Reducing The Negative Impact of Stress on Patient Education

Consider any one of the millions of individuals who visit their doctor annually and are informed that they will need to undergo an unexpected medical procedure. It could be a routine treatment like a colonoscopy, a non-routine operation like back or heart surgery, or anything in between. Anytime a patient must undergo a medical procedure there are a number of pre-operative, perioperative, and post-discharge steps that must be followed. Often patients must alter their diets and physical activities prior to (and following) a procedure. Once admitted to the clinic or hospital on the day of the procedure, the patient follows a number of well-defined, sequential steps to prepare for what’s next. Understanding risks associated with a procedure, receiving medications and anesthesia administered by a care team, and undertaking the actual procedure are each a critical part of the whole patient perioperative experience. And no matter how many times a patient might have faced such an intervention before, the unfamiliar environment combined with the inherent complexities and gravitas of personal health leads to significant stress and anxiety. Simply put, stress and anxiety are detrimental to patient education.

Though it lasts a few hours at most, a medical procedure is often only a small part of the entire patient journey. The post-procedural transition and road to recovery can be as complex, uncertain and stress-inducing as the procedure itself. Once patients leave the clinic or hospital, patients may be instructed to take medication, modify their diets, or follow a specific physical rehabilitation regimen, for instance. The reality is there is a good reason why well-educated patients are proven to have better outcomes and are better able to manage their own health over the long term. At every stage of the patient journey, and through every transition, preparation is key. In its entirety, there is extensive knowledge that patients’ need education during and after the course of treatment, as well as a number of steps that they must follow for any procedure to be measured as a success.

The typical approach is to send the patient home from the doctor with several pages of text that outline the various pre-operative instructions, procedural aims and risks, and post-operative guidelines . The patient is asked to read this information, to follow the instructions, and to reach out with any questions.

From a learning science perspective—the marriage of psychology and brain science—this is a suboptimal approach, even in the absence of stress or anxiety. The patient is overwhelmed with information, is expected to process all of it, and to have the introspective ability to know what they understand and what they do not. A better approach is to provide information in shorter, more digestible lessons, an approach called microlearning. Each module can convey one or two critical pieces of information in 5 to 10 minutes. This information can be followed by brief periods of “downtime” (as little as a minute or 2) that facilitate memory consolidation. Several microlearning modules can be presented to the patient and this can be followed by a knowledge check to determine which lessons were learned, and which were not. A knowledge check can be used to identify information that should be retrained in the next microlearning module, which can then be followed by the presentation of new information. This periodic testing and retraining approach ensures that foundational information presented early in learning is well established in the patient’s brain, so that more information can be layered on top of it. Taken together, this approach is referred to as spaced microlearning with periodic testing and retraining. This ensures strong memory representations for patients that are less susceptible to forgetting.

Now let’s layer the effects of stress and anxiety onto the patient education problem. Let’s face it, a patient who is informed that they need a medical procedure is going to be anxious and have stress. They are going to be filled with uncertainty. They are going to wonder about aspects of the hospital visit that are impossible to predict, and, unbeknownst to them, will have little-to-no impact on their overall experience. What is the preoperative patient waiting room like? What will they wear and who can wait with them? What is the operating room like? Is there a recovery room? Will they experience pain and for how long? What else can they expect that they have not considered?

Spaced microlearning with periodic testing and retraining is highly effective when a patient is stressed or anxious, but these effects can be mitigated even more if the microlearning modules incorporate storytelling. Perhaps you have a series of storytelling-based microlearning modules where you follow the journey of a typical patient during their pre-operative, perioperative, and post-operative phase. These could include a mix of text, video and animation. Your patient guide might walk you through the necessary changes in diet and exercise prior to the operation. They even give you a few clues on how those changes might make you feel. Next, you follow along with the patient as a nurse gives you both a tour of the hospital setting. You see the preparation room, the surgical room, and the recovery room. A nurse introduces you to all the gadgets you might come across during your experience, and even to the “scary-looking” machines that you need not worry about. But just in case, she’ll go over what to expect, and perhaps even how to use your trusty call button if and when necessary during recovery. Finally, you spend an afternoon with the patient while they are recovering at home. They show you all of the medicine that they take and dietary restrictions, and talk about being a little weak, but all in all feeling pretty good. They might reassure you that they are on the road to recovery, one step at a time — and that soon enough, you will be too.

With spaced microlearning and periodic testing, and retraining grounded in storytelling, you “learn through experience”. This broadly engages multiple learning and memory systems in the brain in synchrony while reducing the likelihood of forgetting. This reduces the deleterious effect of stress on learning, while simultaneously reducing patients’ stress and empowering patients every step of the way.

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