Style Guide: Equity, Diversity, & Outreach

Defining specific populations

Underrepresented populations

Specific to minorities

• Internally: “underrepresented populations” 
• Externally: use inclusive language by identifying the racial and ethnic groups to which you are referring, avoid catchall terms such as “minorities” or “minority groups” 
  • Examples: Individuals who are Black, Hispanic, Asian American, American Indian, elderly, LGBTQIA, etc.

Vulnerable populations

Communities that are of low socioeconomic status, medically high-risk, or face English language barriers

• Internally: “vulnerable populations”
• Externally: Avoid catchall terms that put fault on the community; name specific groups and instead opt for “[...] may be disproportionately affected/impacted by [...]”.
  • Examples: individuals experiencing significant financial hardship, individuals who are deemed medically high-risk, individuals with limited English language comprehension, individuals who are non-native English speakers, etc. 

Medically underserved populations

Communities that are geographically isolated from healthcare services

• Internally: use “medically underserved populations” and specify these subgroups.  
  • Subgroup examples: rural/urban, men/women, young/elderly, etc.
• Externally: instead opt for “a community without appropriate resources,” “communities that are under-resourced,” or “communities that are high-priority”
  • Do not use: “hard-to-reach people/places” (this puts blame/fault on these communities).

Representative populations

A small number of people chosen to accurately reflect a larger population

• Internally: use “representative samples” or “representative populations” and specify which demographic your sample derives from.
• Externally: instead opt for “a sample of the [...] population shows [...]” 
  • Examples indicated above.

At-risk populations

Refers to specific groups or communities that experience a higher risk for being diagnosed with lung cancer

• Internally: “at-risk”
• Externally: instead opt for “[who] is at risk for [what]”; be specific and use people-first language 

Elderly

A person who is showing signs of old age or aging

• Internally: “elderly” is preferable to “old” or “aging” when specifying the demographic as a whole.
• Externally: “individuals who are over the age of [...]” is a people-first, respectful, and numerical reference to a specific age demographic. 

Unemployed/patients on disability

Individuals who are unable to work due to the severity of their medical condition/the extent of their cancer

• Internally: use “patients who are unemployed” or “patients on disability” sensitively.
  • Do not use “impaired,” “disabled,” or “handicapped.”
• Externally: opt for “individuals receiving government assistance,” “individuals who are unable to attend work,” or “individuals who tend to their medical conditions full-time” to avoid perceptions of weakness or blame.

Avoiding stigma and blame

Relationship to cigarette smoking

Patient groups categorized by their smoking history

• Internally: "smoker," "nonsmoker," and "former smoker" may be used in the absence of judgment or bias
• Externally: use "person who smokes," "person who does not smoke," person with a smoking history," "person with a history of active tobacco exposure," or "person with nicotine dependence."

Blame language

Traditionally used medical language can sound like blaming the patient. Use these more empathic and nonjudgmental phrases.

• Instead of "noncompliant," say "not able to"
• Instead of "patient progressed," say "cancer progressed"
• Instead of "patient failed treatment," say "treatment failed (or "failed the patient")
• Instead of "chief complaint," say "chief concerns"
• Instead of "prevention," say "risk reduction" ("prevention” is population-centered, whereas “risk reduction” is individual patient-centered)

(Adapted from the IASLC Language Guide)

Defining health inequities

Social determinants of health (SDOH)

Conditions within daily environments such as where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks

• Internally: when discussing the “social determinants of health” specify the domain to which you are referring when necessary (most likely healthcare access and quality; however, can also include housing or living environment, education access and quality, food access and quality, etc.).
• Externally: Refer to how “healthcare access and quality can influence health-related outcomes.”

Implicit/unconscious bias

Attitudes, beliefs, and stereotypes that are unconsciously associated with certain groups of people (e.g., age, gender, culture, race, sexuality, weight, name, height, etc.)

• Internally: reference either “implicit” or “unconscious” bias with context (such as who it is from/toward and how) 
  • Example: elderly individuals often experience unconscious bias from physicians who assume their pain symptoms are merely signs of aging. 
• Externally: opt for “unconscious bias,” as it is more universally understood.

Disparity/inequality

Used to describe things that are drastically different or unequal

• Internally: “disparity” is synonymous with “inequality” when referring to disparities in lung cancer.
• Externally: opt for “inequality” instead and describe these inequalities (e.g., inequalities in access, affordability, income, racial/ethnic inequalities, etc.).    

Continuum of care/cancer continuum

Describes the stages of care that healthcare providers give to adapt to the changing needs of a patient across a span of time

• Internally: the “continuum of care” or “cancer continuum” is used to reference disparities or inequalities in different stages of lung cancer treatment (e.g., access inequalities related to low socioeconomic status or insurance status that affects lung cancer screening, biomarker testing, access to clinical trial, etc.).
• Externally: avoid unless necessary.

Access

Relates to a patient’s ability to find and receive lung cancer-related care

• Internally: “access” is often used to simultaneously refer to a patient's ability to find an experienced doctor and apply for relevant treatment options.
• Externally: expand on this broad definition by specifying for what, such as: “individuals unable to access [...]”. 

Affordability

Relates to a patient's ability to pay for lung cancer-related care

• Internally: “affordability” is often used to refer to limitations related to cost or insurance coverage.
• Externally: expand on this broad definition by specifying for what and why, such as: “individuals unable to afford [...] because of [...].”