It is no surprise that our patients do not always know and understand about cardiovascular disease prevention and management. How can we help them access and apply accurate, evidence-based strategies when they face of sea of easily available, and sometimes dangerous, misinformation available at their fingertips, or from well-meaning friends and family?

Through the power of patient education.

Information Overload and Bias

Before, after, or instead of a clinical visit, many patients rely on health information that they acquire from the internet or well-meaning family members and friends.

A typical internet search for anything—including medical information—can lead to a list of hundreds, thousands, or millions of websites, videos, blogs, podcasts, and other information sources. The quality of search results can vary from providing information that is from trusted and verified sources to information that lacks accuracy and may also be biased.

The onus is on the user to wade through the abundance of options and determine which resources to access. The sheer volume of options may lead the user to select the item at the top of the screen, assuming (sometimes erroneously) that it is the best and most trusted option.

Conflicting information is possible when a user visits more than one site. This may lead not only to confusion on the user’s part but also may lead the individual to give up finding out information entirely due to frustration.

As humans, we also put great stock into what we learn from one another. One person sharing their experience—or even information that they have learned second or third-hand—may have a substantial impact on a patient as it may be perceived as unbiased and truthful information, even if that is not the case.

In clinical settings and the interactions between visits, ensuring that patients have access to information without overloading them can be a delicate balancing act. Patients can often immediately forget 40-80% of the medical information they receive—and what is remembered is recalled at 50% accuracy, at best. Individuals who are older, anxious, and with lower levels of education and health literacy may have more difficulty in recalling medical information—particularly when there is a large amount of information imparted to them.

To overcome these issues, clinicians should:

• Maintain a friendly and open attitude with patients
• Speak at a moderate pace
• Allow for patient questions (without interruptions)
• Prioritize needed information
• Limit the discussion to 3 to 5 key points
• Reinforce what’s been discussed
• Share appropriate resources and follow up as needed.

The Importance of Trust and the Role of the Nurse

Nursing continues to be the most trusted profession. Nurses can share information that patients see as unbiased and trusted. Nurses spend more time with patients and their families than other healthcare professionals. Nurses often utilize methods such as teach-back and active listening to ensure that the information that they are working to impart is actually understood.

As healthcare professionals, we help patients understand information, weigh their options, and determine which strategies may work best for that particular individual. When patients arrive at a telehealth or in-person visit with an array of information that they’ve acquired from verified or not-so-trustworthy sources, it is important to engage them in a dialogue that affirms their efforts in learning more about their health while gently identifying reliable information that can be used in shared decision-making.

The Impact of Health Literacy

In clinical practice, being mindful of differing levels of health literacy can help improve patient outcomes. For patients with cardiovascular disease (CVD), low health literacy is significantly associated with increased mortality, hospital readmission, and decreased quality of life.

The US government’s initiative, Healthy People 2030, identifies two types of health literacy.

• Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Rather than just understanding health information, the emphasis is on whether a person can use it and make well-informed decisions. And the role of healthcare professionals and organizations is part of that equation. Examples of useful strategies to aid in understanding may include:

• Using plain language
• Utilizing the patient’s preferred language and communication channels
• Using culturally and linguistically appropriate language

Language

If you’ve ever visited a location where those around you spoke a different language or even happened upon a show or movie in a different language without subtitles, you may have felt at a loss even to understand a small amount of the information presented. For many patients, this is their experience in following a conversation or resource about their health or a particular disease.

For individuals whose primary language is not the one that is spoken by providers or written in patient education materials, misunderstandings can easily occur. While a trusted family member or friend may serve as a translator in patient-provider conversations, interpreting medical information can lead to confusion and impact shared decision-making. Some clinical practices or health systems utilize an in-person, live online, or even subscription service to communicate with their patients about complex topics effectively.

The Power of Patient Education

As each patient is different, the strategies we use in clinical practice to help them learn more about cardiovascular disease risk and disease management can also vary. Nurse-led interventions can positively impact a patient’s quality of life.

Like other healthcare providers, nurses have access to resources for clinical practice to help explain health-related concepts, describe diseases, and illustrate options for treatment. Resources include print or digital sheets, booklets and charts, models, videos, and more. A clinical decision aid, for example, may provide details in the form of graphs or illustrations that can amplify the information being shared verbally by the healthcare provider. An illustration of 100 human figures, with a particular number in a different color, can help illustrate the prevalence of the disease and help the provider and patient discuss the efficacy of available treatments.

Patient education information and clinical decision tools can help guide the clinical conversation. They can provide key points of discussion, support what is described verbally, and can even be personalized for the patient by circling items on which to focus or adding medication names/dosing instructions and other details.

Take-away references for patients, families, and caregivers allow for reinforcement of concepts discussed during the clinical visit and may provide additional information that was not covered during the visit due to lack of time. Many include checklists for patients to complete and even bring to the next clinical visit (e.g., symptom tracking, a list of side effects experienced, behavior change actions that the patient has taken, etc.).

Digital resources may be shared in the context of the clinical visit, as well as sent via email or even as an attachment in the electronic health record for patients to access. This may spur additional discussion about a topic, galvanize a patient’s knowledge about a subject, or help them remember details that were discussed but they cannot recall from a visit.

Embracing Technology

Behavior change can be supported and amplified when information is easily available, capitalizes on an individual’s interest in engagement and competition (e.g., gamification), has imagery that reflects the intended audience, and is provided in a language that is easy to understand.

The digital gap continues to shrink, and more patients than ever have access to smartphones and computers. While sharing information via digital means may not work for every patient, having digital resources easily available and able to be shared can positively impact many patients and their families.

Some methodologies to incorporate include:

• Instructional and Informational videos
• An interactive education with quizzes
• Apps
• Online communities
• Interactive games
• Podcasts

Clinical Takeaways

• Meet patients where they are and engage them in the conversation.
• Communicate clearly, avoiding medical jargon whenever possible.
• Utilize strategies to enhance learning and application: summarizing, teach-back, questioning, etc.
• Provide information and resources that are culturally relevant and in a language easily understood by patients and families.
• Utilize technology when appropriate.

Patient Education Resources

• PCNA patient tools and handouts

References

1. Jacot A. Patient Education & Information Overload: How Much is Too Much? Cardiology Advisor. July 31, 2023. Accessed Oct. 2, 2023.
2. Kanejima Y, Shimogai T, Kitamura M, Ishihara K, Izawa KP. Impact of health literacy in patients with cardiovascular diseases: A systematic review and meta-analysis. Patient Education and Counseling. 2022;105(7):1793-1800. doi: 10.1016./j.pec.2021.11.021.
3. Onyinyechi Nwosu W, Rajani R, McDonaugh T, et al. The impact of nurse-led patient education on quality of life in patients with heart failure. British Journal of Cardiac Nursing. 2023;18(5). Doi:10.12968/bjca.2022.0040