Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology

• Published in: PloS one 2018-02, Vol.13 (2), p.e0191940-e0191940
• Main Authors: Laws, M Barton, Lee, Yoojin, Taubin, Tatiana, Rogers, William H, Wilson, Ira B
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory care; Ambulatory Care Facilities - organization & administration; Analysis; Biology and Life Sciences; Clinical decision making; Communication; Data collection; Decision making; Diabetes; Emergency medical services; Female; Health care policy; Health services; Humans; Information management; Male; Medicine; Medicine and Health Sciences; Mental Recall; Methods; Middle Aged; Multivariate analysis; Organizational Innovation; Patient care; Patient satisfaction; Patients; People and Places; Physicians; Public health; Recall; Social Sciences
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0191940

While some studies have assessed patient recall of important information from ambulatory care visits, none has done so recently. Furthermore, little is known about features of clinical interactions which are associated with patient understanding and recall, without which shared decision making, a widely shared ideal for patient care, cannot occur. Our objective was to evaluate characteristics of patients and outpatient encounters associated with patient recall of information after one week, along with observation of elements of shared decision making. This was an observational study based on coded transcripts of 189 outpatient encounters, and post-visit interviews with patients 1 week later. Coding used three previously validated systems, adopted for this study. Forty-nine percent of decisions and recommendations were recalled accurately without prompting; 36% recalled with a prompt; 15% recalled erroneously or not at all. Provider behaviors hypothesized to be associated with patient recall, such as open-questioning and "teach back," were rare. Patients with less than high school education recalled 38% of items freely and accurately, while patients with a college degree recalled 65% (p < .0001). In a multivariate model, the total number of items to be recalled per visit, and percentage of utterances in decision-making processes by the provider ("verbal dominance"), were significant predictors of poorer recall. The item count was associated with poorer recall for lower, but not higher, educated patients.