Targeted multimodality inhaler technique education pilot to self-identify errors for primarily Mandarin-speaking subjects.

OBJECTIVE: Inhaler technique education among non-English speaking patients in the United States is understudied, with communication barriers and language differences serving as important challenges to education. A previous needs assessment at our institution identified an opportunity to improve inhaler education for our Mandarin-speaking population. This pilot study evaluates the feasibility of a multimodal intervention to identify errors in inhaler technique. METHODS: Adult Mandarin-speaking subjects with chronic obstructive pulmonary disease or asthma participated in a hospital outpatient clinic inhaler training session that utilized multimedia education. Pre-intervention information on demographics, confidence, and disease control was gathered. Post-intervention, subjects were asked if they would change their inhaler technique and what they found useful. RESULTS: On pre-intervention survey, eight of eleven (73%) subjects reported being very or completely confident in their inhaler technique. Following the intervention, seven (88%) of those 8 subjects self-identified errors in their technique. Video and handout were reported to be the most useful materials. CONCLUSION: A multimodality inhaler technique education intervention helped self-identify errors in inhaler technique among non-English speaking subjects. Implementation and use of language-targeted educational interventions is feasible in an outpatient clinic setting.

Engagement in decision-making and patient satisfaction: a qualitative study of older patients' perceptions of dialysis initiation and modality decisions.

BACKGROUND: Although shared decision-making (SDM) can better align patient preferences with treatment, barriers remain incompletely understood and the impact on patient satisfaction is unknown. METHODS: This is a qualitative study with semistructured interviews. A purposive sample of prevalent dialysis patients ≥65 years of age at two facilities in Greater Boston were selected for diversity in time from initiation, race, modality and vintage. A codebook was developed and interrater reliability was 89%. Codes were discussed and organized into themes. RESULTS: A total of 31 interviews with 23 in-center hemodialysis patients, 1 home hemodialysis patient and 7 peritoneal dialysis patients were completed. The mean age was 76 ± 9 years. Two dominant themes (with related subthemes) emerged: decision-making experiences and satisfaction, and barriers to SDM. Subthemes included negative versus positive decision-making experiences, struggling for autonomy, being a 'good patient' and lack of choice. In spite of believing that dialysis initiation should be the patient's choice, no patients perceived that they had made a choice. Patients explained that this is due to the perception of imminent death or that the decision to start dialysis belonged to physicians. Clinicians and family frequently overrode patient preferences, with patient autonomy honored mostly to select dialysis modality. Poor decision-making experiences were associated with low treatment satisfaction. CONCLUSIONS: Despite recommendations for SDM, many older patients were unaware that dialysis initiation was voluntary, held mistaken beliefs about their prognosis and were not engaged in decision-making, resulting in poor satisfaction. Patients desired greater information, specifically focusing on the acuity of their choice, prognosis and goals of care.

Teaching on the Fly: A Needs Assessment for an Ambulatory Resident-as-Teacher Workshop.

Introduction: Residents play an important role in medical education, yet often feel unprepared without formal training. Teaching in the ambulatory setting raises unique challenges such as the difficulty of educating in a limited amount of time. We designed a brief, focused intervention as an initial needs assessment for a residents-as-teachers program in an ambulatory setting to address these concerns. Methods: A 1-day, 2.5-hour workshop was designed focusing on microskills, providing feedback, and ways to address common barriers in ambulatory teaching. Pre- and post-intervention surveys were conducted with both residents and medical students to assess the effects of the workshop on resident teaching in the clinic. Results: Although post-intervention surveys showed increased resident confidence and self-reported teaching behaviors, medical student surveys did not clearly demonstrate an increase in teaching behaviors. Didactic teaching on feedback and microskills with follow-on role playing were seen as the most helpful parts of the intervention. Conclusions: Self-assessment alone is an inadequate measure of effectiveness of our teaching intervention. While medical student data can help verify resident self-report, future iterations of our intervention should incorporate objective, third-party evaluation of teaching skill implementation.