|Year : 2015 | Volume
| Issue : 4 | Page : 146-150
Increased literacy of the best evidence base optimizes patient-clinician communication in convergent translational health care: Relevance for patient-centered modalities
Allen Khakshooy1, Vandan Kasar2, Melissa Nahcivan2, Quyen Bach2, Francesco Chiappelli3
1 Department of the Health Sciences, California State University (CSUN), Northridge; Division of Oral Biology and Medicine, Section of Oral Biology, University of California (UCLA), Los Angeles, California, USA
2 Division of Oral Biology and Medicine, Section of Oral Biology, University of California (UCLA), Los Angeles, California, USA
3 Department of the Health Sciences, California State University (CSUN), Northridge; Division of Oral Biology and Medicine, Section of Oral Biology, University of California (UCLA), Los Angeles, California; Evidence-Based Decisions Practice-Based Research Network, USA
|Date of Web Publication||27-Nov-2015|
Division of Oral Biology and Medicine, Section of Oral Biology, UCLA Center for the Health Sciences CHS 63-090, Los Angeles - 90095 1668, California
Source of Support: None, Conflict of Interest: None
Introduction: Dentistry in particular and biomedicine in general have undergone a fundamental transformation over the recent decades, which have been formalized by the Affordable Care Act, 2010. In brief, modern contemporary health care has evolved from procedure-driven and intervention-centered care based on research evidence to the administration and delivery of care that is patient-centered, effectiveness-focused, and that utilizes the best evidence base generated by systematic research synthesis (i.e., evidence-based). The present conceptualization of health care integrates translational research and translational effectiveness, and allows convergence of the multiple specialization fields of biomedicine (e.g., dentistry, internal medicine, and psychiatry) as well as the various medical traditions globally (i.e., Western, Ayurvedic, and Chinese medical traditions, etc.). The Hypothesis: Here, we propose the hypothesis that increased literacy of the best evidence base optimizes patient-clinician communication in the current convergent translational health care model including dental care. Evaluation of the Hypothesis: We discuss the salient points of this proposition, and outline the relevance of certain salient convergent patient-centered modalities of health care that intimately intertwine medicine and dentistry.
Keywords: Best evidence base, convergent health care, creative nonfiction, health literacy, patient-centered outcomes research, telehealth, translational effectiveness
|How to cite this article:|
Khakshooy A, Kasar V, Nahcivan M, Bach Q, Chiappelli F. Increased literacy of the best evidence base optimizes patient-clinician communication in convergent translational health care: Relevance for patient-centered modalities. Dent Hypotheses 2015;6:146-50
|How to cite this URL:|
Khakshooy A, Kasar V, Nahcivan M, Bach Q, Chiappelli F. Increased literacy of the best evidence base optimizes patient-clinician communication in convergent translational health care: Relevance for patient-centered modalities. Dent Hypotheses [serial online] 2015 [cited 2019 Nov 14];6:146-50. Available from: http://www.dentalhypotheses.com/text.asp?2015/6/4/146/170641
| Introduction|| |
In the recent decades, our conceptualization of health care has undergone a fundamental transformation. From procedure-driven and intervention-centered care, the administration and delivery of clinical intervention have evolved into a translational patient-centered endeavor.
The translational nature of health care goes beyond the translational research paradigm originally outlined by the National Institutes of Health (NIH), i.e., from the patient to the laboratory and back to the patient. Similarly, it further develops the concepts of translational effectiveness delineated by the Agency for Healthcare Research and Quality (AHRQ), that is to say, the pursuit and dissemination of the best evidence base obtained by systematic reviews and meta-analyses, and its utilization in specific clinical settings. Taken together, translational research and translational effectiveness yield the novel and vigorous modality of translational science in health care. Translational science, the current new movement in health care, focuses on the synergistic interaction of fundamental research, research synthesis, and allied research. ,,,
Translational health care aims to improve the health of individuals and the community by "translating" findings into new and improved diagnostic tools, medicines, procedures, policies, and education. It consists, as the Institute of Medicine states, of two distinct and intertwined translational blocks:
- TB1 aims to obtain, test, and verify basic research findings, and
- TB2 aims to integrate and utilize the best evidence base in patient-centered interventions.
