No, really – patient education that’s actually useful!

23 Aug

by Carolyn Thomas  ♥  @HeartSisters

I think I’ve seen just about every “healthy lifestyle” informational brochure out there. You’ve seen them, too:  Eat better! Lose Weight! Quit Smoking! Get More Exercise! BlahBlahBlah!  None that I’ve found so far, however, mention anything that we don’t already know. Behaviour change is notoriously challenging – otherwise we’d all be doing it already.  It seems to me that the issue is not so much about raising awareness of something that isn’t well understood (Really? Smoking is bad for us?) but more about presenting information in a way that seeks to somehow meaningfully interact with the reader.

In my eternal quest for good solid take-home resources to hand out to the audiences at my women’s heart health presentations, I happened upon one – at last! – that caught my eye.  It’s called Living Well, simply sub-titled “tips for health and happiness”.

I loved the concept of this booklet so much that I immediately ordered 300 of them (they’re free!*)  In fact, I was so impressed that I contacted Dr. Miriam Korn personally to thank her for creating such fantastic educational material. She’s the Dalhousie- and Harvard-trained psychiatrist who came up with the concept, wrote the content, took all the charming photos in this booklet, and happens to live and practice in my town. You can see the full content of the Living Well booklet online by visiting Dr. Korn’s excellent website, Laughing Sherpa: A Happy Guide for Healthy Living*

But first, here’s why patient education material is so important.

Even if I’d never become a heart patient myself, I can tell you with utter confidence (based on over three decades of experience in public relations, communications and marketing) that no matter how brilliant your advice, if you can’t entice others to read it, listen to it or watch it, it is – trust me! – useless information.

Some of the patient education material I received upon hospital discharge following my heart attack, for example, consisted of barely legible photocopies of photocopies of photocopied brochure reprints.  You’d have to really want to plough through this stuff in order to finish it . . .

Good quality patient education turns out to be more important than many health care providers might imagine.

Dr. John Jakicic’s  2010 study on weight loss and exercise is a stellar example.(1)  In this study, he and his team wanted to look at the effects of exercise on about 250 sedentary, overweight/obese subjects. One group studied was assigned to be a self-help group only – just some informational pamphlets and newsletters about the benefits of regular exercise; the study authors offered neither specific goals nor any personal contact to these folks for the 18 month duration of the study. 

But other subjects received targeted and intense prescriptive help throughout: cheerleading phone calls, weekly behavioural intervention sessions, regular and ongoing follow-up, on-site exercise facilities to help each group member reach specific exercise goals as set for them by the study authors.

The results were astonishing.  It turns out that by the end of the study, the self-help group (informational pamphlets only) exercised more (75 minutes/week on average) than the carefully monitored and personally supported group (just 66 minutes of exercise per week compared to their 150 minute goal as instructed).

That’s a pretty powerful endorsement of the wisdom in providing people good basic information (and a surprising result from those who had the luxury of all that hand-holding personal support!)

So here’s what makes Dr. Korn’s Living Well booklet equally impactful.  For each of the 10 lifestyle topics she covers in this little publication, she asks a series of questions that essentially ask:

  • Where are you now?
  • Where would you like to go?
  • How will you get there?

She includes in the early pages of her booklet some sample answers that aim to spark ideas in the reader who answers the questions listed.  For example, in the Eat Well section, we see this page that includes some possible sample answers:

Now, packing veggies for your lunch this week may not sound nearly as impressive a goal as your doctor’s advice to “Lose 20 pounds!”, but when it’s a small self-directed goal that the patient personally comes up with, it might well be a small, successful step to far bigger steps down the road.  As the late tennis legend Arthur Ashe once advised:

“Start where you are. Use what you have. Do what you can.”

Dr. Miriam Korn
Dr. Miriam Korn

When we met in person recently, Dr. Korn explained to me that the focus throughout Living Well reflects the same way she approaches behaviour change challenges that her own clients go through every day.

For people living with heart disease, an approach like this that helps us plan and achieve our own health goals is critically important.

The reality is that one of the biggest risk factors for having a heart attack is having already had one. And we’re far more likely to suffer another cardiac event if we don’t make permanent improvements to our diet, our exercise routines, our stress management skills, our sleep habits and so much more.

