Research Spotlights: January 2023

Medical jargon used in medical settings is poorly understood by patients and contributes to barriers in proper health care communication

The use of medical jargon by health care professionals has previously been identified as a barrier to patients’ proper understanding of their own health care status and outcomes. Despite the known consequences of using medical jargon in conveying health information, its use by health care professionals continues to be common. Past work has examined the use of jargon such as technical terminology, abbreviations, and acronyms, but few studies have explored understanding of “common medical jargon”—terms and phrases that may be commonly used in everyday language but have a different meaning in medicine. Recently published work supported by NCATS and others examined the understanding of medical jargon, specifically focusing on words and phrases with common meanings in regular English usage. Using responses from the public, researchers at the University of Minnesota examined whether certain demographic factors were associated with differences in understanding the selected words and phrases. They hypothesized that this type of medical jargon would be poorly understood among the sample of survey respondents, regardless of age, gender, education, or survey administration method.

The research team conducted a cross-sectional study of 215 volunteers from the public recruited at the 2021 Minnesota State Fair. Eligible participants were at least 18 years of age, had no reported history of medical or nursing training, and self-reported as being able to complete an English language-based survey. The survey contained 13 questions that were a mix of open-ended and multiple-choice formats intended to assess understanding of common phrases in medicine as well as basic participant demographics. The survey was developed into separate written and oral versions, and participants were randomized to the form of survey. The respondents had a mean age of 42 year; 65% reported having at least a bachelor’s degree, and over 60% were female. Researchers did not find a significant difference in responses to the written and verbal surveys, and pooled results for the final analyses.

When examining understanding of terms and phrases meant to convey good news versus bad news, there were mixed results. For example, most respondents (80%) correctly identified that an “unremarkable” chest radiography was good news; however, fewer (21%) understood that “impressive” radiography implied bad news. When examining comparative understanding of paired phrases, significantly more respondents correctly understood the common usage phrases [e.g., “nothing by mouth” (75%),” “blood tests show no infection” (98%)] versus the medical jargon phrases with the same meaning, respectively [i.e., the acronym “NPO”, a Latin abbreviation for “nothing by mouth” (11%), “negative” blood culture (87%)]. Multivariable logistic regression models showed few significant associations between participant demographics and understanding of jargon.

This study had some limitations. Recruitment logistics may have resulted in a nonrepresentative sample, and the sample may also have been biased toward those with higher education level attainment. In addition, the study may have benefitted from the inclusion of a control group of healthcare professionals to validate the clinicians’ intended meaning and context when using these phrases and terms.

In summary, most participants (79%) were able to understand certain terms or phrases as good versus bad news, yet many participants misunderstood “common usage” terms utilized in a medical context, and often assigned meaning opposite to what the clinician intended. For example, in common usage the term “negative” and “positive” have different connotations when used in a medical context; such that “negative” is bad while “positive” is good in common usage, but in a medical context, a “negative” result for cancer screening is good news versus a “positive” result, which is bad news. The researchers noted that while “nothing by mouth” was better understood than “NPO”, 25% of respondents did not understand the phrase “nothing by mouth”. This may be because in everyday language, the act of eating or drinking is not often discussed as “taking something by mouth,” suggesting that the clearest way to convey that a patient should abstain from oral intake may be to use more common phrasing such as “you should not have anything to eat or drink”. Researchers found no significant differences in understanding of medical jargon delivered in written versus oral form, which may have important implications for future considerations in how to optimize patient communication. Future studies are needed to further characterize the understanding of medical jargon among the public and to test clearer alternatives to improve communication between medical professionals and their patients.

Gotlieb R, Praska C, Hendrickson MA, Marmet J, Charpentier V, Hause E, Allen KA, Lunos S, Pitt MB. Accuracy in Patient Understanding of Common Medical Phrases. JAMA Network Open. 2022;5(11):e2242972. doi: 10.1001/jamanetworkopen.2022.42972.

Some young adult males living in certain major U.S. cities face a higher risk of firearm death than military deployed in Iraq and Afghanistan

There has been an increase in violent crimes in the U.S., with 2020 data indicating a 30% increase in homicides with firearms, implying that firearm violence is becoming a leading cause of death for children, adolescents, and young adults. Recently published research funded by NIDA and NIGMS aimed to contextualize this public health crisis by comparing the risk of firearm-related death for young men living in the top 10% of the most violent zip codes areas in four major U.S. cities, with the risk of combat death and injury faced by U.S. military personnel who served during periods of war in Afghanistan and Iraq.

Following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for comparative studies, the researchers conducted a cross-sectional study using public secondary data and findings that included all fatal and nonfatal shootings of young adult males recorded as crimes in 2020 and 2021 in Chicago, Illinois, Los Angeles, California, New York, New York, and Philadelphia, Pennsylvania. Data were aggregated to the zip code level and linked to corresponding demographic characteristics from the 2019 U.S. Census Bureau’s American Community Survey 5-year zip code tabulation areas. The study included 129,826 young adult males (ages 18-29) living in the top 10% most violent zip codes in the 4 cities studied, of whom 45,725 (35.2%) were Black, 71,005 (54.7%) were Hispanic, and 40,355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Wartime data on all types of injury resulting from hostile action was sourced from peer-reviewed analyses of U.S. military data to assess relative risk. Wartime data covered 2001 to 2014 for the Afghanistan war, and 2003 to 2009 for the Iraq war.

