title: Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?
abstract: OBJECTIVE
  To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension.
  
  
  METHODS
  We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance).
  
  
  RESULTS
  Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension.
  
  
  CONCLUSIONS
  Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. kirsten.g.engel@gmail.com
authors.forename: Kirsten G
authors.initials: KG
authors.lastname: Engel
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Dylan M
authors.initials: DM
authors.lastname: Smith
authors.forename: Claire H
authors.initials: CH
authors.lastname: Robinson
authors.forename: Jane H
authors.initials: JH
authors.lastname: Forman
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011939:Mental Recall; D008824:Michigan; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*