The self-directed Living Well format reminds me of Dr. Victor Montori and his Mayo Clinic-based team’s approach to what they call Minimally Disruptive Medicine. This innovative concept differs significantly from the current medical trend of treating to numbers: your diagnostic test numbers are too high, you need to _____ (fill in the blank: take a different drug, take more of your existing drug, see a specialist, have more tests done, come back for more appointments, etc.)  – each “solution” adding to what Dr. Montori calls yourburden of treatment.

Patients treated like this are thus typically on the receiving end of doctors’ orders.  If you fail to follow orders, you’re labelled “non-compliant”, a patronizing term that makes many patients cringe.  Minimally Disruptive Medicine, by comparison, does note diagnostic test results but only as a starting point from which to ask: “What are the treatment goals of this particular patient?” 

That’s also what Dr. Korn’s Living Well booklet focuses on, too: “What are the patient’s goals?” –  instead of “What can I convince the patient to do in order to get the results I want to see?”

She reminds us that every self-directed goal that we individually come up with should be a SMART goal:

  • Specific – not just ‘get more exercise’, but narrow that down: “walk after lunch”
  • Measurable – how much? how many? – this helps you make adjustments if necessary to help you meet the goal, e.g. “walk Monday/Wednesday/Friday after lunch for 15 minutes”
  • Attainable – you want to aim to accomplish something that’s not too easy, not too challenging – but as Dr. Korn suggests, what will “help you grow positively”
  • Realistic – don’t set goals based on what you “should” be doing, but rather on what you’ll have a reasonable chance of achieving, or on what needs minor adjustment
  • Timely – a start date to get going, and an end date to work towards

The Living Well booklet is a practical take-home resource that helps to involve patients in the same way Dr. Korn essentially approaches helping them in her practice.

Besides their immediate health issues, for example, she likes to ask her patients about how they’re connecting with family or friends, about how they’re coping with stress, about how they’re sleeping at night. She offers these samples of how conversations with her patients might go, using the Living Well booklet as a resource:

Patient A:  “I’d like to run a road race some day.”

Dr. Korn: “What could you do today to get one step closer to that goal?”

Patient A:  “I could go for a walk with my dog.”

or

Patient B:   “I want to start painting again.”

Dr. Korn: “What could you do today to get one step closer to that goal?”

Patient B:  “I could get out my paints, and paint for 10 minutes.”

Dr. Korn encourages us to use Living Well like a mini-workbook to write about each personal goal. Setting clear goals is better than having no goals, but writing these goals down in a workbook format is widely considered to be even better.

Dr. Jordan Peterson at the University of Toronto, for example, calls this approach a “growth mindset”. In his study on written goals, he concluded: (1)

“The act of writing is more powerful than people think. This means adopting the mindset that our strengths and abilities are NOT fixed, but can improve over time and with effort, can have self-fulfilling results. And on a purely practical level, writing might force us to consider the potential obstacles we might face.”

His conclusion addresses what so often can happen when we set out to change longterm behaviour if we’re NOT grounded in a growth mindset. 

Most of us, for example, have years of experience rehearsing the poor habits that we say we’d like to change or stop someday.  It’s tempting to view these (especially after repeated failed attempts to change the habits) like this:

  • “I guess this is simply the way things are.”
  • “I just don’t have any willpower.”
  • “I’ve tried before to do this – but failed.” 

That flawed perspective can convince us our strengths and abilities are in fact fixed, and incapable of improvement over time.  The way we are is just the way we’re doomed to remain forever.

This is also why diets don’t work.

It’s why New Year’s resolutions are so often abandoned.

It’s why you see all those barely-used stationary bikes at yard sales.

And it’s also why Dr. Korn says she’d love to see copies of the Living Well booklet in every doctor’s office:

“I hope to provide information and inspiration to help foster positive growth, step by step.

“Small changes can have a big impact!

.

♥  Thanks to Victoria’s Island Heart To Heart Program Coordinator Bernadette Carson for giving me my first copy of Dr. Korn’s Living Well booklet!

