127 Teach-back of discharge instructions in the ED CHAPTER 6 post-ED care (e.g., wound care, lifestyle advice), 4) follow-up appointments (e.g., with their general practitioner or another specialist), and 5) return precautions. They also noted whether patients were accompanied by an informal carer and if theywere cognitively impaired at themoment of receivingdischarge instructions (i.e., signs of early-stage dementia, poststroke, disorientation and confusion). Cognitive impairment was determined after reviewing relevant information in themedical records and observing the patient during the discharge conversation. Both researchers were trained in recognizing predefined cognitive impairment conditions (i.e., signs of early-stage dementia, post-stroke symptoms, disorientation, confusion). Telephone interview N.K. and C.T. interviewed older patients or an informal carer via telephone within 72 hours after discharge from the ED. The conversations were audio recorded after receiving consent. First, a standardized question-based script was used to ask interviewees to state in their own words what discharge instructions were given (Supplement 3 and 4). Questions were open-ended and interviewees were allowed to refer to their written discharge instructions. Knowledge retention of the instructions was determined by listening to the audio recordings and comparing interview answers with the notes from the medical chart and the observed discharge conversations. For each of the five information domains, knowledge retention was rated on a 4-point scale: 1) full, 2) partial, 3) minimal or 4) none. Data were considered ‘not available’ if discharge information was not provided to the participant. Second, interviewees were asked to rate their satisfaction with the ED discharge process on a range from 1 (‘very dissatisfied’) to 10 (‘very satisfied’) and to explain their satisfaction score. Interviewees who received teach-back were also asked if and why (not) they were annoyed by this method of repeating instructions. Finally, we assumed that teach-back could have a positive effect on activating and improving self-management by older patients. Therefore, interviewees were asked to rate four statements froma validatedDutch version of the Patient ActivationMeasure (PAM) which assesses a person’s beliefs about, confidence in and knowledge and skills for managing health-related care tasks.[33,34] The research team selected four relevant statements from the PAM to minimize response fatigue. Data analysis We used descriptive statistics to summarize the baseline characteristics and outcomes of the pre- and post-intervention groups. Characteristics and outcomes were summarized using means (with a standard deviation; SD) and medians (with an interquartile range; IQR) for continuous variables, depending on the
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