University of Michigan Health System study finds patient education video is excellent teaching tool but doctors are better at calming fears
ANN ARBOR, MI — In an age when people often learn health information from surfing the Web and watching television shows set in hospitals, researchers have found that showing patients an educational video about their condition teaches them the facts about their disease even better than when their doctor tells them about the condition.
But the power of videotaped information also has its limits. The same study, by researchers at the University of Michigan Health System, also found that anxiety and stress are reduced much more among patients after they have visited with their doctors than after viewing the information on the educational video.
“The study confirmed the informational value of videotape-based educational materials. In fact, patients learned many more facts from the videotape – which was created with information from physicians – than they learned from their doctors during a clinic visit,” says Jeffrey S. Orringer, M.D., lead author of the study, which appears in the new issue of the Journal of the American Academy of Dermatology.
“We also expected that the educational videotape would reduce patients' anxiety and distress levels about their condition. It did, but their anxiety levels decreased by a much larger margin during clinic visits with their doctors,” Orringer says. “This tells us that the videotape is an excellent educational tool, but that it can't replace a positive patient-doctor relationship.”
Part of the reason the videotape was such a good educational tool, he says, is that the message was consistent. Patients could watch the tape over and over again, and the unchanging information was reinforced each time for the viewer. In contrast, an encounter with another human being is by its nature less consistent and redundant, Orringer points out.
At the same time, the consistency of the videotape helps to explain why it isn't as helpful at reducing a patient's distress and anxiety levels, he says. While the video is invariable, a doctor can tailor information to the specific concerns and fears a patient is encountering, says Orringer, clinical assistant professor of dermatology at the U-M Medical School and clinical director of the Cosmetic Dermatology and Laser Center at UMHS.
The study was conducted with 217 patients who were in two different groups, one of which received the educational videotape before an initial consultation visit at the U-M Multidisciplinary Melanoma Clinic along with questionnaires assessing their knowledge about melanoma and their anxiety levels. The patients were instructed to complete one set of questionnaires before watching the 11-minute video – which was developed by physicians at U-M – and one after viewing the video but before their melanoma clinic visit.
The other group of patients received the same questionnaires but no videotape, and they were instructed to fill out one set of the forms before the melanoma clinic consultation visit. After their appointment but before they left the clinic, they were asked to fill out a second set of questionnaires. The changes in their knowledge about melanoma and anxiety levels were attributed to the usual standard care and were used as a basis for comparison with the first group. (This group also received the videotape after they completed their part in the study.)
In the videotape group, knowledge about melanoma increased by an average score of 8.8 after watching the tape, compared with a 5.1 increase of the average score among the group that was measured after the clinic visit. Anxiety and emotional distress scores showed a decreased score of 3.2 and 0.56, respectively, in the videotape group. The decrease was much greater in the group measured after a clinic visit: 10.2 and 1.4, respectively, which was about three times the decrease of the videotape group's anxiety and distress scores.
While the study was conducted with melanoma patients, Orringer says it could have broad implications in the way health care providers educate their patients.
“The lessons of our study are broadly applicable to people with a variety of conditions,” Orringer says. “Health care providers can use what we have learned to help them develop educational materials, and to understand that a conversation between a patient and doctor is the best way to reduce distress and anxiety.”
In addition to Orringer, the authors on the paper were Timothy M. Johnson, M. D., professor, Department of Dermatology, director of the Cutaneous Surgery and Oncology Unit and the Melanoma Clinic at the U-M Comprehensive Cancer Center, associate professor of surgery, and professor of otolaryngology; A. Mark Fendrick, M.D., professor, Department of Internal Medicine, and associate professor of health management and policy at the School of Public Health; Christopher K. Bichakjian, M.D., Jennifer L. Schwartz, M.D., Timothy S. Wang, M.D., and Darius J. Karimipour, M.D., clinical assistant professors in the Department of Dermatology; and Peter C. Trask, Ph.D., formerly a professor at U-M and now at Brown University.
Funding was provided by a University of Michigan Comprehensive Cancer Center Munn Research Grant.
Reference: Journal of the American Academy of Dermatology, Aug. 2005, part 1; Vol. 53 Number 2.