The understanding of medical terminology used in printed health education materials

Quality of Glioblastoma Multiforme (GBM) Resources Available on the Internet

Glioblastoma multiforme (GBM) carries a poor prognosis, and patients often have trouble accessing high-quality resources. The purpose of this study is to systematically evaluate the information available to GBM patients on the Internet. An Internet search using the term "Glioblastoma Multiforme" was performed using three different search engines: Google, Yippy, and Dogpile. A structured rating tool, validated and developed by our research group, was applied to evaluate the top 100 websites with respect to accuracy, coverage, readability, currency, structure, attribution, and interactivity. Among the 100 websites evaluated, definition and treatment were the most accurately written sections (98% and 78% of websites). Etiology/risk factors and diagnosis were the least accurately written sections (40% and 52% of websites). Half of the websites did not cover etiology/risk factors, and 47% did not cover diagnosis. Only 21% of websites provided complete authorship information, and almost half of websites (46%) were affiliated with commercial websites (.com). Sixty three percent of websites were at a post-secondary reading level. The majority of online GBM websites contains accurate but incomplete information. Many websites do not provide authorship information, last modification dates, and reference materials. Readability was generally inappropriate for GBM patients. This research can be useful for clinicians to guide GBM patients to quality online resources.

Patient understanding of medical jargon: a survey study of U.S. medical students

OBJECTIVE

With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school.

METHODS

533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school.

RESULTS

Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p=0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences.

CONCLUSION

Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school.

PRACTICE IMPLICATIONS

Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula.

Quantifying word use to study health literacy in doctor-patient communication

Most health literacy research to date has assessed health literacy using either general reading tests or text-based appraisals of reading and numeracy skills, yet the definition of health literacy includes domains beyond reading ability. Effective oral communication between doctor and patient is an important component of health literacy, but only recently have efforts been made to develop measures that tap into domains beyond those that can be assessed with text-based measures. Focusing on oral exchange, this article describes computer-assisted approaches to quantifying word use and the development of three word-use measures that can be used to study health literacy in transcripts of clinical encounters. The measures can be used to assess either the expressed literacy level of patients or the aural literacy demands made by doctors. Importantly, the computer-assisted quantitative measures described here make it possible for word use to be analyzed at a level of detail that human raters would be hard pressed to attain.

Medical word use in clinical encounters

OBJECTIVE

Doctors often use medical language with their patients despite findings from a variety of studies that have shown that patients frequently misunderstand medical terminology. Little is known about the patterns of medical word use by doctors and patients during clinical encounters.

METHODS

A content analysis of 16 verbatim transcripts of first clinical encounters between rheumatologists and newly referred patients was conducted to assess how doctors and patients introduced medical words. Medical words were identified via a computer program using a defined list.

RESULTS

Doctors did not introduce or use more medical words than patients, but the types of words that doctors and patients introduced did differ. The majority of patient-initiated medical words occurred during the history taking (94%). Doctors did not explain, or use as part of an explanation, the majority (79%) of the medical words they introduced, and patients seldom responded in a way that would indicate whether or not they had correctly interpreted those terms. There was relatively little repetition of medical words within or even across encounters.

CONCLUSIONS

This study provides insights into how the use of medical terminology could contribute to misunderstanding. Findings suggest that steps already promoted in the literature to improve doctor-patient communication may also ameliorate potential problems arising from the use of medical terminology.

Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists

The period following discharge from the hospital is a vulnerable time for patients. About half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event. This article reviews several important challenges to providing high-quality care as patients leave the hospital. These include the discontinuity between hospitalists and primary care physicians, changes to the medication regimen, new self-care responsibilities that may stress available resources, and complex discharge instructions. We also discuss approaches to promoting more effective transitions of care, including improvements in communication between inpatient and outpatient physicians, effective reconciliation of prescribed medication regimens, adequate education of patients about medication use, closer medical follow-up, engagement with social support systems, and greater clarity in physician-patient communication. By understanding the key challenges and adopting strategies to improve patient care in the transition from hospital to home, hospitalists could significantly reduce medical errors in the postdischarge period.

Comunicação instrumental, diretiva e afetiva em impressos hospitalares

Este trabalho se ocupa dos típicos sistemas semânticos extraídos dos recursos comunicativos de equipes hospitalares, que tentam validar informações como um "objeto" a ser transferido aos pacientes. Descrevemos modelos de comunicação textual em 58 impressos de orientações aos pacientes de cinco unidades hospitalares, coletados de 1996 a 2002. Identificamos três categorias fundamentadas na teoria dos atos de fala (Austin, Searle e Habermas): (1) Proferimentos cognitivo-instrumentais - descrições por meio de termos técnicos validados por argumentação auto-referente, incompleta ou inacessível; função educativa implícita. (2) Proferimentos técnico-diretivos - auto-referentes (contexto dos setores de origem); deslocamento freqüente de atos cotidianos para o terreno técnico com função disciplinadora; impessoalidade. (3) Modulações expressivas: necessidade de conexões intersubjetivas para fortalecer laços de confiança; tendência à infantilização. Concluímos que as categorias estudadas expõem: base em origens fragmentárias; pressupostos de univocidade de mensagens e consumo invariante da informação (motivações e interesses idealizados, alheios às perspectivas individuais); pressuposto de interesses universais como geradores de conhecimento.

[Communication prostheses and behavioral alignment in hospital leaflets]

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

Assessing the written information given to families prior to their attendance at a child development centre

This paper describes an analysis of the written information given to parents of pre-school children with developmental delay prior to their attendance at a Child Development Centre. Texts were analysed for their readability and human interest, and the usefulness of the information was assessed through consultation with parent consumers. The discussion of the results includes suggestions for staff who are involved in the development of client leaflets and booklets.