The process of translational health care consists of four integrated translational phases or tiers: In translational phase 1 (T1), the process of patient-clinician encounter commences and begins right at the onset to incorporate the community of stakeholders. T2 follows and expands the discovery phase by broadening the patient and stakeholder base. T3 signifies the onset of the translational effectiveness-directed phase that aims at establishing the optimal validity, reliability, sensitivity, and specificity of certain treatments or practices in specific clinical settings. In broad lines, the process of translational health care comes to closure at T4, which focuses on identifying and characterizing the best clinical standard operating procedures including reaching clinicians, patients, and stakeholders for dissemination of the best practices with respect to optimizing utilization of the best evidence base in evidence-based revisions of clinical practice guidelines and policies. In short, T1-T4 is a complex multidimensional process that culminates in optimizing stakeholder health literacy and engagement. ,
To be clear, health care in the 21st century is exemplified as an endeavor that crosses the boundaries of medicine, as it was conceived in the traditions of Western societies during the 19th and 20th centuries. Contemporary modern health care recognizes the intimate intertwining across the fields of biological sciences (e.g., neurosciences, psychoneuroendocrinology, psychoneuroimmunology, biological psychiatry). It recognizes that the former separation among specialties of health care such as dentistry, nursing, clinical psychology, and medicine, and is incongruent with the present state of knowledge and understanding of psychobiology in health and disease. Case in point, dental plaque, which is involved in cardiovascular disease, and neurological pathologies such as movement disorders and torticollis may find etiology in temporomandibular joint disorders and consequential neuropathology to terminal branches of the V cranial nerve (trigeminal). Poor oral hygiene has important damaging effects on the overall health of an individual. As previously discussed, orofacial cellulitis, which can result from complications of dental surgeries, root canal procedures, or inadequate postdental treatment care, can spread across the patient's body with potentially life-threatening outcomes such as gangrene, meningitis, lymphangitis, and Ludwig's angina.  In brief, medicine and dentistry are among the principal convergent facets of health care that ought to be not dissociated in the pursuit of comprehensive patient-centered, effectiveness-focused, and evidence-based health care.
Now especially, we cannot ignore the importance of dialogue between physicians and dentists. But unfortunately, the minute discrepancies in the respective practices often prevent a steady line of communication. Collaborative professional interaction, which stems from and is sustained by consistent literacy of the best evidence base among clinicians across areas and specialties of health care, is essential among clinicians across the medical and dental specialties. Furthermore, this collaboration ensures trust, informed knowledge, and information sharing among clinicians, patients, and stakeholders.
It follows that translational health care today depends on the constant betterment and advancement in health literacy. Living in such a densely multicultured populated habitat, many individuals value their traditional and ancestral methods of healing over Western medicine, regardless of their effectiveness. Additionally, with the new reform in health care in the United States, it would only seem natural to shift the views of individual care to populous care and work with different demographics to better understand their views of health in order to share the effectiveness. In that context, it is unquestionable as to whether the convergence of different health care practices across cultural and ethnic backgrounds will surely be beneficial. To limit the clinician's skills and knowledge base to only one form of health care (e.g., traditional Chinese, Ayurvedic, and Western traditions) may be potentially harmful to the patient by failing to propose potentially beneficial alternative treatment protocols that satisfy both the patient's need of a culturally sensitive treatment and the clinician's duty to provide the best treatment available to the patient. Convergent translational health care reflects the ever-changing, evolving, and modernizing drive of our society today.
Convergence in health care is driven teleologically to actualize patient-centered, effectiveness-focused, and evidence-based health care. , Convergent health care integrates clinical dentistry and medicine in the pursuit of maximizing the efficiency of the T1-T4 translational health care process, which itself lies in securing the consistency of growth in health literacy across all stakeholders locally.
One important means toward that goal involves telehealth is the concerted process of integrating new communication approaches in the implementation and delivery of patient-centered health care interventions. Telehealth refers to the delivery of health-related services and information via telecommunication technologies, ranging from discussing a case over the telephone to doing robotic surgery between facilities at different ends of the globe. Telehealth encompasses all of the consultative, preventive, promotional, and curative aspects of translational convergent health care. It stresses and incorporates a myriad of protocol solutions, from telecommunication to telemonitoring, from teleconferencing to teletransmission, from teletriage to telemanagement of disease.
The benefits of incorporating telehealth to the health care system include not only improved, faster, and easier access to health care but also less risk of transmission of diseases. Telehealth emphasizes a patient-centered approach that aims to increase patient satisfaction and health literacy by applying different telecommunication technologies for patients' specific needs, improving patient-clinician communication and by finding the best available treatment to the patient. Patients who had teleconsultations in the Telehealth Network of Minas Gerais reported 95% satisfaction rates with the service  and with more developing technologies, telehealth services are expected to improve and have more satisfaction rates in the future.
