The Teach-Back TechniqueCommunicating Effectively With Patients

Table of ContentsWhat Is the Teach-Back Technique?. 3Why Use the Teach-Back Technique?. 3Health Care Provider Factors. 3Patient Factors. 4How Do You Teach-Back?. 5Cautions. 6Interactive Activities. 7Discussion Questions. 10Conclusion. 11Tips for Implementing the Teach-Back Technique 11References. 12

What Is the Teach-Back Technique?Health Care Provider FactorsTeach-Back is a communication techniqueused to help patients remember andunderstand the important informationregarding their diagnosis, treatment, ormedication. The Teach-Back techniqueinvolves asking patients to recall andthen explain or demonstrate the importantinformation discussed during an interactionwith their health care team. This techniquecan be used any time a health care teammember interacts with patients. Using theTeach-Back technique may increase thelikelihood that patients will better understandinformation and instructions.1 Difficulty simplifying complex orconfusing medical terms or concepts Limited time for discussion Having to communicate a lot ofinformation at once Overestimating the patient’sunderstanding of informationThis booklet will provide you with helpfultips and interactive examples of the TeachBack technique to assist you in your dailyinteractions with patients.Why Use the Teach-BackTechnique?Among patients who could recallPoor communication between health careproviders (HCPs) and their patients is acommon problem. It may result in a lack ofunderstanding by the patient about his orher diagnosis and treatment. The reasonsfor these communication problems varyand may include the factors in the followingsection.2–4their doctor’s instructions,nearly half of the patientsremembered the informationincorrectly53

Research shows that HCPs commonly encounter situations in whichthe patient does not understand the information presented. One survey of patients found up to 47% said they forgot what their doctorhad instructed them to do after leaving the office7 Another survey found that when patients were asked to recall informationgiven by the health care practitioner (HCP), almost 50% remembered theinformation incorrectly6Research shows that using the Teach-Back technique works to improvepatient understanding, which may lead to better patient compliance andoutcomes Patients with diabetes whose HCPs used the Teach-Back techniquedemonstrated significantly better diabetes control7Patient Factors Lack of understanding ofmedical jargon or technicalinformation Age (eg, lower healthliteracy levels and cognitivedecline among the elderly) Language (English maynot be the patient’s primarylanguage)Nervousness caused by being in the doctor’s officeEmotional response to the diagnosisMalaise or lack of focus caused by the illnessMedications affecting memory or cognition, such aspain medication or sleep aidsThe use of communication methods such as the TeachBack technique allows the patient to demonstratecomprehension of what was discussed during the courseof the visit and gives the patient ownership regarding hisor her health care.1 Patients who better understand theirdisease and treatment may be more compliant with itsmanagement, which may reduce mistakes or their needto call the practice for clarification.94Patients using inhalerswho engaged infeedback withtheir HCP usedthe inhalercorrectly over80% of the time8The DiseaseWe covered a lot today aboutyour diabetes, and I want tomake sure that I explainedthings clearly. So let’s reviewwhat we discussed. What are 3things you can do that will helpyou control your diabetes?I want to make sure we areon the same page. Can youexplain to me what your stepsare when you get home?How will you explain yourtreatment plan to your wife/husband when you get home?What are some of the signs youneed to watch for that tell youwhen to take your medicine?

How Do You Teach-Back?Performing the Teach-Back technique is simple and should not add substantially more time to yourpatient visits. Here are some things to keep in mind when communicating with patients.3,4Explain: Using your standard approach, explain to the patient the information regarding thedisease and the course of treatment, and provide instructions about how to properly take his or hermedications.Teach-Back: During the interaction, ask the patient to explain or demonstrate how he or she willperform the recommended treatment, monitor the disease, or take the prescribed medication.Assess: If the patient cannot explain or demonstrate what he or she should do, or if the patientdoes so incorrectly, you must assume that the patient did not fully understand your instructions. Repeat: Reintroduce the concepts you presented previously. Consider the following:— Use simpler language— When discussing timing, number of pills, or other details related to taking medication, allowextra time for patients to ask questions— Break up information into smaller segments. This allows the patient to focus on lessinformation at one time Reassess: Ask open-ended questions until you feel confident the patient understands therelevant information you wanted to convey. Open-ended questions are an effective way toengage the patient. Here are some examples of open-ended questions:The Medication/Treatment Tell me in your own words how you will take this medicine at home. When you get home, how many pills will you take? What time will you take them? What are some of the side effects to watch for with this medicine? What should you do if the side effects become severe? Tell me when you should refill this prescription. Please show me how you will use the glucose meter. When during the day should you take your medicine? Because you have to take several of these pills, what will you do if you miss one of your doses? When is the best time for you to monitor your blood sugar level? Show me how you will do that. Please tell me how many other medicines you are currently takingand when you take them during the day.5

CautionsBe aware of, and try to avoid, these common mistakes when using the Teach-Back technique10: Quizzing the patient at the end of the examination or conversation Using medical jargon, highly technical terms, or language that you think the patientwill have difficulty understanding Appearing rushed, annoyed, or bored during these efforts Asking patients questions that require only a simple yes or no answer, such as— Do you understand?— Do you have any questions?— Do you know how to use the device?— Do you know when to take this medicine?— Are we clear on the treatment steps?6

