Lisa DeTora, PhD, Hofstra University; Kelly Soldavin, Taylor & Francis Group, Philadelphia, PA
The session “For the Present Purpose: Using Medical Rhetoric to Enhance Scientific Communication in an Open World” at the 16th Annual Meeting of ISMPP, June 16-18, 2020, generated much interest from meeting attendees. The session presented rhetorical strategies that can be applied to scientific communications and tools to prevent misunderstandings across different audiences, which are particularly useful in the work of medical communication professionals.
Faculty member Lisa DeTora received various questions from attendees that are broadly applicable across the ISMPP membership. Topics include rhetoric in non-commercial settings, plain language summaries (PLS), simplifying complex information, and building trust in pharma. Lisa discussed the questions with Kelly Soldavin, a medical editor with expertise in PLS and other enhanced content that complements scientific papers. Their dialogue is provided below.
| What is rhetoric? Broadly speaking, rhetoric is the oldest academic discipline. It considers the modes and means of communication designed to persuade people to take specific types of action. Various experts contrast the discipline of rhetoric with “empty rhetoric” or persuasive language that may hinder effective communication. The authors consider both definitions in their discussion. |
How can we identify rhetorical strategies in non-commercial settings?
Kelly: Many sources identify rhetoric as the art of persuasion. On the commercial side, it is often easier to identify persuasive strategies because their objectives typically revolve around education about the product or service and how it compares to alternatives. Recognizing rhetorical strategies in noncommercial and regulatory discussions requires further investigation into best practices, purpose, and audience.
To help identify these strategies, ask yourself about both the intended audience and the communicator.
- Who is the intended audience? What are the objectives of the communication or discussion?
- What type of forum is being used? Live? Written guidance? Social media? Scientific meeting?
- What is the level of medical knowledge and expertise among the audience? The communicator?
Once you have those answers in hand, you can begin identifying rhetorical strategies.
Lisa: Right. Rhetorical strategies vary from setting to setting and even person to person, so it’s important to keep the speaker’s goals in mind. For example, the aim of regulatory bodies is generally to assess whether the benefits of using a product outweigh the risks of harm. However, at stages prior to an Investigational New Drug application (or equivalent), the regulator might need to assess whether the studies were appropriate; for example, were the most relevant reference species studied?
If we think about public health interventions, like vaccines, then the questions, hence the rhetoric, might become more complicated. A pediatrician might need to assess whether an adverse effect justifies discontinuing an immunization regimen in an otherwise healthy infant. The pediatrician will have to consider the benefits and risks to society and the potential for harm (transient and lasting) to the individual infant.
Another group to think about is peer reviewers—and it may be helpful to request the peer review guidelines from journal editors. For example, some journals specifically seek papers with an explicit application to clinical practice while others seek rigorous statistical analyses. Knowing that sort of information can make the peer-review comments more easily interpretable. In fact, the simplest thing is to always ask, “what is the aim of this communication?” or “what is the scientific framework for this discussion?”
What is the general role of plain language in medical communications and publications?
Kelly: When evaluating regulatory communications, it is interesting that the U.S. National Institutes of Health (NIH) places a strong emphasis on using plain language to reduce barriers to communication. (See https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/plain-language.) I believe this focus on plain language demonstrates an effort to move away from rhetoric and move toward clear and concise language for any audience.
Those of us in the medical communications and publishing industries see the emphasis on plain language use increasing alongside a focus on the patient voice. This increased emphasis is accompanied by a focus on developing new guidelines and resources that create consensus and describe best practices in the use of plain language, which will allow our industry to more easily and effectively incorporate plain language into scientific communications.
Lisa: I like the way you refer to what is termed as “empty rhetoric” when considering the NIH and its commitment to plain language. It’s a great segue to discussing the aims of communications like PLSs. Plain language guidelines exist (plainlanguage.gov, and https://ec.europa.eu/health/sites/health/files/files/eudralex/vol-10/2017_01_26_summaries_of_ct_results_for_laypersons.pdf, for example); however, a more salient question might be how we organize the information to communicate effectively to readers, even unanticipated ones. This requires us to consider reader needs and our own aims.
I think each PLS should begin with an aim, or purpose, and limitations. This is an opportunity to direct patients and caregivers to existing standards of care and accepted treatment recommendations. This strategy could also help medically well-informed audiences—for example, medical practitioners, advocacy groups, regulators, or students—understand how to use this information in line with their prior knowledge. It can also bolster trust in the pharma industry by avoiding the appearance of promotion. Obviously, settings like rare diseases and chronic conditions are enriched with highly sophisticated patients and caregivers, so consulting with patient groups or advocacy groups will help tailor PLSs for those readers.
