A Beginner's Guide to Creating Patient Handouts

So you have this idea to create a set of educational materials to help patients who have been asking you about the latest alarming disease of the day. But when you sit down to put your thoughts together, you realize you’ve never done this before. The questions mount: What should the document look like? How specific do I make it? Do I include studies? At what reading level should it be written? Should I make it poster-size and hang it up in the lobby? What about a guidebook? What exactly are the characteristics of a useful patient education resource? The tips and recommendations in this article are designed to answer these and other questions and help you work through the process of bringing your ideas for patient education materials to life.

Peter G. Teichman, MD, MPA, writing on medical documentation and malpractice, said that medical documentation is supposed to “legibly communicate pertinent information” but that physicians often “approach documentation with the goal of communicating effectively with themselves.”

His sentiments were quantified by researchers at Emory University School of Medicine (http://dx.doi.org/10.1016/j.jamcollsurg.2008.06.184; www.medicalnewstoday.com/articles/125340.php) who confirmed that doctors not only frequently approach medical documentation incorrectly, but also do the same when it comes to communicating with patients, frequently overestimating the literacy of their patient population. In one study of a 300-patient cohort whose members averaged a fourth-grade reading level, only 16% could comprehend all seven questions from the International Prostate Symptom Score. Furthermore, there’s no guarantee that relatively literate patients will possess a similar level of proficiency when it comes to understanding math and numbers. A second study using the three-question Woloshin-Schwartz numeracy quiz found that only 31% of a 266-patient cohort was numerate and that “numeracy was shown to be an independent predictor of misunderstanding.” Frustratingly, researchers also reported that carefully designed pictures did not improve patient understanding, either.

Being aware of your patients' potential literacy limitations should affect the type and complexity of the information you offer to your patients.

When gathering information, think not only of simplification—patients in the second Emory study had difficulty discerning between the quantities 33% and one-in-four, and with answering the question, “During the last month or so, how often have you had to push or strain to urinate?”—but of ambiguity. Patients with limited English proficiency interviewed by the Mayor’s Health Literacy Fellowship Program revealed that they found certain words and phrases, such as “Don’t skip a step,” to have double meanings, enabling the New York City Health and Hospitals Corporation to eliminate ambiguous words and symbols from its patient education materials.

Lay out your objectives

Limit the scope of your work. Before you begin your research, decide on a main objective. Will this resource serve as background information for a discussion during an office visit? Should it serve as an at-home reference? Will it be a comprehensive guide that covers pathogenesis, patient risks, prevention, and treatment methods for a particular disease?

Answering such questions at the outset of the document creation process will help establish an appropriate framework for the eventual finished product, allowing you to allocate your research time more efficiently and effectively. This will help you stick within the project parameters and avoid gathering too much (or overly detailed) information.

Then, stick to your plan. If you find yourself drifting into areas outside the scope of the piece, set that information aside and use it to create another resource at a later date.

Select the format

The choice of format comes down to two key factors:

Personal preference: Do you loathe brochures but love booklets? There’s not much sense in working in a medium that you can’t stand. Select the format that you think is most effective.

Method of distribution: However, keep in mind that different formats may be more appropriate than others, depending on where the material is being distributed. If you want patients to grab the material from a waiting room, a small, colorful trifold in a holder might work best to attract their attention. If you’ll physically be handing the resource to someone and explaining the information to them, bulleted, block text on a sheet of paper will keep the information right in front of them for perusing as you talk.

No matter the format you use to present information to your patients, keep in mind that this information and the way in which it is presented must not be a burden to the reader, or they won’t use the resources you give them. Again, consider what purpose you wish the piece to serve. What do you want the patient to do with the information on their own? How much do you want them to rely on you as a resource? Format will dictate how you are able to leverage information in order to meet these goals.

