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To improve communication, cultivate your writing.

Do your written communications oblige the reading level of their intended audience? If not, you're wasting everyone's time--and could be opening your facility to a lawsuit.

LABORATORIANS must communicate regularly with one another, with health care professionals from other departments, and with patients. Yet the daily demands of laboratory work often make it difficult to engage in face-to-face interaction. This is unfortunate since such talks would enable us to watch people's reactions to our messages and to be sure they understood them. We must therefore rely on a flood of written communication.

Yet when preparing letters, long and short explanatory memos, laboratory protocols and policies, consent forms, and a wide variety of other materials, how often do we consider the reading level of those who will receive and use them? It is essential that such information be presented clearly and concisely. If a patient misinterprets the information on a consent form, legal complications may ensue. If a bench technologist misconstrues instructions on a test procedure, patients' welfare may be compromised. Miscommunication is often worse than none at all.

* Audience. Most educational materials intended for patients are written at the sixth- to eighth-grade reading level. While this standard may seem dreadfully low, it reflects the national average.

Many people understand complicated language when not under stress. Reading comprehension levels tend to drop significantly, however, when the material contains information of dramatic importance to the reader's health, such as facts to know before undergoing surgery. As a general rule, therefore, all patient-related communications should be easy to read and interpret.

* Gauging complex language. Fairly reliable reading methodologies have been developed to calculate the reader's level of comprehension. Among them are the Smog Index, Fog Index, Flesch Readability Index, and Flesch-Kincaid Grade TABULAR DATA OMITTED Level. The mathematical equations used in these determinations compare the relationship of reading complexity with such characteristics of written text as the length of words, sentences, and paragraphs. For instance, the formula used to determine a Flesch reading score is 206.835 - X, where X = 1.015 x (average sentence length) + 0.846 x (number of syllables per 100 words). This method uses a scale of 0 to 100. The higher the score, the easier it is to read the writing.

Those who cringe at the mere thought of working with mathematical equations may use any of several reliable software packages designed to do the same work. They cost less than $100, are easy to use, and can be added to many word processing programs. Besides correcting grammar, capitalization, punctuation, and spelling, most will evaluate the readability level of a document, identify misused terms, and monitor the use of jargon and colloquialisms.

Rather than modifying an author's original word processing document, these programs create a second version of the text and apply a detailed critique. The writer then decides which suggestions to implement and which to reject.

* Readability study. Currently, our blood center is scrutinizing the readability of blood transfusion consent forms used in various hospitals throughout our region and around the country. Since these forms help patients understand the benefits and risks of blood transfusion as well as alternatives, it is crucial that they be absolutely clear.

As part of our research, we looked at a physician's resource kit entitled "Informed Consent for Blood Transfusion," which was distributed by the American Association of Blood Banks (AABB) in 1990. This program includes a videotaped program for patients, a sample consent form, and reference information. Several program directors have admitted that the information in the packet is written at a more advanced reading level than all patients can comprehend. Among the clinical terms used without definition are these: attestation, urticarial, hemolytic, and autologous.

In order to determine the reading level of the consent form, we ran it through the following two software packages: Grammatik (Reference Software, San Francisco) and RightWriter (Que Software, Carmel, Ind.). We plan to present our findings at the AABB annual meeting in San Francisco next month in hopes that the organization will consider revamping patient information contents of the kit. A brief synopsis of RightWriter's analysis of the consent form is highlighted in Figure 2.

* Worth the pain. For some people, reviewing the corrections and suggestions made by one of these programs can be a humbling experience. Faith in ourselves as professionals and skilled communicators can easily be shaken by the number of proposed changes. In time, however, these programs can help us to write more clearly and concisely. In our opinion, the grammar and spelling checks that are built into these communication programs alone justify their cost.

As constant communicators, we laboratorian must improve our writing. Assuring intelligible communication is an extremely valuable asset in the laboratory and protects patient welfare as well.

Figure 2 Analysis of an AABB blood transfusion consent form

Original text

I understand that this form has provided me with an explanation of the most common complications, consequences and reasonable alternatives of receiving blood transfusions and/or blood products. I accept that this informed consent does not spell out every possible risk or complication. I know that if I do not understand any of what my doctor has told me, have special concerns, or just want more detailed information, I should ask more questions and get more information before signing this consent agreeing to treatment.

RightWriter analysis (excerpt)

* The writing is complex and may be difficult to read.

* The writing can be made more direct by using shorter sentences.

* The use of adjectives and adverbs is normal.

* The writing contains a good deal of jargon.

* Most sentences contain multiple clauses. (Try to use simpler sentences.)

* Most sentences begin with pronouns. (Try to vary sentence structure.)

* Possible jargon: "complications" and "transfusions"; negative word: "not."

Revised text (proposed)

This form explains most common problems caused by a transfusion of blood or blood products. Other treatments that can be used instead of blood are also explained. I know that all the risks of blood cannot be listed. I also know that I should ask questions if I do not fully understand what my doctor has told me. I can get more information if I want and can tell my doctor what worries me before I sign this paper agreeing to a blood transfusion.

The critique provided by the software program is far more extensive than the synopsis shown here. RightWriter identified the reading level of the original text as that of a college junior--a situation that does not necessarily reflect the state of mind of people who are about to undergo a blood transfusion, however extensive their education. The program generated graphs and computer screens that made general observations about the readability and strength of the material and suggestions for improving sentence structure. Jargon and negative terminology were flagged and the use of descriptive words was rated. Consulting the computer evaluation, the authors simplified the AABB form to achieve a seventh-grade reading level.

Kasprisin is chief medical officer and Clough is medical services assistant, American Red Cross Blood Services, Southwest Region, Tulsa, Okla. Perisho, formerly a medical associate with that facility, is now branch manager, SmithKline Beecham Clinical Laboratories, Tulsa.
COPYRIGHT 1992 Nelson Publishing
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:written communciations for medical technologists
Author:Kasprisin, Duke O.; Clough, Phala; Perisho, Andrea
Publication:Medical Laboratory Observer
Date:Oct 1, 1992
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