Increasing health literacy lies at the very core of efficient development and utilization of telehealth in translational convergent health care. The question remains as to how we can ensure both the efficacy and effectiveness of modalities designed to increase and improve health literacy of the best evidence base among clinicians, patients, caregivers, and stakeholders to ensure patient-centered, effectiveness-focused, and evidence-based dental and medical care.
| The Hypothesis|| |
Taken together, these lines of evidence bring us to propose the hypothesis that increased literacy of the best evidence base optimizes patient-clinician communication in a convergent translational health care model in which dental care is a primary and an essential component. The corollary hypothesis underscores the relevance of convergent patient-centered modalities of health care that intimately intertwine medicine and dentistry.
| Evaluation of the Hypothesis|| |
Optimizing patient-clinician communication for the purpose of increasing health literacy implies numerous aspects. First, its implications stretch to developing and validating novel educational programs and interventions designed to improve teaching of the best evidence base to patients and stakeholders. Second, it ensures improved comprehension, retention, and learning of the information. In a very much related vein, convergent health care intervention programs ought to be specifically targeted at improving patient-centered communication of clinical test results. This is a critical core of bioinformation in health care that depends largely on strengthening health literacy in raising stakeholder engagement. 
Health literacy can be broadly defined as the ability to obtain, read, understand, and use health care information to make appropriate health decisions and follow instructions for treatment. Health literacy involves three primary facets: A context dimension (i.e., setting: Clinical environment vs. home environment), considerations of the mode in which health literacy is imparted (e.g., oral recommendation by the dentist or physician, physician assistant or registered dental assistant, registered nurse or staff; written material as hardcopy, media advertisement, some form of telehealth), and issues regarding the skills and comprehension of the patient or stakeholder (i.e., English competency, reading comprehension). ,, Deficiencies in any of these three domains impair health literacy. Low health literacy - a timely and critical public health concern that reduces the success of treatment and increases the risk of medical error - is one major factor in health disparities as noted by the Healthy People 2020 initiative of the US Department of Health and Human Services.
Ensuring adequate health literacy in our era of convergent translational health care requires four primary activities. First, it requires obtaining and validating the best evidence base by means of systematic research synthesis protocols. Second, it demands effective packaging and distribution of the materials. Third, it necessitates new and improved modalities for packaging the best evidence base so that its communication - that is, teaching - to patients and stakeholders is optimized. Fourth, it requires a concerted set of interventions aimed at securing comprehension and retention - that is, learning and recall - of this information base. Certain advances have been brought forward in each of these domains. In brief:
- The systematic process of obtaining the best evidence base and of incorporating it into evidence-based revisions of clinical practice guidelines elsewhere has been extensively described and documented. ,,
- Health literacy is now understood to require a combination of several structural components, which can be either: Analytic (e.g., traditional literacy, media literacy, information literacy) or context-specific (e.g., computer literacy, scientific literacy, health literacy). Active research in that direction is currently under way.
- The manner in which information is packaged and delivered is central to successfully raising health literacy. Whether the modality be in-person or distance communication (i.e., telehealth and distance education), ,, it is timely and critical to develop new and improved modes of presenting and delivering this new and often complex information to patients and stakeholders.
- Here, we propose that beneficial strides will be made in health literacy by adapting and integrating the narrative style of creative nonfiction in convergent translational health care, with beneficial implications to dental care. Creative (or narrative) nonfiction is a genre of writing that aims to create factually accurate narratives as an educational service to the reader, rather than report scientific facts as a service to science. Creative nonfiction communicates information, shapes it, and packages it in a way that reads like fiction so that it proffers direct and contextual meaning for the reader. , Expectations are that in conveying the best evidence base of convergent translational health care, creative nonfiction should provide a vivid, direct, and simple, yet accurate teaching methodology of the best evidence base for diagnosis and treatment.
The model we propose here serves to ensure increased literacy of the best evidence base in order to optimize patient-clinician communication for convergent translational health care in general, and translational dental care must specifically rely on consultation of RAND expert panels that we described in a recent related communication.  These panels are specialized structures that endeavor:
- To evaluate the best evidence base.
- To develop improved clinical interventions that are patient-centered, effectiveness-focused, and evidence-based.
- To ensure their efficient integration in routine protocols and standard operating procedures in specific clinical settings.
- To secure comprehension and retention - that is, learning and recall - of this information base.
The last point - securing comprehension and retention of the best evidence base - is a requirement sine qua non for improved health literacy. It can be optimized by several techniques that converge to encourage active learning and retention, including:
- Providing simplified information and illustrations that avoid technical jargon and terminology that may not be familiar to all patients and stakeholders.
- Encouraging a "teach back" method that stimulates in-person as well as online questions and discussions, blogs, and related modes of active social-based communication [e.g., interactive radio instruction (IRI), and television-based and Internet-based developments],
- Accessing a plurality of sources, including e-health and other Internet-based information.
