A Method to Quantify Residents’ Jargon Use During Counseling of Standardized Patients About Cancer Screening
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Jargon is a barrier to effective patient-physician communication, especially when health literacy is low or the topic is complicated. Jargon is addressed by medical schools and residency programs, but reducing jargon usage by the many physicians already in practice may require the population-scale methods used in Quality Improvement.
To assess the amount of jargon used and explained during discussions about prostate or breast cancer screening. Effective communication is recommended before screening for prostate or breast cancer because of the large number of false-positive results and the possible complications from evaluation or treatment.
Primary care internal medicine residents.
Transcripts of 86 conversations between residents and standardized patients were abstracted using an explicit-criteria data dictionary. Time lag from jargon words to explanations was measured using “statements,” each of which contains one subject and one predicate.
Duplicate abstraction revealed reliability κ = 0.92. The average number of unique jargon words per transcript was 19.6 (SD = 6.1); the total jargon count was 53.6 (SD = 27.2). There was an average of 4.5 jargon-explanations per transcript (SD = 2.3). The ratio of explained to total jargon was 0.15. When jargon was explained, the average time lag from the first usage to the explanation was 8.4 statements (SD = 13.4).
The large number of jargon words and low number of explanations suggest that many patients may not understand counseling about cancer screening tests. Educational programs and faculty development courses should continue to discourage jargon usage. The methods presented here may be useful for feedback and quality improvement efforts.
- Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743–8. CrossRef
- Roter DL, Hall JA, eds. Doctors Talking with Patients, Patients Talking with Doctors: Improving Communication in Medical Visits. Auburn House: Westport, Connecticut; 1992.
- Coulehan JL, Block MR. The medical interview: mastering skills for clinical practice. 5th ed. Philadelphia: F.A. Davis Co.; 2006:409. xix.
- Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001;76(4):390–3. CrossRef
- Nielsen-Bohlman L, Panzer A, Kindig D, eds. Health Literacy: A Prescription to End Confusion. National Academies Press: Washington, DC; 2004.
- Smith RC, Marshall-Dorsey AA, Osborn GG, et al. Evidence-based guidelines for teaching patient-centered interviewing. Patient Educ Couns. 2000;39(1):27–36. CrossRef
- Stillman PL, Sabers DL, Redfield DL. The use of paraprofessionals to teach interviewing skills. Pediatrics. 1976;57(5):769–74.
- The American Heritage Dictionary of the English Language. Fourth ed. Boston, Massachusetts: Houghton Mifflin Company: 2006.
- American Academy of Family Physicians. Summary of AAFP Recommendations for Clinical Preventive Services, Revision 6.4. 2007 [accessed 06/04/2008]; Available from: http://www.aafp.org/online/en/home/clinical/exam.html.
- American College of Physicians. Screening for prostate cancer. Ann Intern Med. 1997;126(6):480–4.
- American Urological Association. Prostate-specific antigen (PSA) best practice policy. Oncology. 2000;14(2):267–72. 277–8, 280.
- Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin. 2007;57(2):90–104. CrossRef
- U.S. Preventive Services Task Force. Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002;137(11):915–6.
- Veterans Health Administration, ed. VHA Handbook 1120.2 Health Promotion and Disease Prevention Program. Department of Veterans Affairs: Washington, DC; 1999.
- Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146(7):511–5.
- Ransohoff DF, Harris RP. Lessons from the mammography screening controversy: can we improve the debate? Ann Intern Med. 1997;127(11):1029–34.
- Donovan J, Deuster L, Christopher SA, Farrell, MH. Residents’ precautionary discussion of emotions during communication about cancer screening, poster at 2007 annual meeting of the Society for General Internal Medicine, Toronto, Ontario, Canada.
- Donovan JJ, Farrell MH, Deuster L, Christopher SA. “Precautionary empathy” by child health providers after newborn screening. Poster at International Conference on Communication and Health Care, Charleston, SC; 2007.
- Farrell MH, Deuster L, Donovan J, Christopher SA. Pediatric residents’ use of jargon during counseling about newborn genetic screening results. Pediatrics, in press, August 2008.
- Farrell MH, Kuruvilla PE. Assessment of understanding: A quality indicator for communication after newborn genetic screening. Arch Pediatr Adolesc Med. 2008;2(3):199–204. CrossRef
- Farrell MH, La Pean A, Ladouceur L. Content of communication by pediatric residents after newborn genetic screening. Pediatrics. 2005;116(6):1492–8. CrossRef
- La Pean A, Farrell MH. Initially misleading communication of carrier results after newborn genetic screening. Pediatrics. 2005;116(6):1499–505. CrossRef
- Bylund CL, Brown RF, di Ciccone BL, Levin TT, Gueguen JA, Hill C, Kissane DW. Training faculty to facilitate communication skills training: Development and evaluation of a workshop. Patient Educ Couns. 2008;70(3):430–6. CrossRef
- Lang F, Everett K, McGowen R, Bennard B. Faculty development in communication skills instruction: insights from a longitudinal program with “real-time feedback”. Acad Med. 2000;75(12):1222–8. CrossRef
- Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282(24):2313–20. CrossRef
- Graber DA. The Theoretical Base: Schema Theory. In: Graber DA, ed. Processing the News: How People Tame the Information Tide. New York: Longman; 1988:27–31.
- Miller GA. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1994;101(2):343–52. CrossRef
- Seel N. Mental Models in Learning Situations. Adv Psychol. 2006;138:85–110. CrossRef
- White JD, Carlston DE. Consequences of Schemata for Attention, Impressions, and Recall in Complex Social Interactions. J Pers Soc Psychol. 1983;45(3):538–49. CrossRef
- Roter D. Roter Interaction Analysis System Coding Manual. [accessed 06/04/2008]; Available from: http://www.rias.org/manual.
- Feinstein A. Clinical Epidemiology: The Architecture of Clinical Research. Philadelphia: WB Saunders; 1985.
- Stedman TL. Stedman’s medical dictionary. 28Philadelphia: Lippincott Williams & Wilkins; 20061 v. (various pagings).
- Farrell MH. R01 HL086691, Improvement of communication process and outcomes after newborn genetic screening. National Heart, Lung, and Blood Institute: Medical College of Wisconsin: 2008.
- Castro CM, Wilson C, Wang F, Schillinger D. Babel babble: physicians’ use of unclarified medical jargon with patients. Am J Health Behav. 2007;31(Suppl 1):S85–S95.
- Keselman A, Tse T, Crowell J, Browne A, Ngo L, Zeng Q. Assessing consumer health vocabulary familiarity: an exploratory study. J Med Internet Res. 2007;9(1):e5. CrossRef
- Jencks SF, Huff ED, Cuerdon T. Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998–1999 to 2000–2001. JAMA. 2003;289(3):305–12. CrossRef
- A Method to Quantify Residents’ Jargon Use During Counseling of Standardized Patients About Cancer Screening
Journal of General Internal Medicine
Volume 23, Issue 12 , pp 1947-1952
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA
- 2. Internal Medicine, Pediatrics, and Population Health-Bioethics, Center for Patient Care and Outcomes Research, Milwaukee, WI, USA