Mariano E. Menendez|Bastiaan T. van Hoorn|Michael Mackert|Erin E. Donovan|Neal C. Chen|David Ring
Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons
Massachusetts General Hospital|Harvard University|Tufts Medical Center|Tufts University|Massachusetts General Hospital|Harvard University|The University of Texas at Austin|The University of Texas at Austin|Massachusetts General Hospital|Harvard University|Massachusetts General Hospital|Harvard University|The University of Texas at Austin
background midst rapid expansion medical knowledge decisionsupport tools intended benefit diverse patients patients limited health literacy ability obtain process understand information services make health decisions benefit asking questions engaging actively care little known regarding relationship health literacy questionasking behavior outpatient office visits questionspurposes 1 patients lower levels health literacy ask fewer questions general stratified types questions 2 patient characteristics associated number questions asked 3 often surgeons prompt patients ask questions office visit methods audiorecorded office visits 84 patients visiting one three orthopaedic hand surgeons first time patient questions counted coded using adaptation roter interaction analysis system 11 categories 1 therapeutic regimen 2 medical condition 3 lifestyle 4 requests services medications 5 psychosocialfeelings 6 nonmedicalprocedural 7 asks understanding 8 asks reassurance 9 paraphrasechecks understanding 10 bid repetition 11 personal remarkssocial conversation directly visit patients completed newest vital sign nvs health literacy test sociodemographic survey including age sex race work status marital status insurance status three patientreported outcomes measurement information systembased questionnaires upperextremity function pain interference depression nvs scores divided limited 03 adequate 46 health literacy done tools creators also assessed whether surgeons prompted patients ask questions encounter results patients limited health literacy asked fewer questions patients adequate health literacy 5 4 versus 9 7 mean difference 4 95 ci 7 1 p 0002 specifically patients limited health literacy asked fewer questions regarding medicalcare issues therapeutic regimen 1 2 versus 3 4 mean difference 2 95 ci 4 1 p 0001 condition 2 2 versus 3 3 mean difference 1 95 ci 3 0 p 0022 nonwhite patients asked fewer questions white patients 5 4 versus 9 7 mean difference 4 95 ci 7 0 p 0032 patient characteristics associated number questions asked surgeons occasionally 29 2484 asked patients questions encounter patients 79 1924 asked questions conclusions limited health literacy barrier effective patient engagement hand surgery care increasingly tangled healthinformation environment important actively involve patients limited health literacy decisionmaking process encouraging questionasking particularly practice settings decisions preferencesensitive instead assuming patients understand told orthopaedic surgeons may take universal precautions assuming patients understand unless proved otherwise level evidence level ii therapeutic study