Abstract
Introduction
Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.
Objective
To evaluate the efficacy of an iPad-based interactive educational module (iBook) in various otologic pathologies.
Methods
Patients presenting with symptoms of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. In total, 44 patients received the iBook and 22 patients served as controls. Prior to viewing the iBook, patients completed a pre-survey to assess baseline knowledge. After viewing the iBook, patients completed a post-survey to assess changes in perception and knowledge of their disease. Results were compared to that of the control group who did not receive iBook supplementation prior to being seen by the physician.
Results
Paired t -test analysis showed significant improvements (p < 0.01) in both self-reported perception and concrete understanding in various concepts when compared to pre-iBook results. This was further compared to the control group, which showed a significant gain in factual knowledge (p = 0.02).
Conclusion
Patients who viewed the iBook, personalized to their diagnosis, displayed significantly improved understanding of their condition. Increased use of interactive educational modalities, such as the iBook, can be of benefit to an otologic practice in improving patient education and satisfaction.
1
Introduction
Time constraints can prevent physicians from sufficiently addressing patients’ concerns during the office visit. Consequently, patients may become dissatisfied, confused, and frustrated, all while perceiving a reduced quality of clinical care . Physicians have also expressed dissatisfaction with this limited amount of time . Faced with time limitations, large amounts of information, and inadequate educational material, patients may not fully comprehend the nuances of their medical condition by the end of the office visit. In addition, some health systems are beginning to partly compensate physicians based on patient satisfaction and reviews. Sometimes, the patient’s satisfaction is more dependent on a subjective happiness with the visit rather than whether the treatment rendered was efficacious. This dependence of patient satisfaction on subjective issues is primarily since the surveys to measure this are sent to patients within a week or two of their visit. Therefore, the physician has to depend on other means of improving patient satisfaction through education of the patient without increasing the visit duration.
Patient-physician communication is also complicated by variations in patient education, language, and culture . Limited literacy has been shown to hinder patients’ understanding and management of their disease . In the U.S., 50% of adults have difficulty understanding medical jargon often used by physicians . Providers unaware of this issue may overwhelm patients with unnecessarily complex terminology during the visit. Additionally, psychosocial factors including a patient’s fear of judgment or condescension, may prevent the patient from revealing their lack of understanding . This miscommunication has significant consequences on patient satisfaction, treatment compliance, quality of care, incidence of malpractice claims, and likelihood of patients returning for care .
As a result, patient education continues to be a challenge many specialties. To alleviate these challenges in otolaryngology, educational pamphlets published by the American Academy of Otolaryngology were created and shown to be beneficial in patient education . Nevertheless, these pamphlets were fairly challenging to read and comprehend . Given the lack of available resources, patients often frequent websites such as YouTube or Wikipedia to augment self-education .
In an outpatient practice, there is potential for the use of interactive, electronic tools to improve patient education and streamline care. Studies have shown that using a mobile device, such as the Apple iPad, can be an effective instructional aid in academic subjects such as anatomy and pre-operative patient education . It has been well established that active engagement with interactive resources is more effective than passive reading of or listening to static informational resources .
In this study, we explored active engagement by incorporating interactive, electronic educational materials to advance patient education in an ambulatory setting. Utilizing iBooks’ display and a dynamic array of elements including animations, videos, illustrations, and photo galleries, we assessed the impact of iBook supplementation on patient understanding in four common neurotologic pathologies.
2
Materials and methods
For one month, we evaluated consecutive new patients presenting to our tertiary care neurotology outpatient practice. Only patients presenting with a chief complaint of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. Based on the chief complaint, patients were given an iBook corresponding to their pathology after checking in at the front desk. The patients then reviewed the iBook in the waiting or exam room prior to being seen by the physician. Patients were randomly assigned to two groups; one group received the iPad, while the other did not and served as the control. Surveys employed a Likert Scale to assess patients’ technological comfort level with the iPad, as well as understanding of their condition and potential treatments. Patients were surveyed about their perception of knowledge using a five-question survey. Patients’ actual knowledge was tested by five true/false questions about their disease before and after iBook review. Surveys were administered in the waiting room, and patients were subsequently seen by the physician to clarify any concerns or ambiguities from the reading. Patients in the control group received a pre-survey to assess their perception of knowledge (subjective) and actual knowledge (based on objective testing) in the waiting room. They then received a post-survey after seeing the physician to assess changes.
Although four distinct pathologies were assessed, surveys employed a similar question structure. Question 1 (Q1) of each survey addressed patient knowledge of their condition. Q2 addressed patient understanding of post-treatment expectations. Q3 addressed knowledge of treatment options. Q4 addressed understanding of the long-term treatment expectations. Lastly, Q5 addressed patient knowledge of potential risks and side effects.
Four iBooks were created on tinnitus, dizziness, hearing loss, and CI. The iBooks were developed on a 32GB iPad (4th generation) using iBooks Author, a native application found on the Apple operating system. iBooks were written by the research team using simplified lay language ( Fig. 1 ). Statistical analyses were performed using MATLAB® R2015b. t -tests used a 95% confidence interval and rejected the null hypothesis for p < 0.05.
2
Materials and methods
For one month, we evaluated consecutive new patients presenting to our tertiary care neurotology outpatient practice. Only patients presenting with a chief complaint of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. Based on the chief complaint, patients were given an iBook corresponding to their pathology after checking in at the front desk. The patients then reviewed the iBook in the waiting or exam room prior to being seen by the physician. Patients were randomly assigned to two groups; one group received the iPad, while the other did not and served as the control. Surveys employed a Likert Scale to assess patients’ technological comfort level with the iPad, as well as understanding of their condition and potential treatments. Patients were surveyed about their perception of knowledge using a five-question survey. Patients’ actual knowledge was tested by five true/false questions about their disease before and after iBook review. Surveys were administered in the waiting room, and patients were subsequently seen by the physician to clarify any concerns or ambiguities from the reading. Patients in the control group received a pre-survey to assess their perception of knowledge (subjective) and actual knowledge (based on objective testing) in the waiting room. They then received a post-survey after seeing the physician to assess changes.
Although four distinct pathologies were assessed, surveys employed a similar question structure. Question 1 (Q1) of each survey addressed patient knowledge of their condition. Q2 addressed patient understanding of post-treatment expectations. Q3 addressed knowledge of treatment options. Q4 addressed understanding of the long-term treatment expectations. Lastly, Q5 addressed patient knowledge of potential risks and side effects.
Four iBooks were created on tinnitus, dizziness, hearing loss, and CI. The iBooks were developed on a 32GB iPad (4th generation) using iBooks Author, a native application found on the Apple operating system. iBooks were written by the research team using simplified lay language ( Fig. 1 ). Statistical analyses were performed using MATLAB® R2015b. t -tests used a 95% confidence interval and rejected the null hypothesis for p < 0.05.
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