Communications expert: speak no 'medicalese'
PRISM training and tools can help
After years of training that results in physicians and researchers speaking in a way that is at best challenging for patients to understand, they now can learn how to talk like a layperson.
Instead of speaking of a patient's "abrasion," the doctor could refer to the scratch. Rather than calling the patient's chest pain "pyrosis," the investigator could mention heartburn.
It might seem simple, but "medicalese" is so steeped in physicians' culture that they don't even realize they are using medical jargon, says Jessica R. Ridpath, a research communications coordinator at Group Health Research Institute in Seattle, WA.
For six years, Ridpath has made it her mission to teach investigators how to speak simply with plain language. As a research assistant with a passion for writing, Ridpath became convinced that research informed consent forms were too complicated, stocked with medical jargon, and written at inaccessible reading levels.
"I found that many of our consent forms had a college readability level, which was quite shocking to all of us," Ridpath says.
"I did some research and found that it was a well-documented problem in health information and research," she adds. "Health care information requires sophistication to read and understand, although the whole point of writing something is to communicate a message."
With internal funding and investigator support, Ridpath worked to develop a better-written informed consent form. She also developed tools for research staff and a training and editing program called PRISM for Program for Readability in Science and Medicine.
"I do an in-person training workshop and also online training," she says.
The online training course was funded with a grant from the National Institutes of Health, and it's available to researchers at no charge at http://prism.grouphealthresearch.org, she adds.
In the first few months the online training was available, close to 600 researchers registered for it, and its evaluation ratings were high, Ridpath says.
The training will be kept current and improved as users make recommendations and offer other feedback.
Both the PRISM toolkit and training were designed to teach investigators how to replace words and sentences with simple, everyday language.
"Write conversationally, as if you were speaking," Ridpath advises. "A lot of writing has a formal air to it, and plain language is more conversational and understandable."
Here's an example from PRISM of the kind of change that takes a wordy, complex description and makes it more understandable:
- "To obtain the sample, a 6 to 8 mm diameter (~1/4 inch) piece of skin will be taken from the underside of your arm using a sterile biopsy punch. The area will first be sterilized with alcohol wipes, and then a 25 gauge needle will be used to inject a small amount (1 ml) of local anesthetic called lido-epinephrine. If desired, a topical cream (LMX) can be used to numb the skin before injection."
This example reads at a grade level of 11.6 and is labeled "fairly difficult" to read.
- The revised, simpler version says, "We will get the sample by taking a piece of skin about the size of a pea from under your arm. First, we will clean the area with alcohol, and then we will numb it by giving you a shot. If you want, we will rub a cream on your arm to numb the skin before the shot."
This revised version has a reading grade level of 5.5, and it's labeled "easy" to read.
PRISM also contains a 700-word list of medical terms that can be substituted with more common words. Here are some examples from the list:
- Instead of "eliminate," try using "get rid of, remove, cut, end, go to the bathroom"
- Instead of "etiology," try using "cause"
- Instead of "manifestation," try using "sign"
- instead of "sutures," try using "stitches"
- instead of "tachycardia," try "very fast heart beat"
- instead of "toxic," try using "poisonous"
Replacing jargon in informed consent documents is one strategy. Another is to organize the documents' content in a way that makes sense to their intended readers.
"Organize or filter the content with readers' needs in mind," Ridpath suggests. "This means using short sentences and limiting paragraphs to one main idea and boiling the message down instead of using an exhaustive explanation."
Also, researchers should form partnerships with communication specialists and IRB members, she says.
"We can't expect all IRB folks to be bang-up writers," she says. "I like this being a collaborative process where you are getting the right people involved."
Communication specialists can assist investigators with writing the informed consent form, and IRB staff can help ensure the regulatory requirements are met.
Another strategy for improving the informed consent documents is to use reader-friendly formatting, Ridpath says.
"Make the document look easier to read," she adds. "Using small type and margins will defeat the purpose when you're trying to make it shorter."
Instead there should be adequate white space and margins. Large bold headers should break up big chunks of dense copy and catch readers' eyes.
"Most people won't read it fully; they'll skim it, so put key information in bold and bulleted lines to make sure they get the main points," Ridpath says.