Patient comprehension influences their ability to make appropriate health decisions and is linked to outcomes like improved adherence to treatment recommendations and improved self-management.
Yet ensuring this comprehension is a complex task, write LaKesha Anderson and Christy Ledford in JAMA Network, who suggest ways to help improve the communication and understanding between physician and patient.
Although clinicians are typically their primary source of medical information, patients also glean their health information from a number of other sources, like friends, family, and the internet – and may also encounter unfamiliar medical jargon both in and outside the clinical setting.
When clinicians prioritise patient comprehension, they boost the likelihood that patients can follow their recommendations.
Common obstacles to patient comprehension include misunderstood key words; hard-to-envision tasks, processes, and/or anatomical structures; and confusing medical concepts.
An evidence-based approach to explanatory communication, along with respectfully listening to patients, can be invaluable in helping clinicians deepen patients’ comprehension of their care.
Explanatory communication
Clinicians can use three types of explanations to help patients understand potentially confusing recommendations: elucidating explanations, quasi-scientific explanations, and transformative explanations.
Elucidating explanations help people establish meanings for terms used in medical communication. Often, they may not understand certain words or phrases or how some words can be used one way in regular conversation and another way in a medical context.
For example, when a clinician uses the word “culture” to describe part of a laboratory test, patients may not recognise that word as medical jargon because it is a commonly used word. Elucidating explanations define concepts by stating their dictionary definition and then explaining what a term means as well as what it does not mean.
Elucidating explanations also provide examples and non-examples of how terms are used.
In a cross-sectional survey of 215 US adults without medical training, medical jargon was frequently misunderstood. For example, only 9% of respondents knew what the term “febrile” meant and 75% correctly interpreted the phrase “nothing by mouth” compared with 11% correctly interpreting the phrase’s abbreviation, “NPO”.
Of note, 25% of respondents did not understand the phrase “nothing by mouth”, suggesting that the clearest explanation may be to say, “You should not have anything to eat or drink.” Only 41% of participants identified “neuro exam is grossly intact” as good news and only 21% correctly interpreted that the word “impressive” in a radiology report generally represents bad news.
Some patients may think that the term “impressive” indicates that something about their imaging result is better than others, not understanding that impressive in this context indicates a notable finding that is outside normal and requires extra attention.
Quasi-scientific explanations address the challenge that patients have less experience than clinicians with envisioning factors affecting their bodies. These explanations help them to visualise complex structures or processes and make difficult concepts more accessible.
For instance, when a person has trouble breathing due to a pulmonary embolism, they may not initially understand how their difficulty breathing is linked to a blocked artery in the lung.
In addition to using simple words to provide explanations, clinicians may also use verbal or visual devices, such as figurative language, diagrams, or videos, to assist with picturing complex structures, tasks, and processes.
For example, because a patient may not easily visualise layers of skin, fat, and muscle, it may be hard for them to understand how to properly self-administer a subcutaneous injection. Clinicians can use words to describe these layers and may also show patients diagrams that demonstrate the correct way to administer a subcutaneous injection.
A study of 97 parents of children with congenital heart defects demonstrated that 3D models provided clarifying explanations and engaged parents in discussions about their child’s condition.
Additionally, a study of 500 patients with cancer who had low health literacy found that comprehension of the concept of randomisation was greater in those randomised to an explanation using a benign metaphor (chance of a pregnancy resulting in a male or female child) compared with those randomised to a plain-language explanation (P = .04) or control messages (P = .04).
Transformative explanations help people understand confusing concepts that may have an impact on their health choices. Based on their life experiences and observations, people develop knowledge schemas. Schemas help people make sense of the world and determine what is true.
Knowledge schemas can include folk theories or commonly held beliefs. When people encounter a confusing concept that does not fit within their current knowledge schema, they may be unable to act on the new information.
An effective transformative explanation states a person’s lay understanding of a concept as well as its potential merit, creates dissatisfaction with that knowledge schema, and offers an alternative theory to explain the phenomenon. For example, when discussing radiation therapy, it is important for physicians to acknowledge that people often think of radiation exposure as dangerous.
Physicians should explicitly recognise this concern in conversations with patients when discussing radiation treatment: “Sometimes people only associate radiation with nuclear weapons and radiation sickness. Somewhat like fire, radiation is a tool that can be helpful or harmful. Cancer cells grow quickly and radiation, which carefully targets a specific part of the body, can halt the growth of tumours. Let’s talk through the risks involved with radiation therapy and how to use radiation carefully.”
Research has found this messaging to be effective. An experiment involving 330 female smokers tested the effectiveness of messages designed to promote smoking cessation for cervical cancer prevention.
Women who received a message beginning with: “Most people find it hard to imagine how smoking can increase the risk of cervical cancer. If you smoke this is more likely to happen for two reasons…” reported higher intention to stop smoking than women who did not receive a message acknowledging the potentially unclear link between smoking and cervical cancer.
Conclusions
Clinicians can prioritise patient comprehension through the use of elucidating, quasi-scientific, and transformative explanations. These explanations help clinicians identify and address three likely sources of confusion: misunderstanding the essential meaning of a term; difficulty with envisioning complex tasks, processes, and/or anatomical structures; and understanding new ideas that contradict what they know to be true.
Explanatory discourse is a communication strategy that clinicians and their staff can implement in their current practice.
LaKesha Anderson, PhD, CPD, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA: Christy Ledford, Department of Family and Community Medicine, Medical College of Georgia at Augusta University, Augusta, USA.
See more from MedicalBrief archives:
Understanding why and how to manage patients’ expectations
How doctors can deal with rising scepticism of patients
Using the same GP over time means fewer avoidable hospital admissions
Social media complaints and how to deal with them