Linguistic tones in MRI reports correlate with severity of pathology for rotator cuff tendinopathy.

BACKGROUND: Written communication can convey one's emotions, personality, and sentiments. Radiology reports employ medical jargon and serve to document a patients' condition. Patients might misinterpret this medical jargon in a way that increases their anxiety and makes them feel unwell. We were interested whether linguistic tones in MRI reports vary between radiologists and correlate with the severity of pathology. QUESTIONS/PURPOSES: (1) Is there variation in linguistic tones among different radiologists reporting MRI results for rotator cuff tendinopathy? (2) Is the retraction of the supraspinatus tendon in millimeters associated with linguistic tones? METHODS: Two hundred twenty consecutive MRI reports of patients with full-thickness rotator cuff defects were collected. Supraspinatus retraction was measured on the MRI using viewer tools. Using Kruskal-Wallis H tests, we measured variation between 11 radiologists for the following tones: positive emotion, negative emotion, analytical thinking, cause, insight, tentativeness, certainty, and informal speech. We also measured the correlation of tones and the degree of tendon retraction. Multilevel mixed-effects linear regression models were constructed, seeking factors associated with the tone, accounting for retraction, the presence of prior imaging, and for the effects of each radiologist (nesting). RESULTS: There were statistically significant differences for all of the tones by radiologist. In bivariate analysis, greater retraction of the supraspinatus muscle in millimeters was associated with more negative emotion and certainty, and with less tentativeness. In multilevel mixed-effects linear regression, more negative tones were associated with greater retraction and absence of prior imaging. Greater tentativeness was associated with the absence of prior imaging, but not with retraction. CONCLUSIONS: Radiology reports have emotional content that is relatively negative, varies by radiologist and is affected by pathology. Strategies for more hopeful, positive, optimistic descriptions of pathology have the potential to help patients feel better without introducing inaccuracies even if unlikely. LEVEL OF EVIDENCE: Level III, Diagnostic.

Talking About Prescription Opioid Misuse: The Effect of Family Communication Patterns and Messages Advocating Direct and Indirect Communication.

Families play an important role in addressing substance misuse and addiction. Extant literature suggests patterns of communication within families influence the ways in which they engage loved ones who may be misusing substances like prescription opioids. However, little is known regarding how strategic health messages about family communication influence individuals' intentions to engage in conversations about substance misuse. Applying a normative approach, we conducted a (2 × 2) between-participants experiment examining whether messages advocating indirect (versus direct) communication are more effective for individuals (n = 613) who describe their family as having a low (versus high) conversation orientation. Univariate analysis of variance tests show match effects for message attitudes and message elaboration. For intentions to talk with a loved one about the risks of OUD, there was only evidence of a matching effect between the message advocating indirect communication with low conversation audiences. Both message types were equally effective at influencing intentions for high conversation participants. These findings suggest message designers should consider the kinds of communication behaviors and actions advocated in appeals targeting family members. Messages that are inclusive of the conversation dynamics of particular audiences may have greater effect. In particular, for low conversation audiences, messages advocating an indirect approach may be more effective at motivating intentions to engage someone who is misusing opioids.

Medical Metaphors: Increasing Clarity but at What Cost?

Background: Clinicians often use metaphors to explain complex ideas. Metaphors also have the potential to reinforce unhelpful thinking regarding symptoms. We surveyed musculoskeletal specialists regarding use of metaphors in their daily practice and then assessed the contexts in which they are used, the themes of metaphors, and potential for reinforcement of common misconceptions (unhelpful thinking). Two primary research questions were posed: 1- What are the common characteristics of the medical metaphors used in patient-clinician communication by musculoskeletal specialists? And, 2- What percentage of medical metaphors used in patient-clinician communication have potential to induce unhelpful thinking and what are the characteristics of those metaphors? Methods: Eighty-one orthopedic and trauma specialists provided examples of metaphors they use in daily practice. Qualitative analysis of responses was performed through open coding of the data with the use of a constant-comparative technique involving several rounds of reading and rereading the data. Results: The 157 metaphors were categorized into 15 different themes. The most common themes were mechanical, objects, and sports and leisure. We also classified metaphors as addressing the natural history of the disease, treatment, mechanism, anatomy, or other. Thirty-five metaphors (22%) were identified as having the potential to reinforce unhelpful thinking. The most common purpose of these metaphors was for explaining the mechanism or natural history of the disease. Conclusion: Metaphors can either reinforce or reorient potentially unhealthy misconceptions. They can also reinforce despair and worry, or they can improve hope and sense of control. Orthopedic surgeons can be strategic and thoughtful in their use of metaphors, planning and practicing specific metaphors for optimal mental, social, and physical health.

Psychiatric Advance Directives as an Ethical Communication Tool: An Analysis of Definitions.

A psychiatric advance directive (PAD) is a communication tool that promotes patients' autonomy and gives capacitated adults who live with serious mental illnesses the ability to record their preferences for care and designate a proxy decision maker before a healthcare crisis. Despite a high degree of interest by patients and previous studies that recommend that clinicians facilitate the completion of PADs, the rate of implementation of PAD remains low. Research indicates that many clinicians lack the necessary experience to facilitate the completion of PADs and to use them, and, as a consequence, do not effectively engage patients about PADs. This study developed practical recommendations for clinicians to improve their ability to communicate and facilitate PADs. We (1) thematically analyzed definitions of PADs published in 118 articles across disciplines, and (2) presented our recommendations for enhanced communication in clinical practice that emphasizes patient-centeredness, usefulness, and clarity, aligned with evidence-based practices that put patients' autonomy and understanding first. While there is no one-size-fits-all script to engage patients in complex conversations, our recommended strategies include an emphasis on patients' autonomy, the adaptation of word choices, the use of metaphor not simile, and checking for patients' understanding as effective methods of clinical communication.

An Applied Improvisational Pharmacy Communication Workshop Implemented During Orientation for First-Year Pharmacy Students.

Objective. To deliver a brief, applied workshop in improvisational communication skills during the new student orientation for first-year Doctor of Pharmacy students and to assess students' perceptions about the experience. Methods. Communication instructors developed a two-hour communication "boot camp" based on established principles of clear, responsive, flexible communication. They taught core skills through interactive applied improvisational exercises and facilitated debriefings. A questionnaire was administered following the workshop that asked students to rate the quality of the session and comment on its strengths and weaknesses. Results. Of the 124 students who participated in the workshop, 95 (77%) completed evaluations at the end. Their feedback was generally favorable: 90% of participants indicated that the boot camp improved their communication skills and 92% agreed that the activities were realistic and relevant to real-life scenarios. The students reported that they valued the chance to connect with classmates, learn how to adapt to different audiences, and explore how communication skills would be useful in professional settings. Conclusion. This interactive program delivered valuable content in a short period of time. Student feedback suggested that they valued the expertise of communication instructors and the playful, active method of learning. The creation of the workshop was labor-intensive because of the formative research that guided it.