Health Literacy in Palliative Care

Tanja Bahro, Consortium Manager, Southern Metropolitan Region Palliative

Care Consortium

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• What is Health Literacy?• What are the stats?• Why is it relevant to palliative care?• What has the project done so far?• Where to from here?

Definition

 Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Healthy People 2010

WHO definitionHealth Literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.

Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions.

Thus, health literacy means more than being able to read pamphlets and make appointments

This is very wordy and doesn’t follow health

literacy principles

Only 41% of people in Australia have adequate health literacy

(a) Skill levels 3, 4 and 5 represent adequate or better health literacy.Source: Health Literacy, Australia (ABS cat. no. 4233.0)

Health Literacy

Education system

Culture and society

HEALTHLITERACY

Health outcomes

Experience with health system

Changes in the Health Care System

4 - 6 weeks bed rest

in hospital

650

3 weeks in hospital

2 hours a day of diabetic education

classes

2-4 days in hospital

(M&R Guidelines)

10,000 +

outpatient

0-3 hours diabetic

education classes

written materials internet/telemedicine

Treatment of Acute Myocardial Infarction

Available Prescription Drugs

Treatment of new onset diabetes

35 Years Ago Today

Where does it play out?

• Poorer health outcomes (increased hospitalisation and mortality)

• Decisions about life prolonging treatment• Referral to palliative care• Intake and assessment• Confusion about services involved and the

roles of the different professions

Cont.

• Self administered tools• Consenting to, understanding and following

treatment including medications• Carers ability to identify important signs and

symptoms• Accessing after hours support may result in

emergency departments• Understanding processes around death

Case example 1A 71 year old patient with bowel cancer has been prescribed regular laxatives, however even after a week still has very irregular bowel movements. When checking if the patient takes the medicines regularly, the nurse finds that the right amount of medication is missing from the packet. As a result, the doctor prescribes a stronger medication. A week later the nurse finds the patient very ill after having taken the stronger laxatives. What might have happened here?How could it have been prevented?

Case example 2

A palliative care nurse has explained wound care for a simple surgical wound to a carer. After two weeks, the wound is not healing and is infected. The nurse explains how to dress the wound again, however, the situation is worse at the next visit.

The nurse decided to employ the “teach-back” technique and finds out that the carer had been using the same swab several times over.

Challenges for palliative care

• Lack of awareness of HL issues– Assessing patients by “gut feeling” (based on socio

economic status or similar)– Underestimating the impact

• “I already communicate well with patients”• Interventions centering on the patient, not the

provider• Reliance on written material, that has not been

produced with input from consumers

What we have done

• Presentations to service management• Presentations to staff and volunteers• Competition: call for stories• Training in writing for consumers

Planned: • promotion of teach back technique• Health literacy stories to be collected

steps to enhance your interactions with patients:

• Conduct patient-centered appointments • Explain things clearly in plain language• Focus on key messages and repeat • Use a “teach back” technique to check for

understanding • Use patient-friendly educational materials to

enhance interaction.

2 key learnings

• This is about your communication too!• Do not assess someone’s health literacy

(neither by gut feeling or tests)