Journal Article•DOI•
Cognitive load theory in health professional education: design principles and strategies

[...]

Jeroen J. G. van Merriënboer1, Jeroen J. G. van Merriënboer2, John Sweller3•
Open University1, Maastricht University2, University of New South Wales3
01 Jan 2010-Medical Education
TL;DR: Cognitive load theory aims to develop instructional design guidelines based on a model of human cognitive architecture that assumes a limited working memory and an unlimited long‐term memory holding cognitive schemas and learns as the construction and automation of such schemas.
Abstract: CONTEXT Cognitive load theory aims to develop instructional design guidelines based on a model of human cognitive architecture. The architecture assumes a limited working memory and an unlimited long-term memory holding cognitive schemas; expertise exclusively comes from knowledge stored as schemas in long-term memory. Learning is described as the construction and automation of such schemas. Three types of cognitive load are distinguished: intrinsic load is a direct function of the complexity of the performed task and the expertise of the learner; extraneous load is a result of superfluous processes that do not directly contribute to learning, and germane load is caused by learning processes that deal with intrinsic cognitive load. OBJECTIVES This paper discusses design guidelines that will decrease extraneous load, manage intrinsic load and optimise germane load. DISCUSSION Fifteen design guidelines are discussed. Extraneous load can be reduced by the use of goal-free tasks, worked examples and completion tasks, by integrating different sources of information, using multiple modalities, and by reducing redundancy. Intrinsic load can be managed by simple-to-complex ordering of learning tasks and working from low- to high-fidelity environments. Germane load can be optimised by increasing variability over tasks, applying contextual interference, and evoking self-explanation. The guidelines are also related to the expertise reversal effect, indicating that design guidelines for novice learners are different from guidelines for more experienced learners. Thus, well-designed instruction for novice learners is different from instruction for more experienced learners. Applications in health professional education and current research lines are discussed.

994 citations

"Improving patient recall of informa..." refers background in this paper

  • ...Specifically, information appears easier to retain when it is structured in a way that helps the recipient to organise it [28,29]....

    [...]

Journal Article•DOI•
Patients’ Expectations about Effects of Chemotherapy for Advanced Cancer

[...]

Jane C. Weeks1, Paul J. Catalano, Angel M. Cronin, Matthew Finkelman, Jennifer W. Mack, Nancy L. Keating, Deborah Schrag •
Harvard University1
24 Oct 2012-The New England Journal of Medicine
TL;DR: Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences.
Abstract: Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. In multivariable logistic regression, the risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer (odds ratio, 1.75; 95% confidence interval [CI], 1.29 to 2.37); among nonwhite and Hispanic patients, as compared with non-Hispanic white patients (odds ratio for Hispanic patients, 2.82; 95% CI, 1.51 to 5.27; odds ratio for black patients, 2.93; 95% CI, 1.80 to 4.78); and among patients who rated their communication with their physician very favorably, as compared with less favorably (odds ratio for highest third vs. lowest third, 1.90; 95% CI, 1.33 to 2.72). Educational level, functional status, and the patient’s role in decision making were not associated with such inaccurate beliefs about chemotherapy. Conclusions Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients’ understanding, but this may come at the cost of patients’ satisfaction with them. (Funded by the National Cancer Insti tute and others.)

926 citations

"Improving patient recall of informa..." refers background in this paper

  • ...Although they had been informed by their doctors about the advanced stage of their disease and the clinical consequences, they largely overestimated the chance of recovery and failed to understand the palliative rather than curative goal of their treatment [21]....

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Patients' memory for medical information.

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01 May 2003-Journal of the Royal Society of Medicine
Roy P. C. Kessels
A systematic review of interventions to improve recall of medical advice in healthcare consultations.

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01 Jun 2009-Journal of the Royal Society of Medicine
Philip Watson, Brian McKinstry
Memory for medical information

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01 Jun 1979-The British journal of social and clinical psychology
P. Ley
Does Age Really Matter? Recall of Information Presented to Newly Referred Patients With Cancer

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20 Nov 2008-Journal of Clinical Oncology
Jesse Jansen, Phyllis Butow, Julia C.M. van Weert, Sandra van Dulmen, Rhonda J. Devine, Thea J. Heeren, Jozien M. Bensing, Martin H.N. Tattersall 
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01 May 2011-Annals of Oncology
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Frequently Asked Questions (7)
Q1. What is the recent review of the literature?

On average, only 2 out of 5 complications were recalled in the context of elective plastic surgery [18]; 5 out of 32 pieces of information were correctly remembered 2 h after the preoperative discussion prior to brain surgery and 4 out of 25 pieces of information prior to spinal surgery [19] (for a recent review, see [20]). 

For instance, questionnaire data indicate that 87% of patients ‘‘want to be told all information’’ and only 9% ‘‘want the doctor to choose how much information to give’’ [9] (see also [5,6]). 

The influence of prior medical knowledge, subjective well-being, andconcentration ability on recall was assessed by an analysis of covariance (ANCOVA), with number of recalled items as the dependent variable and condition as the independent variable. 

The experts were informed that this information would be given to a patient during discharge from the emergency department, that the time allotted for this consultation was a maximum of 15 min, and that the patient would see his GP within the next two or three days. 

Several review articles have since investigated whether patient understanding and recall of information can be improved by the use of additional communicative aids. 

The mean number of items recalled was 8.12 4.31 (N = 57) in the structured condition and 5.71 3.73 (N = 41) in the nonstructured condition (p = 0.005). 

For instance, recentqualitative studies on communication in oncology have demon-strated that patients’ trust is based primarily on the impression ofclinical competence that emerges from their communication withoncological surgeons and haematologists [13].