A method to quantify residents' jargon use during counseling of standardized patients about cancer screening

BACKGROUND: 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. OBJECTIVE: 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. PARTICIPANTS: Primary care internal medicine residents. MEASUREMENTS: 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. RESULTS: 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). CONCLUSIONS: 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.