Health Promotion, Disease Prevention, and Patient/Family Education
What to teach and how
This domain covers risk assessment, screening, anticipatory guidance, immunization, and education for adults and older adults, including family and caregiver teaching. Know USPSTF grades (A and B recommended, C individualized, D discouraged, I insufficient evidence) and be prepared to weigh benefit against harm for a patient with limited life expectancy; screening that would not alter management within the remaining lifetime offers little benefit and real burden.
Core content: cardiovascular risk and hypertension, diabetes screening, colorectal, lung, breast, and cervical cancer screening intervals, osteoporosis (DXA, FRAX), fall risk using STEADI, depression screening (PHQ-2/9), cognitive screening, hearing and vision, urinary incontinence, and immunizations (influenza, COVID-19, pneumococcal, zoster, Tdap, RSV for older adults). Include advance care planning and POLST conversations, tobacco and alcohol use, and social determinants such as food, housing, transportation, and isolation.
Method matters. Use teach-back ('tell me in your own words how you will take this'), plain language near a fifth- to sixth-grade level, chunking, written reinforcement, professional interpreters, and cultural humility. Motivational interviewing aligned with the stages of change (precontemplation through maintenance) outperforms one-way instruction. Self-management support, not information delivery alone, is the goal.
Traps
- 'Knowledge deficit' framing; prefer interventions addressing literacy, motivation, access, and self-efficacy.
- Recommending screening without weighing life expectancy, goals of care, or downstream harms such as overdiagnosis.
- Confusing teach-back with asking whether the patient has questions.
- Overlooking the caregiver, who is often the actual learner.
Rule of thumb
If the patient cannot teach it back, teaching is not finished. If an intervention would not change care within the patient's expected lifespan, question whether to do it at all.