Interactive ActivitiesThis section contains HCP–patient conversations that will demonstrate both successful andunsuccessful examples of the Teach-Back technique. After reading through the conversations,write down some examples showing when the Teach-Back technique was used. Also, suggestways the conversation could have been conducted differently.Interactive ActivitiesInstructions:Highlight or underline some examples of the Teach-Back technique in the followingconversations.List some changes that would make the conversation more interactive with the patient.Interactive Exercise 1:Mrs. Miller was brought to the emergency room aftersuffering a hypoglycemic episode. She is a 54-year-oldwoman who has had type 2 diabetes for 3 years. She hasa history of poor glucose control. Below is an example ofa conversation between an HCP and Mrs. Miller at herdischarge.HCP: I am concerned about managing yourglucose levels. Do you understand howimportant it is that we adequately monitor yourblood glucose?Mrs. Miller: Yes.HCP: How will you take your medicine?Mrs. Miller: I will take 2 pills a day.HCP: Yes. Make sure to measure your blood inthe morning and before you go to bed. Do youunderstand?Mrs. Miller: Yes.7HCP: Make sure to take your medicine on time,and keep on top of monitoring your glucoselevels. Control of your glucose levels is veryimportant.Mrs. Miller: I understand. Is there anythingelse I can do to help keep my diabetes undercontrol?HCP: Diet and exercise are very important. Anymore questions? Do you understand everythingelse we went through?Mrs. Miller: I think so.

Interactive ActivitiesInteractive Exercise 2:Mr. Reynolds has just received an initial diagnosis of type2 diabetes after a routine visit revealed elevated glucoselevels. He is a 48-year-old overweight man with no othersignificant medical history. Below is an example of aconversation between an HCP and Mr. Reynolds as he isabout to leave.HCP: Do you have any questions about whatwe’ve gone over today?Mr. Reynolds: No, I think I understandeverything we’ve discussed.HCP: Just to be safe, I want to ask you acouple of questions. Diabetes can be a complexdisease, and we covered a lot of information.Can you explain some of the changes wedecided on today during your visit?Mr. Reynolds: I am going to reduce theamount that I eat and try to make better foodchoices, and I am going to try to walk for 30minutes every day. Also, I’m going to take thepills you prescribed every day.HCP: Do you know why it’s important that youdo all of these activities and not just one?Mr. Reynolds: Yes, I need to lose some weightso the medicine will work.8HCP: It’s important that you take the medicinecorrectly. Can you tell me how you will take themedicine?Mr. Reynolds: I need to take 1 large pill withbreakfast and another with dinner. I take theother pill once a day, in the morning.HCP: Do you know when and how to measureyour blood glucose?Mr. Reynolds: Is that the same thing as myblood sugar?HCP: Yes, yes, same thing. Do youunderstand?Mr. Reynolds: Yes, I know how to check myblood sugar.HCP: Great. I have to go see my next patient.Call the office if you have more questions.

Interactive ActivitiesInteractive Exercise 3:Mr. Williams was brought into the emergency room after complaints of shortness of breath andmild indigestion. He was diagnosed with a myocardial infarction; a stent was placed, and he isabout to be discharged. He is a 57-year-old man with a history of elevated cholesterol and type2 diabetes. Below is an example of a conversation between an HCP and Mr. Williams at hisdischarge.HCP: Here are your prescriptions. Take 1 ofthese pills for your cholesterol, and take 1 ofthese 2 times a day for your diabetes. Now, Iwould like to ask you some questions to makesure I’ve explained everything clearly. Is thatokay with you?Mr. Williams: Yes, that would be helpful.Thank you.HCP: Proper food choices, portion control, andregular exercise can greatly help both yourdiabetes and your high cholesterol. Can you tellme why?Mr. Williams: Losing weight will make themedicine work better.HCP: Not exactly. Eating better will help preventlarge swings in your blood glucose and helpnaturally lower your cholesterol. It will alsohelp you to lose weight, which will help yourdiabetes. Do you know what signs you need towatch for to tell if the medicine isn’t working?Mr. Williams: If my blood sugar tests are over300, I should call the office.9HCP: To make sure we help avoid thesecomplications, would you explain to me howyou will take your medicine at home?Mr. Williams: I take 1 pill a day for my diabetesand 2 pills a day for my cholesterol: 2 pills in themorning and 1 pill in the evening.HCP: You only need 1 pill for your cholesterol.You can take it any time during the day. Whenwill you take your cholesterol pill?Mr. Williams: I will take the cholesterol pill inthe morning with breakfast.HCP: You need to take 2 diabetes pills—1 pillwith breakfast and 1 pill with dinner. Can you tellme when you will take your pills?Mr. Williams: I will take 1 cholesterol pill and1 diabetes pill with breakfast. I will also take 1diabetes pill with dinner.HCP: It sounds like you’ve got it. Justremember that even when you start feelingbetter, you should still continue taking yourmedications. Call us in the office if you haveany other questions.

Discussion QuestionsThe following questions may be useful for the interactive exercises:1. Did the HCP appropriately prepare the patient for receiving the necessary information?What could have been done differently?2.Was the Teach-Back technique used in this exercise? Was it used effectively?3.Were there places where the Teach-Back technique could have been used moreeffectively? What might the revised approach sound like?4.Did the HCP use open-ended questions? What other open-ended questions couldbe used?5.Were the HCP’s approach and behavior appropriate? What would you have changed?6. Should the HCP feel confident that the patient sufficiently understood his or herinstructions?7.———8.Was the HCP’s follow-up to the patient’s response appropriate?Did the HCP use the Teach-Back technique in his or her follow-up?Did the HCP sufficiently change his or her teaching approach in the follow-up?Did the HCP use open-ended questions?What other techniques might have been effective in reinforcing the patient’s understandingof the information discussed?Your ChallengeWhat 2 or 3 things can you take from what you have learned about the Teach-Back technique andstart applying tomorrow?10

ConclusionThis workbook has been provided to help you explore the Teach-Back communication techniquein the context of a patient–provider relationship. Improving communication helps HCPs getthe most out of each interaction they have with their patients—which benefits