Psychological Medicine A method for increasing ...

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A method for increasing patients' recall of information  presented by doctors P. Ley, P. W. Bradshaw, D. Eaves and C. M. Walker Psychological Medicine / Volume 3 / Issue 02 / May 1973, pp 217 ­ 220 DOI: 10.1017/S0033291700048558, Published online: 09 July 2009

Link to this article: http://journals.cambridge.org/abstract_S0033291700048558 How to cite this article: P. Ley, P. W. Bradshaw, D. Eaves and C. M. Walker (1973). A method for increasing  patients' recall of information presented by doctors. Psychological Medicine, 3, pp 217­220  doi:10.1017/S0033291700048558 Request Permissions : Click here

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Psychological Medicine, 1973, 3, 217- 220

A method for increasing patients' recall of information presented by doctors1 P. LEY, P. W. BRADSHAW, D. EAVES, AND C. M. WALKER From the Department of Psychiatry, University of Liverpool

Within minutes of leaving the consulting room, patients are frequently unable to recall what their doctor has told them. This paper describes a simple, practical method for increasing recall by the organization of medical information into 'labelled' categories. The success of this technique was demonstrated first in a laboratory experiment with volunteer subjects, and then in a naturalistic setting with general practice patients. SYNOPSIS

Recent evidence has shown that patients EXPERIMENT 1 : RECALL OF FICTITIOUS INFORMATION BY VOLUNTEERS frequently forget information given them within a short time of leaving the consulting room (Ley It has been shown that the forgetting of fictitious and Spelman, 1965, 1967; Joyce, Caple, Mason, medical information by volunteers closely parallels Reynolds, and Mathews, 1969). The amount forgetting of true medical information by patients forgotten varies with the amount presented (Ley and Spelman, 1967; Ley, 1971). This made it (Ley, 1972), thus patients presented with five, 10, reasonable to conduct a pilot experiment with a or 15 statements would be expected to forget (to volunteer sample of 20 undergraduate arts and the nearest whole number) two, five, and seven science students. None knew the purpose of the experiment. The material consisted of the following statements respectively. In view of these findings, it would be useful to 15 statements: have a simple technique for increasing patients' 1. You have a chest infection. recall of what they are told. It is clear from 2. And your larynx is slightly inflamed. 3. But I think your heart is all right. psychological experiments on memory processes 4. We will do some heart tests to make sure. that the organization of the material to be learned 5. We will need to take a blood sample. can have substantial effects on the probability of 6. And you will have to have your chest its recall (Kintsch, 1970). More specifically, it x-rayed. has been shown that the organization of material 7. Your cough will disappear in the next two into categories, and the use of category names days. can increase recall (Tulving and Pearlstone, 8. You will feel better in a week or so. 1966; Bower, Clark, Lesgold, and Winzenz, 9. And you will recover completely. 1969). This last investigation also found that 10. We will give you an injection of penicillin. teaching the subject the categories before present11. And some tablets to take. ing the material to be learned led to an increase 12. I'll give you an inhaler to use. 13. You must avoid cold draughts. in recall, and similar findings from research on 14. You must stay indoors in fog, advance organizers have been reported by Ausu15. And you must take two hours rest each bel (1960) and Ausubel and Fitzgerald (1961). afternoon. The present paper describes an attempt to increase patients' recall by explicitly organizing This material was presented as above (ordinary the material presented to them. condition) or was explicitly categorized (categorized 'The investigation was supported by a grant from the Department of Health and Social Security.

condition). In the categorized condition the material was presented as follows:

218

P. Ley, P. W. Brailshaw, D. Eaves, ami C. M. Walker

'I am going to tell you: what is wrong with you; what tests we are going to carry out; what I think will happen to you; what treatment you will need; and what you must do to help yourself. First, what is wrong with you . . . (statements 1-3) Secondly, what tests we are going to carry out . . . (statements 4-6) Thirdly, what I think will happen to you . . . (statements 7-9) Fourthly, what the treatment will be . . . (statements 10-12) Finally, what you must do to help yourself... (statements 13-15) One of two experimenters read the material to subjects who were assigned randomly to the ordinary or categorized condition, and to experimenter. The material was presented once only, and recall was requested after a four-minute interval. During the interval the subject and experimenter held a conversation about non-medical topics. After this, the subjects recall of the 15 statements was taperecorded.

EXPERIMENT 2\ RECALL OF TRUE INFORMATION BY GENERAL PRACTICE PATIENTS

The subjects were 40 patients attending evening surgeries in a lower-working-class general practice. All were volunteers but as, in fact, no patients refused to take part in the research, the sample consists of all patients who were asked. The patients selected were those who visited one particular doctor, and were consecutive attenders, presenting with a new illness. The material presented was whatever the doctor thought it appropriate to say to the patient. Patients were assigned at random to either ordinary or categorized presentation. When the consultation had finished the patient was interviewed by one of two experimenters who asked the patient to recall what had been said. Assignment to experimenter was also random. All patients were seen within five minutes of their consultation and their replies were taperecorded. The material presented by the doctor was also recorded at the time of presentation.

RESULTS

The categories into which statements fell, and their frequency of usage, are shown in Table 2.