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(1) Jakicic, J., Otto, A., Lang, W., Semler, L., Winters, C., Polzien, K., & Mohr, K. (2010). The Effect of Physical Activity on 18-Month Weight Change in Overweight Adults. Obesity, 19 (1), 100-109 DOI: 10.1038/oby.2010.122
(2) Schippers, M.  Scheepers, A.  Peterson, J.  A scalable goal-setting intervention closes both the gender and ethnic minority achievement gap. Palgrave Communications. Article number: 15014 doi:10.1057/palcomms.2015.14.  Published online 09 June 2015.

* You can email Dr. Korn directly either here or here to request individual or bulk orders of her Living Well booklets. The full content of Living Well is also online at her website, Laughing Sherpa (on which you’ll also find intriguing extras like Why I Prescribe Chocolate and recipes for Simple Tasty Treats, including my favourite yummy AND healthy Chocolate Avocado Mousse).

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Q:  What has your experience been so far with patient education brochures?

See also:

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20 Responses to “No, really – patient education that’s actually useful!”

  1. Maragaret J. Fehrenbach, RDH, MS September 28, 2015 at 8:02 am #

    Need a place to send patients about heart disease? Check out my sister’s blog at http://allthingsheart.com

    Like

  2. The Accidental Amazon September 5, 2015 at 2:15 pm #

    Love it! This is basically the same sort of thing I do as a physical therapist. If a patient tells me they’d like to walk around the block, I help them define smaller goals — like walking for 5 minutes around the house without feeling tired — that are achievable to help them get to the long-term goal. Thanks, Carolyn. Will have to check out this booklet!

    Liked by 1 person

    • Carolyn Thomas September 5, 2015 at 6:21 pm #

      Thanks for your comment, Kathi. I think physical therapists are the masters of this terrific approach! Start low, go slow applies to more than meds. Thanks also for emailing me that link to Deb Madden’s story on cardiotoxicity following cancer radiation treatment. Yoiks…

      Liked by 1 person

      • The Accidental Amazon September 6, 2015 at 6:13 am #

        I referred Deb to your blog, Carolyn. Cardiotoxicity from chemotherapy and radiation occurs more often than folks realize. Her description of brushing off her early symptoms reminded me of so many of your posts. Thank goodness she finally paid attention & got others to pay attention. Oy…

        Liked by 1 person

  3. Kit Filan August 24, 2015 at 6:20 am #

    Hi Carolyn,

    Do you have any more copies of the Living Well booklet? If so can I have one? Thanks.
    xo

    Liked by 1 person

    • Carolyn Thomas August 24, 2015 at 6:43 am #

      YES. I have 300 of them! Will bring one for you on Wednesday at our walk, okay?
      xo

      Like

  4. Sara Twycross August 24, 2015 at 3:19 am #

    Very interesting. I have been given numerous leaflets and books in my time and verbal advice from doctors to lose weight, eat healthier, but never really do they show you what to do. It’s very well saying to do it, but sometimes we need help to achieve these goals.

    When my hubby was diagnosed with gallstones, we were given the best leaflets I’ve ever seen where it told you how much fat to avoid and what was good, how to read food labels to make the right choice. It helped my hubby and it also helped me to lose some weight and get fitter. Now we live well having learned so much.
    Hugs,
    Sara

    Liked by 1 person

    • MioMyo August 24, 2015 at 1:45 pm #

      Oh, I am so interested in where such good doctors even exist… When I was diagnosed with gallstones, I was told that I can eat anything I want. And when my gallbladder was cut out by surgeons, I was told “People do not even need a gallbladder” and put on painkillers — I live with them for several years from that time. Now I am diagnosed with a kidney stone and told again that “A kidney stone is ok, does not need treatment, just take painkillers and come to the hospital for your morphine shot — you’ll be fine”.

