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PACE-talk: An Interactive, Tailored Intervention for Teens

by Kenneth Lazarus, MD

This patient education project uses an interactive, tailored intervention for required high school health and wellness classes, teaching students how to actively participate in their health care

Indianapolis, IN Patient Education

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About this project

The problem we solve:
Physicians are now trained in interpersonal skills intended to engage patients in shared decision making options and collaborative care. However, successful communication cannot rest solely on the shoulders of the provider; patients need to be educated equally if they are expected to be active participants in their health care. The adolescent and young adult (AYA) population has difficulty making the transition from seeing a doctor with their parents to visiting a doctor independently and communicating health concerns to physicians. Currently no health intervention exists to broadly educate the AYA population about these changing expectations. The lack of patient training in school represents a missed opportunity to inform the incoming adult population of the changing paradigm of the patient-provider relationship.

About our solution:
Health and Wellness classes are part of the required high school curriculum for most states in the U.S. This presents the ideal time to begin educating youth – before they become adult patients navigating their own healthcare. According to health communication experts, interactivity may be the communication attribute with the greatest power to improve health promotion. Researchers report that actively interacting with games and stories led to a broad spectrum of desirable outcomes from knowledge increases to attitude and behavior changes. Additionally, tailored interventions that are customized to an individual create a more personally relevant narrative; as such, they are more likely to be read and cognitively processed with a better chance of effecting behavior change. The creation of an interactive, tailored intervention using an evidence-based model of patient education will prepare the AYA population to be active adult participants in their health care.
Progress to date: The prototype using the evidence-based model for patient education – PACE –was created with funding and partnership between IU Health, IUPUI, and the IU School of Medicine. Adapted for the first time to the AYA audience, “PACE-talk” used teen actors in short films to present the skills needed to become an active patient – Present information, Ask questions, Check understanding, and Express concerns. This project has received local, national, and worldwide attention – winning awards at both clinical conferences (CTSI) and health communication conferences (DCHC). In 2015, the project was selected for an oral presentation at the International Shared Decision Making conference in Sydney, Australia. The IRB approved intervention was informed by teen focus groups in two different schools and piloted at a third school. Guided by the pilot study, PACE-talk 2.0 seeks to redesign passive role-play simulations as an interactive, tailored intervention.

About Our Team

Kenneth Lazarus, MD
Pediatric Hematology/Oncology , Practicing Physician
Medical school: Indiana University School of Medicine
Bio: After spending nearly 35 years in the practice of pediatric hematology/oncology in military, private and academic settings, Dr. Lazarus is actively involved in developing curriculum to teach medical students about health systems science as well as helping adolescents be more involved in their personal health care.
Title: Senior Academic Content Specialist

About Team Members

Mark Di Corcia
Assistant Dean for Academic Affairs and Associate Professor of Clinical Biomedical Science at Florida Atlantic University, PhD
Biography: As a health communications scholar, Dr. Di Corcia created curriculum that focuses on understanding privacy and communication skills for medical students and residents
Samuel Riche
Visual Media Coordinator at IU Health, BA
Biography: Sam is an expert in the development of multi-media materials that are used in the advancement of the mission of IU Health
Peter Anderson
Clinician-Researcher at the Cleveland Clinic, Md, PhD
Biography: Dr. Anderson is a world expert in osteosarcoma. As a practicing clinician and researcher, his focus includes improving communications with patients and creating resources to help educate and guide patients and families.
Donald Cegala
Emeritus Professor of Health Communication at Ohio State University, PhD
Biography: Dr. Cegala is a world respected researcher in health communication. He is the developer of the PACE model for shared decision making that is designed to improve patients' interactions with physicians. The PACE model is used by the American Heart Association and other health groups
Janet Panoch
Doctoral Student, MA
Biography: Janet is active in the development of health communication resources with special interests in patient education and shared decision making. The creation of adolescent health interventions is the basis for her dissertation. She is interested in interactive game design and interdisciplinary collaboration

