A recent study found patients frequently did not understand common dermatology terms, and that some patients with higher education and prior medical experience even overestimated their understanding of these terms.
It is important providers are cognizant of these barriers and to take time to discuss and reaffirm a patient’s understanding of the terminology being used during a visit, the researchers said.
In the study, 313 respondents completed an in-person survey of 11 dermatologic terms, presented alone and in a sentence using the term in contexts frequently used by dermatologists. Participants defined the term in their own words and rated their level of confidence in understanding each term on a 5-point scale. Their definitions were graded by 2 blinded physicians based on their accuracy using a 5-point scale. The researchers assessed the associations between accuracy and perception regarding the understanding of the terms.
Overall, the researchers found the average perceived understanding of a term was 3.7 out of 5, and the average accuracy of a term was 3.8 out of 5 (reviewer concordance 92.3%). In 20.1% of instances, patients reported being “not confident” or “not confident at all” in understanding a term. Likewise, 75.6% of respondents reported being “not confident” or “not confident at all” at least once during the survey. In addition, an accuracy of 1 or 2 out of 5 was reported in 24.2% of cases, the researchers said. The 2 terms respondents reported being less confident about were “pathology” and “metastasis.”
In 20.5% of cases, respondents reported a higher perceived understanding than the graded accuracy of a term.
Definition accuracy was positively associated with education level and previous experience in the medical field. However, the researchers also found higher education levels and previous medical experience was associated with respondents’ overestimating their understanding of a term (24.4% with graduate degrees vs 17.9% with high school diplomas and 25.7% vs 19.6% without previous medical experience, respectively).
White respondents were also found to more frequently overestimate their understanding of a term compared with black respondents (24.9% vs 15.9%). Compared with men, women were more confident in their understanding of a term and had a higher accuracy in their definition.
The Dermatologist discussed these findings further with lead study author Brett C. Neill, MD, with the division of dermatology at the University of Kansas Medical Center in Kansas City, Kansas.
The Dermatologist: Why did you decide to conduct this study?
Dr Neill: We encounter patients with drastically different socioeconomic backgrounds and understanding of medical terminology. When patients do not have a full understanding of their medical care it may lead to errors in medication use and negatively impact treatment outcomes, so it is important to minimize these cases.
As dermatologists we use a lot of specific jargon that is not completely understood within the greater medical community, let alone by our patients. It is likely that this lack of patient understanding of dermatology jargon is more prevalent than we perceive. Our goal with conducting this study was to identify the prevalence that our patients did not understand, or perhaps even more importantly, incorrectly understood commonly used dermatology terms.
The Dermatologist: How did you determine patients’ understanding of common dermatologic terms? What were some notable findings from your study and were you surprised by any of them?
Dr Neill: We identified a set of terms, which were relatively specific to dermatology and often used in our everyday practice, and had patients rate their level of confidence in their understanding of each term. We then had the patients define the terms using their own words so we could assess the accuracy of their perceived understanding. This allowed us to identify the frequency with which patients did not understand commonly used phrases.
Our study notably found that, roughly 20% of the time, patients were not confident in their knowledge of these terms. Interestingly, even when patients were confident, they frequently overestimated their understanding. When patients were more educated, they overestimated at even higher rates! If our patients perceive their knowledge to be correct, they may be less likely to seek clarification during visits. Thus, it is important to be cognizant of this and minimize use of jargon during visits.
The Dermatologist: Was the role of the internet and publications by non-medical professionals a part of participants confidence in understanding dermatology terms?
Dr Neill: We often found patients were confident in their understanding of the terms; however, this confidence did not always correlate with their definitions being correct or accurate.
While we did not specifically inquire about where our patient’s knowledge originated from (the internet vs medical providers), the internet undoubtably plays a major role in how we obtain information in today’s world. While there are many positive implications of this reality, it is also important that as providers we provide accurate and easy-to-understand explanations for the patients whenever possible.
The Dermatologist: Do you anticipate these results affecting clinical practice in any way? How can dermatologists better educate patients on common terms to ensure patients are able to participate in shared decision-making?
Dr Neill: I think these results reinforce what is often perceived within the medical field—we utilize too much jargon with our patients.
For dermatology, in particular, I do not think we expected the lack of understanding to be so extensive. However, this should serve as a reminder that patient understanding is variable and often incorrect. Simply put, dermatologists need to be aware of the terms they use when speaking with patients.
For example, instead of saying “benign” say “harmless,” or instead of saying “excision” say “remove.” Describe to a patient what sending the tissue specimen to pathology means, such as telling them it will be sent so someone can “look at the skin under a microscope to see if it is cancer.” Taking the brief amount of time to elaborate and using the teach-back method may help us identify when information is not completely understood and provide an avenue to further clarify and simplify.
We encourage providers to not only modify their practice habits in order to improve patient care as they see fit, but also pursue future research aimed at identifying ways that we can efficiently maximize patients’ understanding in the clinical setting. Our study has provided useful insight into this problem, but more work is still to be done to alleviate it.
Neill BC, Golda N, Seger EW, et al. Determining patient understanding of commonly used dermatology terms: A multicenter cross-sectional survey [published online January 17, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.01.016