Words Matter: Diction in Electronic Communication Influences Palliative Care Consultation Implementation

Palliative care consultation teams (PCCTs) provide input to other health-care providers working with patients who have life-limiting disease. This study examines whether the diction and phrasing of consultation recommendations in the electronic health record influence their implementation. We reviewed 288 verbatim PCCT recommendations that were made for 111 unique patients in a Veterans Affairs hospital and available in the electronic health record. Recommendations were coded for linguistic features, such as the presence of conditionals (e.g., could) and tentative phrasing (e.g., would suggest). Each patient's subsequent treatment was followed in the medical record to determine whether PCCT recommendations were implemented. Only 57% of the consultation recommendations were eventually implemented. Recommendations that included a conditional word or phrase were significantly less likely to be implemented. In particular, recommendations that included the words could and consider were less likely to be implemented. PCCTs may enhance their effectiveness by attending to the subtle pragmatics of how they communicate with other health-care providers, particularly in electronic communication where nonverbal features of communication are unavailable.