About Our Company

PACE-talk: Patient Training for High School Health and Wellness Classes
Location: Indianapolis, Indiana
Product stage: proto
Sales: Working on it
Employees: 10-20

How We Help Patients

Studies show that 72% of patients look up their symptoms on the internet before visiting their doctor. Yet many patients are unprepared to think critically about their treatment options or to engage actively and meaningfully in their health care. Medical professionals receive training in shared decision making; often with medical decisions, research does not indicate one correct treatment and patients are now being asked which treatment choice they prefer. This may include watchful waiting to aggressive treatment interventions that dramatically affect the lives of both the patient and their family. Too often, patients revert to the passive patient/expert doctor paradigm that leaves the patient feeling not in control, frustrated, and less likely to follow treatment decisions. Educating young people about the expectation for collaborative care will lead to improved self-efficacy with an engaged population prepared to embrace their role in living longer, healthier lives.

How We Help Education

Medical students are now being trained to engage in values elicitation with patients for informed shared decision making. Preference sensitive decisions where research does not indicate one clear treatment choice require the input of patients for quality of life decisions that impact them and their families. Unfortunately patients are often unprepared to engage actively in medical decisions, placing the onus of making treatment choices directly on the health care professional. This leads to less patient satisfaction and adherence and more burnout and litigation for providers. Medical education needs to be balanced with patients; patient education should occur before youth become adult patients navigating their own care – in required high school health classes. Creating an interactive, tailored game with role-play techniques will prepare the incoming adult population to be engaged and knowledgeable about the changing expectations of health care.

How We Help Physicians

Physicians appreciate patients who actively participate in their health care. Patients who embody the skillset in the evidence-based PACE model of patient education are prepared to Present information not just about symptoms but when and where they occur. They also Ask questions with an increased sense of self-efficacy about their health care. Patients who use PACE know how to Check understanding, using the teach-back method to make sure they understand the treatment decision. And patients know how to Express concerns about treatment choices, increasing the likelihood that they’ll adhere to the agreed upon plan. The implementation of an interactive, tailored PACE-based module for required high school health and wellness classes represents the ideal time for patient education. High participation patients encounter a number of benefits associated with their more collaborative and inquisitive communication style including lower mortality rates and positive clinical health outcomes.

Challenge Mission

Mission: Our interdisciplinary team includes physicians and experts in medical education, health communication, and health informatics to create this translational curriculum co-created with teen stakeholders.
Use of funds: Funding for the PACE-talk 2.0 Interactive, Tailored eHealth Intervention for High School Health and Wellness classes is needed for continued dissemination purposes (travel, conference fees, etc.). Upcoming presentations include the June 2016 conference for Partnering with Patients in Decision Making at Johns Hopkins and include return speaking engagements at the National Communication Association conference (November 2016) and Shared Medical Decision Making (October 2016). Consulting fees from grants go toward interactive game development with the IU School of Informatics and hosting with IU Health’s IT team, Learning Solutions. Co-founder Janet Panoch is funded from grants as the part-time co-educator/research assistant, representing PACE-talk as conference speaker, organizing research and publication efforts and facilitating meetings between interdisciplinary teams; PACE-talk 2.0 is the foundation for her dissertation.
Intellectual Property Status: The first iteration was funded by an IU Health Values Grant for Education for production and development in 2014-2016. While the product is owned by IU Health, the PACE-talk project belongs to the creators – Dr. Kenneth Lazarus and doctoral student Janet
FDA Status: All focus groups and pilot tests for research and production of PACE-talk materials was approved by the IRB.
Personal Message: Medical students are taught to engage with patients in managing health care and negotiating treatment options. However, patients are not receiving equal education for expected collaboration. Required high school health classes are optimal for an evidence-based interactive intervention designed for attitude and behavior change. The PACE-talk 2.0 project seeks to bring patient education to each state’s curriculum for an incoming population prepared to be actively engaged in healthier lives.


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    05/14/2016 JOAN MOOYIN - Patient Activist / Advocate

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Kenneth Lazarus, MD
Senior Academic Content Specialist
Indiana University School of Medicine

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