Assessment of the Otorhinolaryngologist’s Role in Patient’s Education

Introduction

The physician’s role as a patient educator is not new.The word’doctor’comes from the Latin,docere,meaning’to teach, to lead forth,’ and as early as the fifth century BC, Hippocrates endorsed the practice.

In 1910 Abraham Flexner, in his highly regarded commissioned report on the state of medical education in the United States, affirmed the view that ‘the physician’s function is fast becoming social and preventive, rather than individual or curative,’ and urged physicians,’through measures essentially educational, to enforce the conditions that prevent and make positively for physical and moral welbeing.’

Physicians have a central role in educating patients and the public in the elements of personal health maintenance. To be an effective teacher, one must recognize the learning needs of each patient and use methods of information transfer that wil result in comprehension and compliance.

“If you don’t realize poor adherence to treatment is a major problem in every physician’s practice—including yours then it’s probably because you are not com- municating with your patients,” declared Thomas C. Bent, MD, medical director of the Laguna Beach Community Clinic in Laguna Beach, California, at the Summit on Improving Patient Adherence, convened by the Primary Care Education Consortium (PCEC) July 23-25, 2010. The view of Dr. Bent regarding poor adherence is demonstrated by extensive research.

A positive, trusting clinician-patient relationship is strongly associated with adherence to treatment and perceived effectiveness of care. It is also associated with a greater likelihood that patients will share information regarding their medication use, including issues and barriers that impede appropriate use.

Providing education about a patient’s condition and the medications necessary to treat it is essential for patients who demonstrate concerns about taking medications, lack of knowledge about a medication and/or their con- dition, or denial about their condition or its severity. The education provided should be guided by patient feedback but should generally encompass the disease, the reason for treatment, and expected short- and long-term benefits of treatment, as well as likely adverse effects of treatment and what can be done to minimize them.

Patient involvement and participation in their decisions regarding treatment, translates into improved quality of life, greater satisfaction, and improved breast cancer survival [8–11].

Methodology

A multicenter cross-sectional study design was used to enroll 128 ORL consultants and assistant while residents exclude them from this study, over a period of one month in June/2018.

The approval was obtained from the local Institutional Human Ethical Committee of king Fahad hospital. Questionnaire was consist from 20 questions that testing patient education within ORL staff in different hospitals in kingdom of Saudi Arabia, and gulf countries.

Questionnaire was distributed by using monkey survey web by sending emails through members of Saudi ORL society. Survey Instrument and Distribution The data were collected using a structured questionnaire developed based on comprehensive literature review. Questions in patient education related knowledge section used attitude and perceived barriers questions were assessed using 5-point Likert-type scale responses (agreement, and frequency answers).

Additional information was gathered on basic demographics (age and sex), profession-related characteristics (workplace /current category like consultant, resident etc.., ORL subspecialty, and years of working experience), and average number of patient seen in ORL clinic. The questionnaire was tested for reliability and validity. Content validity was performed by academicians and experienced ORL physicians, to obtain feedback on the clarity and understanding of the questions.

RESULTS

The questionnaires were adequately filled and returned by 128 otorhinolaryngologists, out of which 45 (35%) were Rhinologist, 13 (10%) were Otologist, 7 (6%) were Head&Neck,6 (5%) were Pediatric ORL, 2 (2%) were Laryngology/Phoniatric, 5(4 %) were Facial plastic , and 49(39 %) were General ORL.

Majority of them were males (84%), their ages range from 30-50 years old (73%), and 54% of them were consultants. The feedback of the survey was taken from different regions of the kingdom including central area (30%), western area (14 %), southern area (10%), northern area (5 %), and also from Gulf countries (30%).

The ORL physicians who have experience less than 15 years after residency was 63%. Out of 128 respondent 54 (42%) see more than 20 patients per session and 2-5minutes spent on patient education by 55% of them while 30% spend more than five minutes. Majority of physicians 110(87%) consider patient education is an important factor for treatment adherence and patient compliance and 90 (71%) of the total respondents always educate their patient in the clinic and only 10% will assess health literacy for their patients.

The Commonest way that physicians educate their patients is by Verbal instruction, and drawing and most of them (70%) are keen to provide further assistance by personal phone or office number. Regarding social media, 48% do not use it for education and if they do, the choices were variable with no preference of one way over others. Sixty tow percent of the physicians will always explain the diagnostic tests to their patients and 58% will explain the medications details for them. Time constraint, lack of educational and human resources were the common factors perceived as barriers toward patient education.

