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HealthNovember 04, 2021

Guiding healthcare language towards inclusivity and equity

With COVID-19 most severely impacting communities of color, the CDC now calls racism and the healthcare inequity it causes a public health threat. But what is less recognized is that the lack of healthcare equity often stems from biases deeply embedded in the very language of healthcare.

The language of healthcare consists of anything that is written, visual, spoken, or in any way communicated to healthcare professionals and patients, guiding the decisions they make. Bias in healthcare language can start with a phrase as simple – yet potentially as damaging – as this: “The most common symptom of a heart attack is chest pain.”

While this may be true for men, it’s not necessarily true for women, who typically experience different symptoms of a heart attack. Language can impact patient care by perpetuating misconceptions and supporting stereotypes, and can influence clinician decision-making of diagnoses or medication prescriptions. This bias may extend to age, sex, gender identity, ethnicity or race, weight, national origin, and more.

Bias impacts many aspects of the healthcare journey

Research shows that bias in spoken and written language influences clinicians’ perceptions of patients and can negatively affect treatment plans. A recent clinical study found that medical students who read a clinical description of a sickle cell patient that used biased language were more inclined to have a less positive view of the patient and were less likely to prescribe needed analgesics.

In fact, the language of healthcare needs to consider not only a person’s medical situation, but also their broader socioeconomic situation including social determinants such as environmental contributors, community assets, family and cultural traditions, and individual choices. This broader recognition can help dispel common assumptions and stereotypes that are integrated into word and image choices.

To start making inroads in battling bias, healthcare stakeholders must take an intentional and deliberate approach to systematically review for bias and then proactively become facilitators of change.

At Wolters Kluwer, we are committed to doing our part to change healthcare’s language across patient communications, nursing and medical education materials and solutions, medical journals and books, and workflow solutions so clinical decisions are based on bias-free evidence.

Raising awareness on healthcare inequity, making change happen

People should see themselves represented with spoken and written language that reflects their lives and acknowledges relevant differences. Healthcare stakeholders must address this issue, whether it’s in patient communications like brochures, videos, and social media or professional materials like journal articles. Even chart comments will ultimately impact the care that people receive.

Research shows people subjected to more stigmatizing language may feel shame, reducing their willingness to complete treatment plans or even seek treatment at all. This makes a difference in health outcomes and plays a central role in managing healthcare disparities.

People need more than information to take action on their health in a meaningful way. They need to trust the source of the information, the information itself and that everyone is working together for the good of the patient.
Eve Gaus, Editorial Director, Clinical Effectiveness at Wolters Kluwer, Health

Healthcare equity starts with building trust

In a Scottsdale Institute-hosted webinar, Addressing Bias in Healthcare to Optimize Care for Vulnerable Populations, Eve Gaus, Editorial Director of Clinical Effectiveness at Wolters Kluwer, Health, says it’s time to acknowledge that structural racism in healthcare exists. Lived experiences vary from person to person, and in patient education, it’s crucial that personal bias or assumptions aren’t slipping into clinical content. Trust, Gaus says, extends to the information that people receive so they can take action on their health decisions in a more meaningful way.

When patients can’t understand information, they’re more distrustful of it. Patient communications and education should:

  • Incorporate plain language: For clarity, keep things simple, comprehensible, and at a 4th grade reading level
  • Define terminology: Provide definitions for medical terms and concepts that patients may be unfamiliar with so that all patients are all working from same knowledge base
  • Include understandable specifics: Avoid generalities and vague information that patients may not relate to, and make language conversational but not colloquial so those who speak English as a second language can easily understand
  • Reflect the patient population by incorporating people with different ethnic backgrounds, body shapes, sizes, etc. 

Inclusivity in healthcare goes beyond words 

Inclusivity is much more than just words. Gaus points out that assumptions about certain patient populations can find their way into communications. Inclusive strategies should incorporate:

  • Thoughtful choices in art AND language: We should avoid assumptions about patients, so imagery and content must reflect the diversity of the population
  • Inclusive social circumstances: We take into consideration all possible social determinants that may impact the patient
  • Modes of outreach: Not all patients have smart phones or computers, so it’s important to have multiple communication options

Breaking the cycle of bias in medical research

Each year, more than 2 million medical journal articles are published. That represents a tremendous potential for unconscious bias. Recognizing that research is crucial for evidence-based decision-making, medical societies and associations are faced with making certain that the research presented in their publications reflects more of a commitment to health equity.

It’s not just current research that bears reviewing – it’s also historical content that was created long before the focus on inclusivity and diversity. Jenn Brogan, Vice President, Global Journals and Society Solutions, Health Learning, Research & Practice at Wolters Kluwer, Health points out a perfect example of a rare retraction almost 50 years in the making.

In 1951, the Journal of Nervous and Mental Disease published an article titled Observations of Homosexuality Among University Students. It was retracted in December 2020 due to views expressed that seemed to advocate conversion therapy, a controversial “treatment” condemned by the American Psychiatric Association. A reader wrote to the editor-in-chief and requested the retraction, which the journal agreed to, based on current science and society norms.

If the research is biased in some way and the journal makes a decision to publish it, that’s what’s driving other research and other practices. It has a significant impact on outcomes and how patients are treated.
Jennifer Brogan, Vice President, Global Journals and Society Solutions, Health Learning, Research & Practice at Wolters Kluwer, Health

Additionally, in June 2021, the editor-in-chief of the Journal of the American Medical Association (JAMA) resigned due to a JAMA podcast and social media post that asserted physicians aren’t racist and dismissed the presence of systemic racism in healthcare. That same month, the journal issued New Editorial Priorities and Key Approaches of JAMA and the JAMA Network Journals to Strive for and Promote Diversity, Equality and Inclusivity (DE&I). These are examples of progress, but there’s still a way to go.

Charting the way towards healthcare equity

These examples illustrate the need to address bias in the publication process. The focus should be twofold: 1) to prevent bias in the first place, and 2) to detect and manage it. Consider the following when taking important first steps:

  • Key roles such as editors can be champions for these efforts and need to be more aware of bias and take necessary steps to guide the content, bring awareness, and ensure diversity among editorial boards and peer reviewers.
  • Journal editors should have a stated DE&I policy to guide article submission. Many journals are now producing an equity pledge which can help advance positive change.
  • Peer reviewers and editorial boards need to be more aware of bias such as ideologic, affiliation, ad hominem or referee bias, common types of peer review bias.
  • Double-blind reviews are also an important first step in mitigating peer-review bias and should become the new standard.
Teams that are diverse in terms of gender, ethnicity, and social background produce better health science, are more highly cited, generate a broader range of ideas and innovations, and better represent society.
The Lancet, gender equity and diversity pledge

All healthcare stakeholders have the opportunity to shape healthcare language today and tomorrow by doing what we can to identify and eliminate unconscious bias and increase inclusivity. With a commitment to reduce — and, ultimately, eliminate — disparities in healthcare and strive for the highest possible standard of health for all people, we can do our part to bring down healthcare’s language barriers.

Explore how Wolters Kluwer is committed to advancing health equity to provide patients with the best care everywhere.

Learn About Our Best Care Everywhere Initiative

Wolters Kluwer Expert Contributors

  • Eve Gaus, Editorial Director, Clinical Effectiveness
  • Jennifer Brogan, Vice President, Global Journals and Society Solutions, Health Learning, Research & Practice
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