Starting with limitations provides a way to explain the nature of findings for less well-informed audiences. Initial Phase 1 studies, for example, often don’t lead to approved products—stating that clearly could be helpful.
Kelly: It is easy to say that we need to use plain language, but it is much harder to define what that is, especially with regard to PLSs, which have such varied audiences, as you point out.
My first recommendation is to determine if the journal, publisher, or organization provides specific guidelines for PLS writing or format. These guidelines typically provide advice and instructions on how to write an effective PLS and suggested resources that offer further information about the PLS format and plain language itself.
If you don’t have specific guidelines, standard advice is to write to an 8th grade (U.S.) level; www.readable.com is a helpful resource. Other resources include:
- the Universal Patient Language website: www.upl.org;
- The Book of Good Practices: https://synapse.pfmd.org/book-of-good-practices; and
- PLS tool kits available at www.envisionthepatient.com/plstoolkit/ and https://ktdrr.org/resources/plst/.
The exciting news is that new PLS resources and guidelines are in development. As these become available, it will become only easier to produce an impactful and effective PLS.
| Essential Points on Plain Language & PLS – Plain language is clear and concise communication that can be understood by any audience. – Plain language summaries (PLS) use clear and concise language to summarize scientific articles for a wide range of readers, including healthcare providers, patients, and caregivers. – A PLS should include an aim or purpose and limitations to help the audience understand existing standards of care and also the nature of a study’s findings. – There is an array of existing resources and guidelines available to guide writing and publishing of PLS. Reach out to your journal editorial contact, explore ISMPP’s educational literature and webinars, and visit PLS tool kit websites, such as www.envisionthepatient.com/plstoolkit, for more information. |
What are some strategies to simplify complex information for different audiences, like healthcare providers or patient groups?
Kelly: One of the best resources for making effective PLSs and simplifying complex information for different audiences is your publications team. This doesn’t have to be a “formal” team. Experts can be found in companies, academic institutions, medical communications agencies, publishers, or even patient advocacy groups. Engaging an expert medical writer will ensure that your PLS is written in clear, plain language and is organized effectively. Getting feedback from your intended audiences—patients, caregivers, peers, and clinicians, among others—will help identify areas that need improvement.
Finally, remember that a picture is worth a thousand words. Consider creating your PLS as an infographic or image, in addition to, or in place of, plain text. There is plenty of research that emphasizes the impact of images when it comes to communicating key scientific messages and medical information.
Lisa: You rightly point out that visuals are an important way of providing simplified but accurate information to general reading audiences.
One area we don’t always consider, because we have relatively little control over it, is journalistic media. A podcast, for example, could lead with a statement like “chocolate may cure cancer,” based on a murine model finding sometimes associated with a decreased risk for some specific type of cancer in another animal model. So that headline is actually very misleading. We not only don’t want to engage in that sort of rhetoric, we also (politely) probably want to start calling out those kinds of practices as, at the very least, inaccurate.
How do we build trust in pharma and corporate partners?
Lisa: One way that pharma and vaccine companies appear to be unworthy of trust is that business communications, like press releases, can be just as confusing as scientific information and may appear dishonest. Principles of plain language and effective use of visuals can help in these settings, as well as in medical communications. In fact, any truthful communication that shows how sponsors actually care about and benefit people would be helpful. Asking for input and then showing how the input was taken seriously is also helpful in building trust. As you point out, seeking advice from stakeholders and using that feedback to identify areas for improvement is vital. We also need to enact those improvements.
Conclusion: What is the simplest thing we, as a profession, can do to make our work more effective?
Lisa: One thing we can do is to recognize our expertise. Publication professionals are not really lay consumers of scientific or medical data, even outside of our expert areas, because we reflexively understand certain types of terminology and the limitations of datasets. This is why we need to consult with people who have different ways of understanding health information.
One simple change that can have a huge impact on medical publications and other medical communications is to continually remind ourselves who is communicating with which audience and why. In other words, we need to think about the scientific, medical, and other aims of all communications. Who is communicating? To whom? Why? How? We need to ask stakeholders their opinions, and we need to improve our communications in response to their feedback. In other words, we can’t just ask for feedback and proceed; we need to think about how to make ongoing adjustments in response to those who took the time to comment. As I said in ending out my presentation, there’s no one answer to these questions. We need to continually think, try new things, and always aim to improve.
| Ask Yourself… – Who is the author? – What is the aim of the research? – Who is the audience? – Why are the findings important? |