DISCUSSION

Patient’s education is one of the basic concepts of health care. Engaging patients is necessary to help them to understand their health condition and to make their own decision regarding diagnostic and management options.

Healthcare providers have become more aware of the importance of educating patients both because of increasing interest from the patients themselves in learning about their condition, and because standards of treatment and health outcomes improve among patients who are able to participate in their own care.(1) Almost all of our respondent in this study strongly agree about that and they always provide education to their patient.

Health literacy is relatively a new concept, which is becoming increasingly important and a lot of studies done on different population it is still remains little known by clinicians (2). The concept of health literacy refers to the ability and skills to access, understand, appraise and use health information (3). Our analysis showed few of respondents they always assess health literacy of the patient before starting education, by that patient with low health literacy level might not receive the needed education.

People with low literacy tend to be less responsive to health education, less likely to use disease prevention services, and associated with several adverse health outcomes like poor compliance, uncontrolled chronic disease (4).

To assess health literacy in the population different instrument exist are useful screening tools in clinical setting such as: the test of functional health literacy in adults (TOFLA) (5), the Rapid Estimate of Adult Literacy in Medicine (REALM) (6), the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) (7), US Health Activity Literacy Scale (HALS) (8), the Newest Vital Sign (NVS) (9), and Single Item Literacy Screener (SILS) (10). Each instrument tool contain different items, all the tools sharing the same concept to assess health literacy.

Other than instrument tools for screening health literacy, physician can detected those patients with limited level of health literacy by personal behaviors, study by Menendez et al. showed patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen and condition than patients with adequate health literacy (11) . Other behaviors suggestive of limited literacy are inability to keep appointments, noncompliance with medication, poor adherence to recommended interventions or postponing decision making (12).

A recent study done showed majority of Saudi individuals had inadequate health literacy that associated with poor knowledge of health information, the authors highlighted the importance of understanding the status of health literacy among Saudis and the need for educational programs to raise the health literacy awareness among Saudi population.(13)

Recommended steps to enhance understanding among patients with low health literacy (12, 14): First, Slow down, and take time to assess the patients’ health literacy skills. More than half of the physician involved in our study, they spent a good time for patient education (2-5 minutes). Second step, using a clear plain language without difficult medical terminology. Third step, Show or draw pictures to enhance understanding and subsequent recall. We found the majority of our respondents’ preferred using verbal instruction and drawing to educate their patients. Forth step, Limit information given at each clinic visit, and repeat instructions. More than one third of the physicians in our study they repeat the education process in the subsequent visits. Fifth step, Use a “teach back” or “show me” approach to confirm understanding. Our study showed 8% of respondents they always assess the understanding of the patient by asking them to repeat what they understand, the percentage a little higher comparing to similar study (2%) (15). Last step is to be respectful, caring, and sensitive, that permit patients to participate in their own health care.

The main factors that perceived as a barrier toward patient’s education is time constraints, other barriers were reported like lack of educational materials in Arabic language and lack of human resources, same findings consistent with the result of many previous studies.(16-19)

The availability of the Internet and smartphones have greatly increased patients’ access to health information and allowed the introduction of new more methods for delivering the health educational material.(1)

Social networking sites such as Facebook, YouTube, Instagram, Snapchat, and Twitter consider one of the most sites used by people daily. As the use of social media has grown in popularity, its applications have expanded beyond personal communication to involved the professional use specifically public health Twitter, with more than 300 million active users, is unique in its function of communicating in the use of the hashtags, as well as links, pictures, and videos after the tweet thus allowing public health professionals to connect and communicate quickly and efficiently, this making Twitter the most popular digital platform for public health professionals. Quarter of respondents involved in the study they used Twitter as the main site for education purpose.

This study to the author’s best of knowledge is the first study assess the role of otorhinolaryngologists in patient’s education among GCC physician.

Limitations

As the data collected by self-administered questioner, the results are likely susceptible to recall bias. Because of nature of electronic survey the study not equally distributed throughout the otorhinolaryngology subspecialty, although a chronic cases almost present in all subspecialty.

Conclusion

Patient’s education is an important aspect of preventing and treating diseases. Providing proper educational aids and allocating time for patient’s education is crucial. Further studies are needed to assess the impact of patient’s education on treatment adherence in otolaryngology field.

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