      I have atrial fibrillation & heart disease, and just slowly dying on my painkillers, without any help. Oh please tell me where the good doctors live…

      Like

      • Carolyn Thomas August 24, 2015 at 2:29 pm #

        MiyoMyo, there are indeed many good doctors out there (I know because I regularly see at least three of the best!) But just in case, it’s also the patient’s job to learn as much as possible about any diagnosis – we have to become the “World Experts” in our particular health conditions. I’m not a doctor, but it’s fairly common knowledge that kidney stones, for example, are often treated only with painkillers, drinking lots of water and possibly medications called alpha blockers to help pass the stone. Larger stones may require ultrasound treatment or surgery – the important point is that knowledge is power! Even if you don’t receive a comprehensive patient education brochure from your doctors, please find out as much as you can about this condition (and any other diagnosis) so you can have a good discussion about options with your doctors. The Mayo Clinic website is a good place to start researching any condition. Best of luck to you…

        Like

        • MioMyo August 24, 2015 at 2:53 pm #

          Thank you Carolyn, for your reply. I am not very lucky even to have a family doctor — nobody here accepts new patients. I called Mayo Clinic to find out about the treatment options and was told to start treatment with anti inflammatory meds right away. The quote is: “You cannot treat such symptoms with painkillers, it is dangerous”. But the doctors here do not prescribe anti inflammatory meds to anybody with a heart condition. The circle is closed…

          Like

    • Carolyn Thomas August 24, 2015 at 2:17 pm #

      That’s a great example, Sara, not only of useful patient information, but of a patient (and spouse) who actually took the time to read those good leaflets and then act on the information learned. Good for you!

      Like

  5. Curious to the Max August 23, 2015 at 6:58 pm #

    Oh Carolyn, I wish I could say that information, taking doable steps, helps me but my history is that I do “it” for a short period of time and then stop. I’ve read, listened, watched and know exactly what/why/how. I’ve given workshops on how to make change! I just don’t keep it up for myself.

    I exercise almost daily because Freddie my dog needs exercise but my eating habits are not good for my health. It’s like rewriting decades of habit and I continually run out of ink.

    Liked by 1 person

    • Carolyn Thomas August 23, 2015 at 7:06 pm #

      I hear ya! Thank goodness you have Freddie, Judy-Judith! Perhaps that’s the best strategy… How are Freddie’s eating habits, by the way? 😉

      Like

      • Curious to the Max August 23, 2015 at 7:08 pm #

        Freddie is insatiable but he can’t reach the dog-food. I’ve tried putting my own food out of reach but I’m verrrrrrrrrrry clever and know where the ladder is and how to drive a car . . .

        Liked by 1 person

        • Carolyn Thomas August 23, 2015 at 7:19 pm #

          That reminds me of the old advice to put chocolate chip cookies into the freezer so we won’t be tempted to eat them (until we discover how terrific frozen chocolate chip cookies are!) We’re too smart at figuring SOME stuff out… Serious Q: what would you have advised your own students/clients who had a cookie-freezing problem?

          Liked by 1 person

          • Curious to the Max August 23, 2015 at 8:00 pm #

            When clients wanted help with certain issues, like food, I told them the truth – that I can’t help them because I have the same problem and referred them out. I learned that I had to be honest with myself and my clients in order for them to be honest with themselves. It was often empowering for them to understand I was not a “paragon of virtue” who led a perfect life, and struggled with many of the same things they did.

            There is a line between self-disclosure for therapeutic reasons and self-disclosure for ego.

            Like

  6. Andrea Rosenhaft August 23, 2015 at 5:21 am #

    I’d like to recommend – think of it as an expanded and comprehensive educational booklet – “The Women’s Healthy Heart Program” by Dr. Nieca Goldberg who is the Director of a Women’s Heart Center in New York City. This book encompasses everything you want to know about heart disease in women including recommendations on exercise and eating programs. It’s written in a very user-friendly style. I bought a used copy on Amazon for $3.00 which arrived in excellent condition and if you go to Amazon you can bring the book up and preview portions of it.

    Liked by 1 person

    • Carolyn Thomas August 23, 2015 at 6:28 am #

      Hi Andrea – thanks for that recommendation. Dr. Goldberg has another terrific book that I also really like, called “Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women”

      Like

  7. A Tired Heart August 23, 2015 at 4:41 am #

    Reblogged this on Journey of a Tired Heart and commented:
    As I was lamenting in an earlier post the poorly- copied, half-heartedly presented written materials given to heart patients by the hospital, this blog post – Thank you Heart Sisters! – is excellent! A must read!

    Like

    • Carolyn Thomas August 23, 2015 at 6:26 am #

      Thanks for reposting this article on your blog! You’re so right – there is certainly a lot of poorly done education material out there that health care professionals should feel embarrassed to hand out…

      Liked by 1 person

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