The risk of experiencing firearm-related homicide for young adult men living in the most violent zip codes in Chicago exceeded the risk of combat death experienced by military service members, while the risk faced by the same population living the most violent zip codes in Philadelphia was comparable to the risk of those military service members deployed on wartime duty. In Chicago, nonfatal shooting risks were comparable with, or exceeded the injury risk of combat in Iraq. These findings were not observed in similar populations living in comparable high violence zip codes in Los Angeles and New York City. The researchers noted that the risk of firearm death and injury observed across the 4 settings studied had the highest impact on Black and Hispanic males, representing 96.2% of those who were fatally shot, and 97.3% of those who experienced nonfatal injuries.

The researchers noted that previous studies have found associations between combat exposure and stress-inducing hypervigilance, an elevated risk of homelessness, alcohol use, substance use, and mental illness, supporting the hypothesis that ongoing exposure to violent events and their risks are significantly correlated to other health problems and at-risk behaviors in underserved communities. This study’s findings may suggest that public health strategies in urban areas should prioritize violence reduction and perhaps address health equity challenges by taking a trauma-informed approach. Further research is needed to determine what factors influence the lower risk of firearm mortality and injury in New York and Los Angeles compared to the same risk in Chicago and Philadelphia.

Among the study limitations noted, the researchers point out that while wartime tours of duty in Iraq and Afghanistan were time-limited exposures of approximately 12 months, the people living in these high violence urban zip codes are exposed to elevated risks of violence each year they live in these areas, indicating that there is no posttraumatic period for these individuals and that ongoing risks of violence and trauma may accumulate over time.

Del Pozo B, Knorre A, Mello MJ, Chalfin A. Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected U.S. Cities with Wartime Service in Iraq and Afghanistan. JAMA Netw Open. 2022 Dec 1;5(12): e2248132. doi: 10.1001/jamanetworkopen.2022.48132. PMID: 36547982.

Community mobilization efforts effective in preventing mpox transmission in the U.S.

According to an HHS press release dated Dec 2, 2022, it is not expected that the current mpox emergency declaration will be renewed when it ends on January 31, 2023, although case trends will continue to be monitored and vaccine distribution upheld in communities across the U.S. According to a recently published CDC morbidity and Mortality Weekly (MMWR) Report study, the U.S. mpox outbreak appears to have been thwarted due to the moderating effect of community mobilization and transmission prevention through outreach and vaccine distribution. This study was supported by NIMH, NINR, and others.

The first U.S. case of mpox was confirmed on May 17, 2022, and a public health emergency was declared on August 4, 2022. For this study, researchers reviewed and analyzed responses to a mpox-specific follow-up survey completed by respondents who had originally responded to the annual American Men’s Internet Survey (AMIS). AMIS is an annual, cross‐sectional, online behavioral survey of a convenience sample of cisgender, gay, bisexual, and men who reported sexual contact with other men (MSM) in the U.S. and aims to monitor trends in sexual health, originally targeting HIV prevention. The AMIS 2021 survey participants (n=2999) were invited to complete a follow-up survey assessing knowledge of and experiences with mpox, of which 825 participants (27.5%) answered questions about

  • general knowledge, awareness, and concern about mpox
  • personal behavior changes during the past 3 months because of mpox outbreak
  • receipt of vaccine to prevent mpox infection

The survey results show that approximately 50% of these respondents self-reported changing sexual behaviors since learning about the mpox outbreak, which led to lower risk exposure through incorporating significant changes in social activities. Vaccine receipt (18.6%) was more prevalent among respondents who made few to no changes in sexual behaviors or social activities. Receipt of vaccine was found to be more prevalent among those taking HIV preexposure prophylaxis (PrEP), as well as more prevalent among men who received testing for another sexually transmitted infection during the preceding 3 months, and overall, most respondents (82.3%) self-reported feelings of confidence regarding protecting themselves from mpox.

Additionally, the findings from this study indicate racial and ethnic disparities, as well as urban versus rural differences in mpox vaccination distribution, implying the continuing relevance of equitable vaccine program implementation that involves community engagement, partnership with providers and health workers already serving special populations, and delivering vaccines through mobile outreach and pop-up events, diversifying times and locations for vaccine administration. Given that inequities in vaccine access and coverage is an urgent public health priority, the researchers advise that public health authorities continue to work with state and local organizations to develop “respectful” and “tailored” harm reduction messaging, and to monitor the impact of messaging and prevention strategies to include vaccination.

Delaney KP, Sanchez T, Hannah M, Edwards OW, Carpino T, Agnew-Brune C, Renfro K, Kachur R, Carnes N, DiNenno EA, Lansky A, Ethier K, Sullivan P, Baral S, Oster AM. Strategies Adopted by Gay, Bisexual, and Other Men Who Have Sex with Men to Prevent Monkeypox virus Transmission - United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022 Sep 2;71(35):1126–30. doi: 10.15585/mmwr.mm7135e1. PMID: 36048582; PMCID: PMC9472779.