Guiding healthcare language towards inclusivity and equity

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.

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.