RESULTS The experiment involved a two-factor analysis of variance design. The analysis is shown in Table 1. The results showed that categorization led to

TABLE 2 FREQUENCY WITH WHICH THE DIFFERENT CATEGORIES WERE USED

TABLE 1

Number of occurrences in

INFORMATION

Source A. Ordinary v. categorized conditions B. Experimenter AxB Error

Sum of squares df

36-45 1-25 4 05 66-80

1 1 1 16

108-55

19

Category of statement • Mean square

36-45 1-25 405 417

F

8-74(P00l) NS NS

a significant increase in recall of the material, and that this effect was the same for both experimenters. The mean number of statements recalled in the ordinary condition was 6-50, and in the categorized condition it was 9-20. This result was promising and made it clearly worth while to investigate the effects of categorization in a real-life situation.

'What is wrong' 'Tests' 'What will happen' 'Treatment' 'What you must do'

'Categorized group'

'Non-categorized group'

20 9 20 18 20

20 6 20 18 19

87

83

Further information on category usage is given in Table 3, which shows the distribution of numbers of categories used with patients. These data testify to the success of the randomization procedure in producing comparable groups of patients, in that the doctors' use of categories appears to be very similar for both groups. All statements in the present study could be grouped into the given categories.

219

A method for increasing patients' recall of information presented by doctors TABLE .1 NUMBER OF DIFFERENT CATEGORIES OF STATEMENTS PRESENTED TO TWO GROUPS OF PATIENTS

Number of patients receiving statements from indicated number of categories Number of categories into which .statements presented fell

Categorized group

Non-categorized group

3

1

1

4 5

II 8

15 4

As the patients were presented with varying numbers of statements, recall scores were turned into percentages and an arc-sine transformation was carried out on them before the analysis of variance. The results of the analysis are shown in Table 4. TABLE 4 ANALYSIS OF VARIANCE OF PATIENTS' RECALL SCORES

Source

Sum of squares

A. Ordinary v. categorized B. Experimenter A X B Interaction Error

0-8762 0-4213 01630 6-2465

df 1 1 I 36

TABLE 5 ANALYSIS OF VARIANCE OF MEAN PROPORTIONS (ARC-SINE TRANSFORMATION) OF DIFFERENT TYPES OF STATEMENTS RECALLED BY PATIENTS

Sum of Mean squares df square A. Categorized v. non-categorized Subjects within groups B. Type of statement AB B x subjects within groups

Mean square 0-8762 0-4213 01630 01785

Thus each patient had three scores. As one patient in the non-categorized condition received no advice, a randomly selected patient in the categorized group was dropped to equalize numbers in groups and make the analysis easier. The results of the analysis are shown in Table 5. Only the categorized r. non-categorized difference was significant.

130-89

1 130-89

349-92 36 52-59 38-52

2 2

747-79 72

F 13-47 (P000I)

9-72 26-30 19-26

2-53 (NS) 1-85 (NS)

10-39

Mean proportions recalled

4-9l(P005) 2-36 (NS) (NS)

For those who are suspicious of transformations, the F ratio for the untransformed score for factor A was 5-41 (P 0-05) and the other F ratios were not significant. Thus, once more, categorization led to an increase in recall, while the other factor and the interaction were not significant. The subjects in the ordinary condition recalled on average 3-60 statements out of an average of 7-15 presented; while the subjects in the categorized condition recalled on average 4-65 out of an average of 7-5 presented. The effects of categorization on recall of different types of statements was also investigated. For this analysis statements were classed as 'what is wrong', 'what you should do', and 'other'. Each patient was given a score for each type of statement. This score was the proportion of statements of a given type that he recalled.

What is wrong Non-categorized Categorized

0-605 0-667

What you should do 0-283 0-654

Others 0-461 0-703

DISCUSSION

The results obtained show that recall of medical information can be increased by the use of explicit categorization. In the first experiment, where subjects received 15 statements to remember, recall of material was increased by nearly 50% as a result of categorization, while in the second experiment recall of an average of seven or so statements was increased by approximately 25%. The difference in improvement might be due to the difference in the amount of material presented, to differences between real-life and laboratory learning, or to subject differences. On the basis of the present data it is not possible to decide between these possibilities, but in both cases recall was significantly improved by categorization.

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P. Ley, P. W. Bradshaw, D. Eaves, and C. M. Walker

Further research is needed to discover the best categories to use, the situations where the gain is not worth the extra effort, and whether there are simpler ways of improving recall. REFERENCES

Ausubel, D. P. (I960). The use of advance organizers in the learning and retention of meaningful verbal material. Journal of Educational Psychology, 51, 267-272. Ausubel, D. P., and Fitzgerald, D. (1961). The role of discriminability in meaningful verbal learning and retention. Journal of Educational Psychology, 52, 266-274. Bower, G. H., Clark, M. C , Lesgold, A. M., and Winzenz, D. (1969). Hierarchical retrieval schemes in recall of

categorized word lists. Journal of Verbal Learning ami Verbal Behaviour, 8, 323-343. Joyce, C. R. B., Caple, C , Mason, M., Reynolds, E., and Mathews, J. A. (1969). Quantitative study of doctor patient communication. Quarterly Journal of Medicine, 38, 183-194. Kintsch, W. (1970). Learning, Memory, and Conceptual Processes. Wiley: New York. Ley, P. (1972). An equation for predicting patients forgetting. (Awaiting publication). Ley, P., and Spelman, M. S. (1965). Communications in an out-patient setting. British Journal of Social and Clinical Psychology, 4, 114-116. Ley, P., and Spelman, M. S. (1967). Communicating with the Patient. Staples Press: London. Tulving, E., and Pearlstone, Z. (1966). Availability versus

accessibility of information in memory for words. Journal of Verbal Learning and Verbal Behaviour, 5, 381 -391.