AAFP Core Educational Guidelines

Patient Education



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Am Fam Physician. 2000 Oct 1;62(7):1712-1714.

Patient education can be defined as the process of influencing patient behavior and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health. The Latin origin of the word doctor,“docere,” means “to teach,” and the education of patients and their families, as well as communities, is the responsibility of all physicians. Family physicians are uniquely suited to take a leadership role in patient education. Family physicians build long-term, trusting relationships with patients, providing opportunities to encourage and reinforce changes in health behavior. Patient education is, therefore, an essential component of residency training for family physicians.

Patient education is critically important because it is clear that the leading causes of death in the United States (i.e., heart disease, cancer, stroke, lung disease and injuries) are closely associated with unhealthy lifestyles. There is also strong evidence to suggest that counseling and patient education provide substantial benefits. Providing patients with complete and current information helps create an atmosphere of trust, enhances the doctor-patient relationship and empowers patients to participate in their own health care. Effective patient education also ensures that patients have sufficient information and understanding to make informed decisions regarding their care.

To provide effective patient education, a variety of practical skills must be mastered. These include ascertaining patients' educational needs, identifying barriers to learning, counseling concisely, evaluating and utilizing written, audiovisual and computer-based patient education materials, and incorporating education into routine office visits.

Attitudes

The resident should develop attitudes that:

  1. Recognize patient education as essential to the discipline of family medicine and as an integral part of each patient encounter.

  2. Recognize that educational interventions are essential in the treatment of disease and in the maintenance of health.

  3. Recognize the responsibility of the physician to educate the patient and the family.

  4. Emphasize the necessity of educating the patient and/or responsible parties in issues involving informed consent.

  5. Appreciate the importance of assessing a patient's educational needs, readiness to learn and comprehension of information.

  6. Recognize that cultural differences affect health beliefs and that patient education must take these differences into account.

  7. Value the opportunity to utilize “teachable moments” in a patient-physician encounter.

  8. Understand the need to empower the patient in the decision-making process.

  9. Value the power of a trusting, long-term doctor-patient relationship in effecting behavior change.

  10. Promote the physician's role in influencing the health status of the community through involvement in community education projects.

  11. Recognize the responsibility to model healthy lifestyle practices.

Knowledge

  1. Principles of patient education

    1. Adapt teaching to the patient's level of readiness, past experience, culture and understanding.

    2. Create an environment conducive to learning with trust, respect and acceptance.

    3. Involve patients throughout the learning process by encouraging them to establish their own goals and evaluate their own progress.

    4. Provide motivation by presenting material relevant to the patient's needs.

    5. Provide opportunities for patients to demonstrate their understanding of information and to practice skills.

  2. Barriers to patient learning

    1. Physical condition

    2. Financial considerations

    3. Lack of support system

    4. Misconceptions about disease and treatment

    5. Low literacy/comprehension skills

    6. Cultural/ethnic background/language barriers

    7. Lack of motivation

    8. Environment

    9. Negative past experience

    10. Denial of personal responsibility

  3. Selected educational topics*

    1. Health promotion/disease prevention

      1. Domestic violence

      2. Exercise

      3. Family planning and pregnancy

      4. Immunizations

      5. Menopause and hormone replacement

      6. Nutrition

      7. Osteoporosis

      8. Safety and injury prevention

      9. Screening for prevalent diseases (e.g., blood pressure, cholesterol)

      10. Breast and testicular self-examination

      11. Sexuality counseling

      12. Smoking cessation

      13. Stress management

      14. Substance abuse

      15. Weight control

      16. Well-child anticipatory guidance

    2. Disease management

      1. Arthritis

      2. Asthma/chronic obstructive pulmonary disease

      3. Depression/anxiety

      4. Diabetes

      5. Headaches

      6. Hyperlipidemia

      7. Hypertension

      8. Obesity

      9. Sexually transmitted diseases/human immunodeficiency virus (HIV)

      10. Sports injuries

      11. Upper respiratory infections/otitis media

*—This is not meant to be an exhaustive list of topics. It represents core areas in which family practice residents should have knowledge of specific educational interventions and to which family practice residents should be exposed during teaching opportunities.

Skills

  1. Basic skills

    1. Identify patient's educational needs.

    2. Gather information about patient's daily activities, knowledge, health beliefs and level of understanding.

    3. Tailor education to the patient's educational level and cultural background.

    4. Inform patient of findings clearly and concisely.

    5. Discuss treatment plans in terms of specific behaviors.

    6. Encourage questions and provide appropriate answers.

    7. Utilize appropriate written, audiovisual and computer-based materials.

  2. Short-term plans for acute illness

    1. Prepare patient for symptoms and effects of condition, examination or treatment.

    2. Assess patient's ability to carry out treatment plan; identify barriers and individualize treatment plan accordingly.

    3. Assess patient's understanding by having him or her restate the treatment plan.

    4. Document educational efforts in specific terms in the record.

  3. Long-term strategies for chronic disease

    1. Involve patient in setting treatment goals and treatment plan.

    2. Present manageable amounts of information to patient over time.

    3. Provide opportunities for patient to discuss feelings.

    4. Provide patient with adequate feedback on progress toward goals.

    5. Assess influence of patient's background, home and work environment on treatment plan and adapt education accordingly.

