Computer-aided teaching comes of age - now a valid choice for patient ed

CD-ROM excellent for rote instruction, gives staff more flexibility

The technology viewed by Star Trek movie-goers in the sick bay of the Starship Enterprise may not mirror medical interventions today, but it is getting close. With technological advances, computers have become valid teaching tools. Soon, patients scheduled for surgery at Memorial Sloan-Kettering Cancer Center in New York City will sit down with a computer for pre-op instruction instead of sitting down with a nurse. A CD-ROM has been created to do the pre-op teaching for 150 surgeries.

"The nurse no longer has to spend time going over pre-op instructions, so her time can be spent on very patient-specific questions," says Patricia Agre, EdD, RN, director of patient and family education at Memorial Sloan-Kettering. "Nurses spend about 20 minutes giving the patients pre-op instructions. We want to eliminate the rote teaching on the part of the nurse. We want to allow the nurse to spend time with the patient addressing patient-specific needs, rather than system-specific needs."

After using the CD-ROM, each patient will take a brief quiz as part of the program. The nurse will review the answers to make sure the patient understands the information to ensure a safe surgery. Anything that is not clear can be reviewed by the nurse.

In addition to pre-op instructions, the CD is a resource for information. For example, there is information on support services, smoking cessation programs, tests the patient might have before surgery, and details on the gift shop, cafeteria, and blood bank. There isn't enough time in a consult to answer all the conceivable questions a patient might have, but the patient can find the answers on the computer.

Becoming commonplace

Computer-aided education is becoming as common as the video or pamphlet as a teaching tool, says Agre. Memorial Sloan-Kettering has completed four CD-ROM programs including bone marrow and stem cell transplantation, an operation on the pancreas, soft tissue sarcoma, and prostate cancer. Staff at the cancer center plan to create six more in 1998, including preparing for your operation at Memorial Sloan Kettering Cancer Center, pain, chemotherapy, lung cancer, ovarian cancer, and colorectal cancer.

The technology is not out of reach for most hospitals. "Anyone who has bought a computer in the past couple of years has a CD-ROM with multimedia capability," says Agre.

Because the development of many of the Memorial Sloan-Kettering programs is funded by grants from drug companies, the CDs will be distributed to health care facilities free of charge once complete. Patient education managers will be able to obtain them from drug reps; however, those that are produced without grants from drug companies shouldn't cost patient education managers much more than $20 because CDs are inexpensive to reproduce.

"Next fall we will open a new facility, and we will have computers in many areas so the patients can use the CD-ROMs we created. Ultimately, we will give them to patients to take home," says Agre.

While computer-aided teaching can make better use of staff time, it might not be right for everyone, warns Barbara Kass, MPH, director of Fort Bliss Wellness Center at William Beaumont Army Medical Center in El Paso, TX. People who aren't used to using computers have a high anxiety level they must overcome before they can begin absorbing the information. (For information on introducing underserved populations to the technology available at learning centers, see story, p. 59.)

Also, people learn in different ways. Some like to read the information, others are visual, and some like to learn with other people. Therefore, offering a variety of learning methods, such as brochures, videos, multimedia CD-ROMs, and classes, works best, says Kass.

"The right teaching combination is usually someone explaining the information with visual aids, then allowing patients to read the same information at their own pace, followed by working with the information. Those three elements are key. Using a computer might be only one or two of those parts," she says.

Donna Wohlhuter, RN, BSN, health education specialist at the Mayo Clinic in Rochester, MN, says that a computer is a tool and should be used with a combination of teaching methods. If a patient education manager only offers one teaching tool, it often negates the education of those that don't learn that way. Yet computers can cover material of a sensitive nature in a safe, confidential way. For example, when doing a risk assessment for sexually transmitted diseases, most patients find it easier to tell a computer about their sexual habits than they would a provider, she says.

Agre sees computer-aided education providing enormous benefits for the patient. Patients don't have to wait to have their questions answered, and they can have them answered at their leisure. They are in total control and can explore as much of the information as they desire.

"In our CDs, we use video, color, graphics, animation, and audio, so they are not like a booklet which is just text and illustrations. Nor are they like a video, where the patient has to rewind the tape if some information is missed," says Agre. (For information on evaluating computer-aided programs for purchase, see story, p. 60.)

Computer programs have many uses. They can provide patients with the information they need to make a decision on treatment options, learn about a procedure, or educate about a disease. Also, they make an extensive amount of education easily accessible.

When Agre was working on a CD-ROM for bone marrow transplants, she searched the Internet to determine what was available via the World Wide Web. She found 97,000 Web sites.

"It would be difficult for patients to work their way through all of those sites to get the information they need. Our program is pretty much one-stop shopping. It covers anything people would need to know about a bone marrow transplant, with the exception of prognosis," says Agre.

While multi-media computer programs offer patients lots of information and a variety of teaching methods, assessing learning can be difficult, says Wohlhuter.

"For example, a diabetes program provides good background information, but the educator still needs to spend time with the patient to review injection skills or glucose monitoring. You can't do that through a computer. To assess if the patient knows the steps, you have to watch them," she says.

To determine if patients retain key information, quizzes can be built into the programs, says Agre. A nurse can quickly review the quiz, see which questions the patients answered wrong, and review the information.

If CD-ROMs don't have a learning assessment method, Kass designs her own. She creates pre- and post-tests for both videos and CD-ROMs used at the wellness center, which usually focus on prevention.

"They are exposed to the information the first time when they take the test. Then they watch the video or interact with the computer and get the information a second time. Then they get the information a third time by taking the post test. It reaffirms what they did know and helps them learn what they didn't know," says Kass.

Just as CD-ROMs are one option for patient education, they are also a good tool for teaching staff. When staff at Henry Ford Health Systems in Detroit developed guidelines for the treatment of congestive heart failure, they introduced them to physicians in various ways. They provided written materials, talks, and presentations at meetings and distributed a CD-ROM that uses six case studies to present the guidelines.

The physician works his or her way through the six cases selecting a preliminary diagnosis, determining diagnostic tests, and creating a treatment plan. Terri Knox, MS, RD, project manager for health education and new media at Henry Ford, says, "The correct answers all are based on the guidelines. At each section, the user is told whether the answer is right or wrong and why.

While Henry Ford Health Systems and Memorial Sloan-Kettering are producing educational CD-ROMs with either in-house funding or grant money, institutions don't have to create these educational tools. Many selections are becoming available for purchase from a variety of sources including health care facilities and organizations. (See list of computer-aided education options, p. 61.)

"Computers are the way of the future," says Agre. "I think in 25 years everything will be on CD-ROM, and computers will be all over the place in hospitals. Patients seeking information will have instant gratification because they will be able to get into and out of programs in a flash."