Strategies to Aid Understanding

00:01 All right. So I think in understanding, after we've disclosed the information, really important to make sure that we assess comprehension.

00:10 And the ways that you're going to disclose the information is going to influence the patient's ability to understand it.

00:16 So hopefully, you would go through this slowly and clearly.

00:20 You shouldn't just sort of rush through, risk benefits alternatives, very quickly.

00:25 You need to give enough time so the patient can hear the information and process it.

00:31 It's best if you use non-medical language, so don't use the medical terminology.

00:35 If you do use it, then try to define the term.

00:39 If the patient has used their own terms to describe their condition, good to use those who because that's going to reinforce the patient's understanding.

00:48 Always helpful to use analogies.

00:50 So wherever you can sort of paint a picture for a patient through the use of analogies that might help to aid their understanding.

00:58 And even just, actually drawing pictures.

01:00 So if it's a surgery and you're proposing surgery on their liver, describing or actually drawing a picture of the anatomy of the abdomen, and where the liver is and what you're intending to do.

01:16 And I'll be helpful for the patient understand what the surgery is going to entail.

01:22 And a lot of people might have difficulty with numeracy or not understanding numbers.

01:28 So it's best not to use probabilities and percentages, but try to use numbers clearly.

01:34 So say, one out of 10 rather than 10%, for instance, make it understandable so that the patient could comprehend it, and then have that as useful information.

01:47 And I think a very useful strategy is something called Ask-Tell-Ask.

01:50 So you first ask a question.

01:53 Try to explore what the patient already knows.

01:56 Then you tell some information.

01:59 And then you ask about the information that you've shared.

02:02 So it's a back and forth.

02:03 And as you see, it's Ask-Tell-Ask which means more weight is placed on the patient talking rather than the clinician talking.

02:11 So in the in the old days, the informed consent used to be just the disclosure of information, sort of a soliloquy by the physician.

02:19 But in this case, with Ask-Tell-Ask, you're really trying to engage the patient in talking as you're disclosing the information.

02:28 So how would it work? So the first ask would be, what do you know about your condition, or this proposed treatment? Maybe they've had prior experience with maybe they've had a family member that's gone through a similar thing.

02:40 So they might already have some background knowledge, and that's going to lead again in their understanding.

02:47 If they're unaware of something, then you give them a certain amount of information, a chunk of information.

02:52 It shouldn't be a long list of things.

02:54 It should hopefully just be in chunks, so short segments that they can then process.

03:00 And then you follow that up with an ask question.

03:02 "So what do you think about what I've said? Or can you tell me in your own words, what I've said?" That's a way that you're going to make sure that they are processing it, and using their own own words or own language to describe it.

03:18 And it's important to recognize that this is an iterative process.

03:21 So it's a ongoing back and forth.

03:23 So you explain the concept.

03:25 You assess their comprehension.

03:28 If they don't get it quite right, then you might clarify the details, then you reassess their comprehension.

03:33 So you're continually trying to reinforce their understanding.

03:38 And it's also going to be helpful in terms of adherence to treatment in the future.

03:41 So if it is prescribing a medication, the better they understand it up front, and what's required, the more likely they are to adhere.

03:48 Or if it's a surgery, or procedure, what do they need to prepare for what they need to go through after the procedure or surgery, all that's an iterative process to get them to an understanding.

04:02 And just recognize that every contact we have with the patient, is an opportunity to reiterate information, reinforce information, to really make sure that their decisions are informed and voluntary.