Evaluating Teach Back as a Method for Improving Self-Care Behaviours in Heart Failure Patients

The recruitment status of this study is unknown because the information has not been verified recently.
Verified February 2011 by St. Michael's Hospital, Toronto.
Recruitment status was  Active, not recruiting
Sponsor:
Information provided by (Responsible Party):
St. Michael's Hospital, Toronto
ClinicalTrials.gov Identifier:
NCT01311583
First received: February 22, 2011
Last updated: January 18, 2013
Last verified: February 2011
  Purpose

Patient education using Teach Back has the potential to increase self-care behaviour in heart failure (HF) patients and reduce adverse clinical outcomes. Teach back is an interactive teaching method that uses plain language, focuses on key points, and asks the patient to verbally recall information just discussed. Questions are asked to confirm patient understanding of the information delivered.

This pilot study will be conducted to evaluate the effectiveness of teach back on self-care (as measured by the European Heart Failure Self-Care Behaviour Scale- EHFScBS) and determine if teach back affects the number of ER visits and re-admissions post discharge. The study will also assess if teach back technique is a feasible, acceptable and sustainable method of discharge teaching for hospitalized HF patients at St Michael's.


Condition Intervention
Heart Failure
Behavioral: Teach Back method of patient discharge teaching

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Supportive Care
Official Title: Evaluating Teach Back as a Method for Improving Self-Care Behaviours in Heart Failure Patients

Resource links provided by NLM:


Further study details as provided by St. Michael's Hospital, Toronto:

Primary Outcome Measures:
  • self-care behaviour score [ Time Frame: change from baseline in self-care behaviour score at one week. ] [ Designated as safety issue: No ]
    mailed questionaire

  • self-care behaviour score [ Time Frame: change from baseline in self-care behaviour score at one month ] [ Designated as safety issue: No ]
    mailed questionaire

  • self-care behaviour score [ Time Frame: change from baseline in self-care behaviour score at three months ] [ Designated as safety issue: No ]
    mailed questionaire


Secondary Outcome Measures:
  • patient visits to ER or admission to hospital [ Time Frame: one week since discharge ] [ Designated as safety issue: No ]
    mailed questionaire

  • patient visits to ER or admission to hospital [ Time Frame: at one month since discharge ] [ Designated as safety issue: No ]
    questionaire

  • patient ER visits or admission to hospital [ Time Frame: three months since discharge ] [ Designated as safety issue: No ]
    questionaire

  • impact on nurses' workload [ Time Frame: up to 12 weeks from the last enrolled patient ] [ Designated as safety issue: No ]
    focus group

  • satisfaction with the training for the nurses' to provide teach back [ Time Frame: up to 12 weeks from the last enrolled patient ] [ Designated as safety issue: No ]
    focus group

  • nurses' conviction and confidence related to Teach Back [ Time Frame: up to 12 weeks from the last enrolled patient ] [ Designated as safety issue: No ]
    focus group


Estimated Enrollment: 80
Study Start Date: October 2011
Estimated Study Completion Date: February 2013
Primary Completion Date: October 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: usual care plus Teach Back intervention
Trained nurses will provide Teach Back to the intervention group. The nurses' training will focus on the concepts of Teach Back, provide coaching and guidance on how to use it as well as review the principles of conducting research. Role play will be a feature in the education sessions to improve the nurses' comfort level
Behavioral: Teach Back method of patient discharge teaching
Trained nurses will provide Teach Back to the intervention group. Appendix D lists the four questions that will be used in this study to confirm the patient's understanding. The nurses' training will focus on the concepts of Teach Back, provide coaching and guidance on how to use it as well as review the principles of conducting research. Role play will be a feature in the education sessions to improve the nurses' comfort level
No Intervention: usual care
All participants will experience the current practice of discharge teaching: daily interaction with the interdisciplinary team members via rounds, counseling on diet and medications with a dietician and pharmacist when referred, view the Heart Failure Discharge Video, and receive a Congestive Heart Failure education package which includes the Heart and Stroke "Managing Congestive Heart Failure" booklet.