- Monitoring the accuracy and validity of the exchanged information by a discussion leader trained as a health literacy director/instructor and well-versed in the best evidence base under discussion.
| Conclusion|| |
In conclusion, the pursuit of improved health literacy of patients and stakeholders is a critical component of translational health care, particularly with respect to the convergence of dental and medical clinical practice. Increased health literacy optimizes patient-clinician communication and secures the overall patient-centered, evidence-based, and effectiveness-focused management of health care, from care delivery to the patient and related administration of clinical protocols to formative and summative evaluation of new and improved standard operating procedures. From this conceptualization, health literacy emerges as a meta-construct that consists of an individual's ability to search for, to access successfully, to comprehend and appraise critically, and to retain and utilize desired health information from a range of sources (e.g., from traditional hard copy materials in libraries to e-health materials and other electronic sources). Appropriate assessment of health literacy requires the development of multifaceted instruments and their validation as performed for the expanded GRADE  and revised Risk of Bias tools.  Cognizant that interprofessional dialogue,  particularly between physicians and dentists, is critical to optimize outcomes research and patient-centered health care. We must incentivize the drive of the profession, be it in dentistry or medicine, to do more and better prevent diseases that arise from the natural world we inhabit.
To identify and to utilize the best evidence base to diagnose and to cure disease is a timely and essential component of health literacy and of patient-clinician communication. Therefore, as we optimize our use of professional skills with the best evidence base for efficacy and effectiveness, we must also dedicate efforts to improving communication and disseminating the evidence with the premier goal of raising patients' and stakeholders' health literacy. Here, we recommend disseminating the best evidence base in a "stakeholder-friendly" style such as creative nonfiction.
Financial support and sponsorship
Conflicts of interest
Francesco Chiappelli has editorial involvement with Dent Hypotheses.
| References|| |
Chiappelli F. Fundamentals of Evidence-Based Health Care and Translational Science. New York: Springer-Verlag; 2014.
Chiappelli F. Comparative Effectiveness Research (CER): New Methods, Challenges and Health Implications. Hauppauge, NY: NovaScience Publisher Inc.; 2015.
Bach Q, Kasar V, Chiappelli F. Implications and applications of systematic reviews for evidence-based dentistry and comparative effectiveness research: A sample study on antibiotics for oro-facial cellulitis treatment. Dental Hypotheses 2015;6:134-140.
Chiappelli F, Caldeira Brant XM, Neagos N, Oluwadara OO, Ramchandani MH. Understanding Evidence-Based Practice: Toward Optimizing Clinical Outcomes. New York: Springer-Verlag; 2010.
Alkmim MB, Marcolino MS, Figueira RM, Sousa L, Nunes MS, Cardoso CS, et al
. Factors associated with the use of a teleconsultation system in Brazilian primary care. Telemed J E Health 2015;21:473-83.
Moura Jde A, Costa BC, de Faria RM, Soares TF, Moura EP, Chiappelli F. Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science. Bioinformation 2013;9:718-20.
Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21 st
century. Health Promot Int 2000;15:259-67.
Zarcadoolas C, Pleasant A, Greer DS. Understanding health literacy: An expanded model. Health Promot Int 2005;20:195-203.
Zarcadoolas C, Pleasant A, Greer D. Advancing Health Literacy: A Framework for Understanding and Action. San Francisco, CA: Jossey-Bass; 2006.
Barkhordarian A, Ramchandani MH, Dousti M, Kelly-Gleason L, Chiappelli F. Disseminating the best available evidence: New challenges in public reporting of health care. Bioinformation 2012;8:293-5.
Chiappelli F, Barkhordarian A, Arora R, Phi L, Giroux A, Uyeda M, et al
. Erratum: Correction in co-author name to: Reliability of quality assessments in research synthesis: Securing the highest quality bioinformation for HIT. Bioinformation 2015;11:223.
Masic I. E-learning as new method of medical education. Acta Inform Med 2008;16:102-17.
Silva AS, Rizzante FA, Picolini MM, Campos KD, Corrêa Cde C, Franco EC, et al
. Bauru School of Dentistry Tele-Health League: An educational strategy applied to research, teaching and extension among applications in tele-health. J Appl Oral Sci 2011;19:599-603.
Masic I, Pandza H, Kulasin I, Masic Z, Valjevac S. Tele-education as method of medical education. Med Arh 2009;63:350-3.
Gutkind L. The Art of Creative Nonfiction: Writing and Selling the Literature of Reality. New York: John Wiley & Sons; 1997.
Gutkind L. Keep it Real: Everything You Need to Know about Researching and Writing Creative Nonfiction. New York: W.W. Norton & Co.; 2008.
Phi L, Ajaj RA, Ramchandani MH, Brant X, Oluwadara O, Polinovsky O, et al
. Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study. Open Dent J 2012;6:31-40.
Barkhordarian A, Pellionisz P, Dousti M, Lam V, Gleason L, Dousti M, et al
. Assessment of Risk of Bias in Translational Science. J Transl Med 2013;11:184.
D'Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu MD. The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. J Interprof Care 2005;19(Suppl 1):116-31.