Guest Blog by Andrew Jesse Brown (CUNY SPH)
In a recent podcast, Dr. Martin Zielinski, trauma surgeon and Assoc. Professor of Surgery at the Mayo Clinic (Rochester, NY) discusses the results of his research on effective patient discharge communication. He studied how well trauma patients understand discharge instructions. Dr. Zielinski’s study of trauma patients at discharge hypothesizes that the presentation of concussion may effect a patient’s ability to comprehend discharge instructions.
I propose that health communicators ought to be sensitive to a variety of factors when designing discharge materials for a target audience such as audience demographics (e.g., age, preferred language, level of educational attainment, religious/spiritual preference), situational attributes (e.g., what settings is the care transition involving, who are the agents involved in the patient’s care), and socio-environmental factors (e.g., is the patient willing and able to follow the care instructions they are given). What other factors could health communicators be sensitive to when designing messages, specifically discharge materials, for a target audience?
If you’re attending our Communicating Public Health class this semester at Hunter, this podcast episode may have seemed particularly resonant with our discussions in Class 2 and 3 about health literacy and models of effective communication. The podcast also ties in with the Zarcadoolas, Pleasant, & Greer article regarding an expanded model of health literacy. Readers seeking additional information on the topic may also be interested in the research of Eric A. Coleman, an expert who has performed quality assessments of the patient discharge experience. The discussion with Dr. Zielinski underscores an important consideration in health communication: the ability of the audience to understand. The audience’s ability to understand cannot be overestimated by those who intend to facilitate effective discharge instruction. Communicators should never assume they are always understood.
Readability — the level at which material is prepared for the general public — is typically qualified by grade level of educational attainment. The American Medical Association recommends that material prepared for the public should be readable at a 6th to 8th grade “reading level”. As a result of Dr. Zielinski’s disciplinary analysis of the readability of their discharge materials, the Mayo Clinic now targets its trauma discharge instructions to be readable at a 6th grade literacy level. In fact, the study’s results has led other departments at the Mayo Clinic (plastic surgery, for example) to revise their discharge materials with the end-users’ readability in mind.
Considering communication through the lens of a dynamic constructivist model allows for the development of appropriate, informative, multidisciplinary, multifaceted, high-touch, consistent and repetitive communication through which effective discharge and care coordination may be realized. The commentators in the discussion suggest this could be positive or negative. On the one hand, a more integrated system provides greater aptitude for change. On the other, more cooks in the kitchen leads to a higher likelihood of mishandling, more cracks for patients and patient care to fall through, and so on.
What is your impression on the issue?
Have you ever been bewildered by discharge materials after an encounter with an inpatient situation? If there was one thing you could change when it comes to discharge materials, what would it be and why?