Detailed Description:

Background: Heart Failure (HF) is a common and debilitating disease associated with frequent hospitalizations, decreased quality of life, and requires complex health care regimen. Heart failure management programs promote self-care by teaching patients how to recognize signs and symptoms, how to respond to these symptoms and who to contact for advice. Teaching interventions aimed at self-care have been shown to improve patient outcomes, however, the optimal method of delivering the education is unknown.

Patient education using Teach Back has the potential to increase self-care behaviour in HF patients and reduce adverse clinical outcomes by using plain language, focusing on key points, and asking the patient to verbally recall information just discussed, in an interactive manner. Research has shown Teach Back to be an effective strategy to improve patient comprehension in chronic conditions such as HF and diabetes.

The RNAO Best Practice Guidelines for Self-Management in Chronic Conditions (2010) recommends a nursing communication technique of "Closing the Loop" also known as "Teach Back" to assess patient understanding of information. The level of evidence for this technique is level III (from well designed, non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies). This study will provide additional evidence in a randomized experimental design.

The objectives of this study are to evaluate the effectiveness of Teach Back on self-care (as measured by the European Heart Failure Self-Care Behaviour Scale) and determine if Teach Back affects the number of ER visits and re-admissions post discharge. A secondary objective is to assess if Teach Back technique is a feasible, accepted and sustainable method of discharge teaching for hospitalized HF patients at St. Michael's.

  1. Research Question: Does discharge teaching using the Teach Back method from trained nurses improve self-care behaviour in HF patients as measured by the EHFScBS scale as compared to standard care discharge teaching?

    Hypothesis: Patients who receive teach back discharge teaching will have improved self-care (achieve lower scores on EHFScBS).

  2. Research Question: Are there fewer ER visits and hospital admissions post discharge in patients who receive instruction with teach back method?

    Hypothesis: Patients who receive discharge teaching with Teach Back will have less ER visits and hospital admissions in the 3 months following hospital discharge.

  3. Research Question: What is the feasibility and acceptability of adapting Teach Back as standard practice of discharge teaching for heart failure patients in the in-patient cardiac care units at St. Michael's?

Hypothesis: Teach Back is an accepted and sustainable method of discharge teaching in HF patients in the in-patient cardiac care units at St. Michael's as evidenced by participants' feedback (patient questionnaires and nursing focus groups).

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients admitted to the in-patient cardiology (7CCS) or Coronary Care Unit (CCU), with documentation of HF as the most responsible diagnosis
  • Prescribed a diuretic such as Lasix plus or minus Metolazone
  • New or established diagnosis of HF

Exclusion Criteria:

  • Cognitive impairment
  • Suffer from a co-existing, severe, chronic debilitating disease
  • Require hemo or peritoneal dialysis, have planned surgical intervention that will impact the etiology or manifestation of HF symptoms
  • Life expectancy of less than three months
  • Unable to receive discharge teaching, or are unable to communicate on the telephone
  • Already enrolled in a patient education study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01311583

Locations
Canada, Ontario
St. Michael's
Toronto, Ontario, Canada, M5B 1W8
Sponsors and Collaborators
St. Michael's Hospital, Toronto
Investigators
Principal Investigator: Ada Andrade, MN St. Michael's
Study Chair: Vimy Barnard-Roberts, MN St. Michael's
Study Chair: Haytham Sharar, MN St. Michael's
  More Information

No publications provided

Responsible Party: St. Michael's Hospital, Toronto
ClinicalTrials.gov Identifier: NCT01311583     History of Changes
Other Study ID Numbers: 11-010
Study First Received: February 22, 2011
Last Updated: January 18, 2013
Health Authority: Canada: Ethics Review Committee

Keywords provided by St. Michael's Hospital, Toronto:
Self-care
Teach Back

Additional relevant MeSH terms:
Heart Failure
Heart Diseases
Cardiovascular Diseases

ClinicalTrials.gov processed this record on September 18, 2014