    6. Document educational efforts in specific terms in the record.

  4. Health promotion

    1. Determine patient's health-risk behaviors through interview and health-risk appraisals.

    2. Introduce health-promotion topics during “teachable moments.”

    3. Assess patient's priorities and readiness to change health-related behaviors.

    4. Respond to patient's interest in health promotion with specific suggestions for behavior change (e.g., exercise prescription).

    5. Employ educational messages appropriate for various stages of behavior change.

    6. Enlist assistance of other health care professionals (e.g., nurses, health educators, dietitians, certified fitness instructors).

    7. Incorporate use of appropriate community resources.

  5. Incorporation of patient education in practice

    1. Develop patient education handouts and protocols.

    2. Evaluate commercial education resources, such as brochures, books, audiotapes, videotapes and Internet materials.

    3. Select instructional materials appropriate for patient's readiness to learn and level of understanding.

    4. Develop systems to facilitate use of patient education materials in office practice.

    5. Develop systems to involve office staff in assisting with patient education.

    6. Utilize family conferences when appropriate.

    7. Participate in health education presentations to community groups.

    8. Be aware of emerging technologies.

Implementation

Each family practice residency program should ensure that faculty and preceptors who provide direct patient care include patient education as an integral part of each patient encounter in order to set examples for residents. Faculty should demonstrate a commitment to patient education by including patient education issues in direct resident teaching and precepting. Questions regarding educational issues should be part of discussions of individual cases during rounds and precepting on an ongoing basis.

Each residency is encouraged to form a patient education committee comprising residents, faculty, staff and, if possible, patients and members of the community. This committee may participate in the patient education curriculum for the residency. The patient education committee may also help to design systems to incorporate patient education activities in a model office practice, so that residents can transfer this knowledge into their own practice situations after graduation.

Each residency is encouraged to maintain an adequate supply of patient education materials of all types, including written, audiovisual and computer-based materials. These materials should be organized for easy access, with frequently used materials kept in patient examination rooms. Patient education materials should cover the common health problems in the community, as well as frequently requested health promotion topics. The materials should be appropriate for the reading and comprehension levels and the cultural and ethnic diversity of the patient population. Each residency should maintain a current list of resources available in the community to supplement the patient education provided in the family practice center and should promote resident familiarity with these resources.

Patient education should be taught longitudinally throughout all 36 months of family practice residency. In addition to didactic hours on patient education, opportunities should be made available for residents to attend patient education conferences and to participate in community education projects.

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

RESOURCES

American Academy of Family Physicians Foundation Health Education Program. Database of reviewed health education materials. Leawood, Kan.: AAFP Foundation. http://www.aafp.org/hep/

Family health facts. Leawood, Kan.: American Academy of Family Physicians. http://www.familydoctor.org/healthfacts/

Papers from the Annual Conference on Patient Education. Leawood, Kan.: American Academy of Family Physicians and Society of Teachers of Family Medicine. http://www.aafp.org/catalog/patientpapers.html

Patient education: a leadership role for family physicians and the AAFP. Leawood, Kan.: American Academy of Family Physicians, 1993. http://www.aafp.org/catalog/patient/patientleadership.html

Doak CC, Doak LG, Root JH. Teaching patients with low literacy skills. Philadelphia: Lippincott, 1995.

Falvo DR. Effective patient education: a guide to increased compliance. Gaithersburg, Md.: Aspen, 1994.

Moore SW, Griffith JA, Griffith HW. Griffith's Instructions for patients. 6th ed. Philadelphia: Saunders, 1998.

Kelly RB, Falvo DR. Patient education. In : Rakel RE, ed. Textbook of family practice. 5th ed. Philadelphia: Saunders, 1995.

McCann DP, Blossom HJ. The physician as a patient educator. From theory to practice. West J Med. 1990;153:44–9.

U.S. Preventive Services Task Force. Guide to clinical preventive services: report of the U.S. Preventive Services Task Force. Baltimore: Williams & Wilkins, 1996.

Schmitt BD, Jacobs JT. Instructions for pediatric patients. 2d ed. Philadelphia: Saunders, 1999.

Woolf SH, Jonas S, Lawrence RS. Health promotion and disease prevention in clinical practice. Baltimore: Williams & Wilkins, 1996.

Prochaska JO. Changing for good. New York: Avon, 1994.

Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford, 1991.



Copyright © 2000 by the American Academy of Family Physicians.
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