Patient education about anticoagulant medication: is narrative evidence or statistical evidence more effective?
OBJECTIVE
To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication.


METHODS
600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information. 317 patients completed both the baseline and post-test questionnaires. Questions assessed knowledge, beliefs and adherence to medication and laboratory monitoring regimens.


RESULTS
All three approaches positively effected patients' warfarin-related knowledge, and beliefs in the importance of lab testing; there was also some indication that viewing a video strengthened belief in the benefits of warfarin. There was some indication that narrative evidence had a greater impact than statistical evidence on beliefs about the importance of lab testing and on knowledge. No other evidence of the differential effectiveness of either approach was found. No statistically significant effect was found on intent to adhere, or documented adherence to lab monitoring.


CONCLUSIONS
Videos depicting a physician-patient dialogue about warfarin were effective in educating patients about anticoagulant medication, and had a positive impact on their beliefs. The use of narrative evidence in the form of patient anecdotes may be more effective than statistical evidence for some patient outcomes.


CONCLUSIONS
Patients on oral anticoagulant therapy may benefit from periodic educational efforts reinforcing key medication safety information, even after initial education and ongoing monitoring. Incorporating patient anecdotes into physician-patient dialogues or educational materials may increase the effectiveness of the message.
Mazor
Kathleen M
KM
Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, United States. Kathleen.Mazor@umassmed.edu
Baril
Joann
J
Dugan
Elizabeth
E
Spencer
Frederick
F
Burgwinkle
Pamela
P
Gurwitz
Jerry H
JH
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000739:Anecdotes as Topic; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D003142:Communication; D003627:Data Interpretation, Statistical; D016903:Drug Monitoring; D004521:Educational Measurement; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014743:Videotape Recording / Q000592:standards*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin