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.
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Acknowledgments: Lindsay Deuster was supported by a training grant from the National Heart, Lung and Blood Institute (T35-HL72483-24). Dr. Farrell was supported in part by grant K01HL072530 from the National Heart, Lung, and Blood Institute. An earlier version of this paper was presented as a poster at the 2007 annual meeting of the Society of General Internal Medicine. The authors are grateful to Dr. Jeffrey Stein for assistance with educational workshops and transcript proofreading, and to Dr. Richard Frankel for very helpful critique and suggestions about the manuscript.