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From: harwo001@mc.duke.edu
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Subject: [NIFL-HEALTH:2260] Re: It's a plain language issue
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The writers below express concern about HCPs not distinguishing between 'benign'
and 'malignant' when discussing a brain tumor. SM's statement that 'Benign
tumors rarely kill people unless they happen to be in a particular location'
really hits on an important point. Brain tumors ARE different in that it is the
primary tumor, rather than metastases that typically kill the patient and the
benign vs. malignant distinction is of little importance relative to the growth
rate of the tumor.
A helpful strategy I have found in this situation, and many others, is to
acknowledge the patient's knowledge and direction from which the question is
coming, and use that as an opportunity to provide information relevant to their
situation. For example:
'THat's an excellent question. With just about any other type of tumor, that
would be a very important distinction. Because malignant brain tumors don't
tend to spread elsewhere in the body, and benign brain tumors may be just as
life-threatening, we tend to use a different way of classifying them. Let me
tell you first about how we classify brain tumors, and then about how your tumor
fits into this classifcation system....."
Kerry Harwood, RN, MSN
Director, Cancer Patient Education Program
Duke University Medical Center
sm@smcmillan.com (Seamus Mcmillan) on 03/01/2000 10:58:20 AM
Please respond to nifl-health@literacy.nifl.gov
To: Multiple recipients of list <nifl-health@literacy.nifl.gov>
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Subject: [NIFL-HEALTH:2259] Re: It's a plain language issue
In message <B479992EC0BFD311A1DA009027D5CD462A02B5@SMAIL02> writes:
> I couldn't agree more with this current thread. While we've specialized in
> health information at a literacy level of 3rd to 4th grade for some
> populations, that's only a small part of our work. Our biggest challenge in
> health communication (and medical literacy) is and has always been
> struggling to interpret "medical-ese" for laypeople at all literacy levels.
> Plain language- and common language- is not an easy issue.
>
> Are the people who treat you doctors, nurses, or healthcare providers?
> Depends on where you get treated. My sister was diagnosed with a brain
> tumor last summer, and when she asked if it was benign or malignant (seems
> like a reasonable question) was told, "we don't use those terms anymore;
> now they are staged in five stages, based on how fast they are growing".
> Fine, except that that doesn't clarify anything for a patient (college
> educated) whose frame of reference is that tumors are "benign or malignant".
>
======================================================
As an aside I'm not sure that it's even medically correct to ignore the question
about benign vs malignant. Tumor staging is generally based on a number of
characteristics, growth rate, cell morphology and type (cell appearance and
lineage), mitotic index (proportion of cells actively growing), presence of
secondary tumors, size of primary, etc....
Irrespective of growth rate the distinction between benign and malignant
generally refers to a tumor's metastatic potential, ie the tumor's potential to
generate secondary growths. Benign tumors rarely kill people unless they happen
to be in a particular location. Conversely a cancer's lethality derives from
its ability to generate metastases.
Best regards
Seamus McMillan
Seamus McMillan, Ph.D.
Office: (612) 937-5134 Fax: (612) 975-9708
E-Mail: sm@smcmillan.com (preferred) or smcm@aol.com
WWW: http://www.labmed.umn.edu/~seamus/
Delphi Assoc. Inc., |16526 W. 78th St.|Second Source Alliance,
smcm@DelphiGrp.com |Suite 197, |seamus@secondsource.org
http://www.DelphiGrp.com |Eden Prairie, |(612) 975-6078
|MN 55346-4358. |http://www.secondsource.org
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