Patient Comprehension via Explanatory Communication—Reply

In ReplyIn their letter about our recent article, 1 Dr Back and colleagues highlight a particular sentence in the Table : "Palliative care is not hospice care and it is not giving up," and indicate that this phrasing may be problematic due to its use of negation.The sentence is an example of an elucidating explanation, 2 a technique that we discussed in the article as a way to clarify a concept by explaining both what it is (affirmation) and what it is not (negation).The negation is not intended to stand alone.Instead, the elucidating explanation is part of a larger conversation about palliative care.In the case we described in the Table, the clinician conversation began in the patient scenario row, including an introduction to palliative care, which would describe what palliative care is (affirmation statement).The elucidating explanation, including the negation statement, then helps patients navigate the information that came in the affirmation statement.Back and colleagues describe the concept of negation not only as the presence of words like "no" and "not," but add the listener's associated negative meaning.This extends beyond the denotative use of negation and introduces the concept of valence.Extending beyond the simple definition of words, valence is the listener's association (negative or positive) with words, which prompts an emotional reaction and response. 3 Health communication scientists study both the cognitive and affective effects of messages and then recommend communication strategies.In our article, 1 we focused on improving patient knowledge and comprehension, which limited our discussion to the cognitive effects of messaging.Our intention was not to imply that efforts to improve communication should be hindered by rigid approaches.Interpersonal communication is an iterative, dynamic process between the patient and clinician. 4 The ways in which we communicate vary substantially depending on the patient, context, and the message being conveyed.Palliative care is a topic that elicits strong cognitive and affective responses.Clinicians cannot ignore the affective components of these conversations when communicating with patients.