Research your material

Whether you’re building a new piece from scratch or you’re updating a pamphlet or brochure you’ve been using for years, the best place to start your search is the public domain. The depth and breadth of healthcare information presented on the websites of the CDC, the NIH, the AHRQ, and organizations such as the American Heart Association and American Cancer Society, makes it perfect source material for patient handouts—it’s already been extensively vetted and designed with the patient in mind. These resources offer a wealth of condition- and disease-specific information online, including disease histories, geographic and demographic data, risk factors, prevention, diagnosis, treatment, side effects, complications, and new research.

However, if your requirements call for more specialized content, you can turn to the professional literature and medical journals for more in-depth information (just remember that you will have to do quite a bit of work to interpret and contextualize this information for most patients). Physician-authored blogs are also an increasingly popular resource for assessing current opinion on new developments in a particular field and sharing anecdotal information.

Depending on your practice setting, you may have to submit your materials to a review process before you are allowed to give them to patients. Even if that is not the case, it’s never a bad idea to consult with colleagues and other experts before you finish work on your project. Their insights, suggestions, and perspectives will allow you to see your subject from new angles and help improve the quality and educational value of the resource.

Creating copy

Don’t be afraid to run long in your first draft. Now is not the time for brevity! You’ll be trimming and editing the piece regardless of how succinct you believe yourself to be. Besides, starting with too much information is a good way to separate wheat from chaff while ensuring you cover all the bases. (Mixed metaphor alert!)

Although editing for space is essential, remember that “concise” is not always synonymous with “effective.” Though a patient’s attention span and ability to process information might be shorter and poorer than you’d like, use that to your advantage. Strike a balance between a Twitter post and the Encyclopedia Britannica and make every word count.

What about outsourcing?

Many physicians view the creation of patient education materials as part of their duties as healthcare professionals and therefore would not seek the aid of a freelancer for such a project. Others might not want to cede control over the creative process. For others, the issue may be as simple as money—why pay someone to do something that you can do yourself?

But time is also money, and not everyone is interested in adding “writer” and “artist” to their job description. In that case, why not simply take advantage of all that information available online and find some ready-made patient education materials for use in your practice? While there are many excellent tools and resources for patients available online, many physicians report that one size definitely does not fit all, and that materials customized to the unique needs of their patients can often make a big difference in whether and how the patients use that information.

More food for thought: The one successful method tested by Emory researchers to improve patient understanding was a computer-based program through which a figure spoke to patients and asked the same questions that were on the International Prostate Symptoms Score questionnaire. The program improved understanding for all patients at all educational levels. If you are interested in learning more about creating multimedia patient education resources, the UNC-Chapel Hill Health Sciences Library’s Media Design Studios offers step-by-step guides on creating animations, websites, posters, presentations, brochures, and digital images. These additional skills can help you better communicate with patients who may not respond to traditional means of information delivery.

Improving organization

Don’t let all your hard work go to waste because you lost the latest version of your project due to a computer crash, or because you saved it “somewhere” and now can’t find it on your hard drive. Good filing and data backup practices are a must. Collecting all versions of your files in folders organized by topic type gathers all related items in one place. Subfolders or a standardized file naming practice will compartmentalize raw data and source material, working, and finished documents, as well as format types and older versions of since-updated materials.

In an environment where numerous people have access to the same materials, a well-managed filing system will prevent one person’s modifications from altering the preferred aspects of a document for someone else. Additionally, well-kept records allow you to assimilate multiple projects into more complicated efforts, and also make it easy to refer to previous work when modifying and updating your materials.

Further, keeping hard copy records in a similar filing system keeps extra materials handy and can serve as a physical backup if any electronic snafus occur.

Well-planned and executed patient education materials are an important component of the physician-patient communication process. Although there are many useful resources available online from trusted sources that you can use in your practice, you may find that it is more than worth it to take the time to create customized materials with the unique educational needs of your patient population in mind.

Brad Schmidt is a former MDNG editor and a freelance healthcare writer. His article “Where Do We Go from Here? A Health 2.0 Progress Report” appeared in the January 2009 issue of MDNG: Primary Care/Cardiology Edition.