Clear communication key to treating complex conditions

Information that is devoid of medical jargon can enhance patient care and allow patients to assess the pros and cons of various treatments.

By Susan J. Landers — Posted Dec. 11, 2006

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An informed patient can make managing complex conditions, including arthritis, much easier for physicians, said several presenters at the American College of Rheumatology/Assn. of Rheumatology Health Professionals' Scientific Meeting held in mid-November in Washington, D.C.

But the best steps to take are not always obvious, and two separate sessions at the meeting focused attention on factors for both physicians and patients to consider.

For instance, helping patients harness the power of the Internet can offer great potential for answering their questions and helping them adhere to treatment plans. In another presentation, researchers emphasized that, for physicians, making written materials more understandable is also an important building block.

The vast numbers of arthritis patients as well as those with other chronic diseases make it essential that patients are partners to physicians and help maximize limited office-visit time.

But first, some ground rules need to be established, said Liana Fraenkel, MD, MPH, associate professor of medicine at Yale University School of Medicine in New Haven, Conn.

Patients must appreciate the uncertainties in medicine to "buy in" to the importance of their participation in choosing treatment options, and they must understand that there are trade-offs to each option, she said. This circumstance requires sensitivity from the doctor.

"We, as physicians, must make patients understand that their values are important to us," she noted.

In addition, patients sometimes fear that they will antagonize their physicians by asking too many questions. Physicians may have to seek a patient's opinion explicitly, she said.

Patients have a role to play, too. Their grasp of the situation and the condition is central to making informed decisions, said Gail Kershner Riggs, a researcher at the Arizona Arthritis Center at the University of Arizona in Tucson.

One Internet-based arthritis self-management program studied by Stanford University researchers was found to bring about improvements in health status for its 639 participants, a much larger group than could be reached with a traditional group run from a physician's office, said Kate Lorig, RN, MPH, DrPH, director of Stanford University School of Medicine's Patient Education Research Center.

The six-week program enrolled 24 participants per session and provided interactive materials that enabled them to manage their condition between office visits.

They also exchanged information among themselves in bulletin board discussions.

The participants' mean age was 54, and the vast majority were white women recruited over the Internet from several states. Most had osteoarthritis while others had rheumatoid arthritis and fibromyalgia.

Those who participated in the study reported improved health status six and 12 months after completing the course, compared with others who were assigned to usual care.

The researchers concluded that using an Internet program could prove to be an effective way to reach large numbers of people. The program is expected to be offered online through the California Community College System, Dr. Lorig said.

To recruit more men, the possibility of linking to the National Football League's Web site is being considered and, in an effort to attract a more ethnically diverse audience, links to Native American sites also are planned, she noted.

Meanwhile, physicians should take care to ensure that written patient communications are clear and effective. Presenters recommended giving consideration to using the SMOG (simple measure of gobbledygook) factor of text.

The SMOG factor looks at the number of words of three or more syllables in a text sample and estimates the years of education a reader would need in order to understand the text.

The formula was devised in 1969 by G. Harry McLaughlin, PhD, a British newspaper editor who emigrated to Canada and then the United States and has continued to work in various settings -- including health care -- to make texts more readable.

Physicians also could be sure that they use plain language, provide only three or four points for each patient interaction, and make it clear how and where to get more information, said the presenters from Harvard's School of Public Health and Brigham and Women's Hospital in Boston.

Steps for creating readable materials include determining the intended audience, the need for the material and the potential uses of the material, said Rima E. Rudd, ScD, MSPH, a lecturer and researcher in health literacy studies at Harvard.

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External links

AMA Foundation on health literacy (link)

SMOG (Simple Measure of Gobbledygook) factor (link)

Harvard University School of Public Health, health literacy studies (link)

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