Doctors using confusing language in cancer consultations

The public are confused by many of the medical terms used by doctors in cancer consultations, according to a new study¹ by Cancer Research UK scientists.

Researchers in Brighton found terms commonly used by doctors in the UK such as ‘progressing tumour’ and ‘remission’, as well as those used to describe screening procedures for breast and bowel cancer, were poorly understood by the public.

The study, published in the August 2003 issue of Psycho-Oncology, suggests there is an urgent need for doctors to change the way they communicate important information to patients.

Experts at the charity hope the news can encourage doctors to provide better and clearer explanations in consultations.

“Growing evidence suggests the majority of people with cancer want to be fully informed about their illness whether the news is good or bad. A clear understanding of the situation can improve a patient’s treatment, recovery and quality of life. So it’s crucial that doctors avoid ambiguous language or medical jargon in consultations,” says one of the study authors, Professor Lesley Fallowfield from the Cancer Research UK Psychosocial Oncology Group at the University of Sussex.

Researchers selected potentially confusing words and phrases from 50 videotaped cancer consultations where patients had indicated they did not understand the information given or doctors used medical jargon.

They designed a detailed questionnaire with scenarios containing the terms. Diagrams of the body, on which to locate organs that could be affected by cancer, were also included in the survey to test the participants’ knowledge of basic anatomy.

People in and around the Brighton area were approached to take part in the study in June 2001 and around 100 men and women, aged between 16 and 64, completed the questionnaire. Participants were also asked to rate how confident they were about their answers.

Researchers found that only six out 10 of those questioned understood that ‘metastasis’ meant cancer was spreading. Only around half of the participants knew the term ‘remission’ meant there was no detectable sign of cancer and understood the phrase ‘the tumour is progressing’ was not good news.

Three out of 10 had poor understanding of the term ‘seedlings’ – a euphemism for the spread of cancer – and 2 out of 10 were confused by the phrase ‘spots in the liver’.

Researchers found many of those who completed the questionnaire thought they understood terms when they were actually quite confused by them.

More than half of the study group either didn’t know or showed partial understanding of breast cancer screening techniques such as mammography while 4 out of 10 had a low understanding of various methods used to detect bowel cancer.

Participants’ knowledge of where organs in the body lie varied. While 9 out of 10 correctly identified the lungs only 5 out of 10 located the liver. Many of those questioned also had trouble locating where the cervix and prostate are in the body.

Prof Fallowfield says: “The study shows a substantial proportion of the public don’t understand terms often used in cancer consultations.

“There’s an urgent need for doctors to reassess the way they explain the diagnosis and treatment of cancer to patients. Our results would suggest using plain language, steering clear of euphemisms such as ‘an abnormal growth’ to describe cancer, while making sure patients know which organ is affected by the disease and where it is in the body, would help avoid confusion.

“Doctors also need to be aware that asking people if they understand what’s being said is likely to overestimate comprehension and it may be better to ask what they have understood.”

“We need to ensure that results of this research are made available to everyone involved in teaching communication skills to doctors,” she adds.

Dr Richard Sullivan, Head of Clinical Programmes at Cancer Research UK, says: “It’s important that doctors do not use terms that maybe confusing to people especially since lack of understanding can affect a patient’s treatment choices, adherence to treatment, quality of life and survival.

“Doctors have a responsibility to communicate effectively and clearly with people who have cancer to enable them to make up-to-date and informed decisions about their future.”

ENDS