A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines1
DK Raynor, A Blenkinsopp, P Knapp, J Grime, DJ Nicolson, K Pollock, G Dorer, S Gilbody, D Dickinson, AJ Maule and P Spoor. Health Technology Assessment 2007; Vol 11:number 5
Medication Information Leaflets Fail To Meet Patient Needs
This monograph is the culmination of a review of 70 studies2 concerning patient medication information published in the United Kingdom, Europe, Australia and the United States, two patient workshops convened specifically for this report, and a survey of the expert literature on information design.
Because the heterogeneity of the studies precluded data pooling and synthesis, the monograph elaborates on the primary source information for nearly 200 pages, but the findings can be summarized in a few lines:
- Patients consistently report that leaflets provided with prescription medications do not meet their needs
- The leaflets do not improve patient understanding of their medications
- Patients express the desire for information that better helps them evaluate pros and cons of a specific medication
- Patients value the idea of information that is tailored, set in the context of the particular illness of the individual patient
- Patients want written information in addition to — not instead of — spoken instructions from their health care professionals
- No evidence was found that the information affected patient satisfaction or affected compliance
- Patients do not see improving compliance as a function of the leaflets (an informed decision not to take a medicine is an acceptable outcome); many healthcare professionals, in contrast, view increasing compliance as a primary goal of the leaflets
Further, according to the Partnership for Clear Health Communication, nearly half of all American adults have difficulty understanding and using health information. In fact, the organization says, literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level or racial/ethnic group.
An unanswered question is the means by which to convey the likelihood of benefits and adverse drug effects. Colloquial descriptors such as “rare” or “common” are viewed as too vague to be useful, but terminology more typical of the professional literature such as percentages or “numbers needed to treat” often proves confusing to patients.
Not only is the text faulty but, according to the studies, the design and layout make navigation problematic, especially in the United States.
Recommendations, primarily culled from information design textbooks, include
- Use short, familiar words and short sentences
- Use short headings that stand out
- Use the largest possible type size
- Leave plenty of white space
- Use bullet points to organize lists
Commentary
I suspect that few individuals who have tried to read the information provided with medications will find any surprises in the conclusions of this review.
The only addition I suggest (and it may have been covered in some of those 200 pages that I haven’t read) is that the print on the leaflets should be large enough and contrast enough with the background for the typical over-50 individual adult with just a tad of presbyopia to read without the necessity of finding his reading glasses.
It is a superfluous but irresistible observation that the recommendations are little different than my 9th grade English teacher’s instructions on writing essays and need to be applied in many other areas as well as drug leaflets (software Help dialogs, toy assembly directions, and blogging guidelines come to mind).
Implications For Patient Compliance
Finally, I am especially taken with this finding,
I would maintain that this dichotomy of views speaks to the meaning of patient compliance as well as (or perhaps rather than) the purpose of medication leaflets.
This disparity resonates with what I’ve written before (for example, in How To (Correctly) Not Take Medications As Prescribed) about the problem of directly or indirectly coercing even “empowered patients” to follow instructions and the need to extend patient compliance to include the patient communicating to the clinician the decision not to take a prescribed medication.
Clarifying the purpose of medication leaflets as information for decision-making by the patient rather than propaganda to persuade the patient to follow orders seems an ideal step in redefining patient compliance into a clinically useful concept.
Just a thought.
Footnotes
