Teach-Back: An Effective Patient Education Strategy

Teach-back is an evidence-based method of ensuring that a patient or caregiver understands the information being discussed and their responsibilities by cordially asking them to explain in their own words what they need to know and/or do. It is not a test, but rather a measure of how well a clinician or staff member has explained something to a patient or caregiver. The clinician or staff member checks for understanding and reexplains when needed, then rechecks understanding after each explanation.
 

Improving Patient Understanding Takes Time to Learn

Clinicians are commonly surprised that patients initially have trouble explaining what they need to know or do in their own words. As clinicians start using teach-back, they begin to adjust their explanations and learn what does and does not work to increase patient understanding.
 

Replacing Yes/No Questions With Teach-back Questions

The key to teach-back is asking nonjudgmental open-ended questions rather than close-ended yes/no questions. Examples include: 

• I want to make sure I’ve explained everything clearly. Can you explain it back to me so I can make sure I did?
• We’ve gone over a lot of information. In your own words, can you review with me what we talked about?

Teach-back is the responsibility of everyone in a healthcare organization, from the staffer registering the patient to the practitioner examining the patient.
 

Risk Recommendations: Commit to Using Teach-back in Your Organization

Encourage teach-back to evaluate patient understanding of education and instructions. 

• Advise clinicians to use teach-back and plain language as tools to improve explanations. 
• Recognize that acquiring new skills takes time and can initially extend patient visits as clinicians gain teach-back experience.
• Advise clinicians to slowly incorporate teach-back into their routine. 
  • Consider starting with the last patient visit of the day to give the clinician enough time to adequately check the patient’s understanding and reexplain when necessary.
  • Start using teach-back for high-risk health literacy situations, such as informed consent and care transitions. 

Train and coach clinicians and staff. 

• Observe patient interactions to evaluate teach-back competency. 
• Consider using a checklist or observation tool to guide coaching conversations. 
• Determine trainee conviction and confidence with teach-back before training, then at one- and three-month intervals after training. 

Prepare the healthcare team for lack of patient understanding. Advise them to:

• Rephrase if the patient does NOT understand. Do NOT simply repeat.
• Ask for teach-back until you are comfortable that the patient really understands. 
• Consider other strategies if the patient is unable to teach-back after several tries. For example:
  • Include a family member.
  • Take a break or schedule another time.
  • Ask a colleague to explain instead. 

Sustain teach-back use. 

• Include teach-back in clinical competencies, policies, and procedures. 
• Require teach-back documentation in patient records. For example, use a “patient/family able to teach-back the plan/goals” or similar prompt to document teach-back use. Provide a drop-down menu of answers, including “yes,” “no,” and “partially.” 
  • Audit medical records for teach-back documentation. 
• Ask patients to document teach-back on plain language consent (permission) or refusal forms. 
• Check in with clinicians and staff at defined post-training intervals to determine if they are still using teach-back. If not, provide another round of training and coaching.

 

Resources

Agency for Healthcare Research and Quality

• Always Use Teach-back Training Toolkit
  • 10 Elements of Competence for Using Teach-back Effectively
  • Coaching to Always Use Teach-back 
  • Conviction and Confidence Scale
  • Interactive Learning Module
  • Teach-back Observation Tool
  • Why Use Teach-back? A Patient Story–Inadvertent Overdose

Health Literacy Research and Practice 

• Perception Versus Reality: The Use of Teach Back by Medical Residents
• The 5 Ts for Teach Back: An Operational Definition for Teach-Back Training

Teachback.org

• Teach-back Presentation (train-the-trainer)
• Teach-back Checklist

Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.