S3003 Promoting Patient-Centered Language in Gastroenterology Documentation: The Impact of an Educational Intervention

Introduction: Stigmatizing language in medical documentation can compromise patient trust, engagement, and communication. In gastroenterology (GI), terms such as morbid obesity, alcoholic, drug abuse or addict, non-compliant, poor historian, and poor prep can carry negative connotations. This study evaluated the impact of an educational intervention on the prevalence of stigmatizing language in GI medical records at an urban university medical center in effort to promote respectful, patient-centered documentation. Methods: A review of outpatient and endoscopy records during a 2-month pre-intervention (pre) period was conducted to identify stigmatizing terminology. An educational session introduced evidence-based alternatives for stigmatizing terms: BMI for obesity, alcohol use disorder for alcoholic, substance use disorder for drug abuse or addict, unable to adhere to recommendations because of a stated reason instead of non-compliant and Boston Bowel Preparation Scale instead of poor prep. Records were assessed for 2-months post-intervention (post). Analysis was performed using Fischer Exact test with significance set at P < 0.05. Results: 3417 records were reviewed (pre: 1653, post: 1764). Use of the term obesity significantly decreased (pre: 5.6%, post: 3.6%; P= 0.012), while use of BMI significantly increased (pre: 8.8%, post: 16.6%; P < 0.001). There was a non-significant decrease in the term alcoholic (pre: 1.1%, post: 0.6%; P = 0.17), with an increase in alcohol use disorder (pre: 0.12%, post: 0.4%; P = 0.11). There was no significant difference in the use of the terms drug abuse or addict (pre: 0.73%, post: 0.45%; P = 0.36), non-compliant (pre: 0.24%; post: 0.06%; P = 0.21) or poor historian (pre: 0.18%; post: 0.34%; P = 0.51). Of 1028 colonoscopy records, 873 had optimal preparation and were excluded resulting in 155 (pre: 99 pre; post: 56) eligible records. There was a significant decrease in the use of poor prep (pre: 51.5%; post: 23.2%; P = 0.002) with a significant increase in the use of Boston Bowel Preparation Scale <6 (pre: 48.5%; post: 76.8%; P = 0.001). Conclusion: Stigmatizing language was infrequently used in GI documentation at baseline, suggesting an existing culture of thoughtful and respectful communication. Nevertheless, a brief targeted intervention led to a significant decrease in the use of the terms obesity and poor prep to more objective, patient-centered alternatives. These findings demonstrate the effectiveness of low-resource educational efforts to foster inclusive and respectful medical documentation.