V38 N1 / 2023 ©2023 American Medical Writers Association. All rights reserved. ISSN 2163-5315 AMWAJournal.org 24 Speakers Leila Emery, MA Senior Medical Editor/RTI-HS Diversity and Inclusion Advisory Council, RTI Health Solutions, Research Triangle Park, NC Joyce Clark Hicks, BA Senior Medical Editor/RTI-HS Diversity and Inclusion Advisory Council, RTI Health Solutions, Research Triangle Park, NC By Rebecca Moran, MD Medical writers are uniquely positioned to help address inequities and bias in medical research and reporting by adopting best practices for use of inclusive language. Writers who embrace inclusive language strive to focus on the perspectives and voices of those who have traditionally been marginalized or stereotyped and aim to avoid expres- sions that exclude groups of people who have historically faced discrimination. Although the inclusive language umbrella encompasses a variety of groups and people, this presentation specifically focused on inclusive language as it applies to race, ethnicity, gender identity, and sexual orien- tation. To aid in the audience’s understanding of these con- cepts, the speakers provided definitions of several key terms (Table 1).1 GOOD FOR SCIENCE, SOCIETY, AND BUSINESS Adopting principles of inclusive language makes data stronger. It recognizes that people use different terms to self-identify based on their race, ethnicity, gender, gender identity, and/or sexual orientation. When surveys or other research tools use generalizations or stigmatizing terms, study participants might feel confused, negated, or “oth- ered.” As a result, they may feel unable to accurately com- plete a survey or be unwilling to participate in the study at all. Using inclusive language increases the likelihood that a diverse array of people will participate in research, which in Session Report Inclusive Language: Best Practices and Practical Applications For Medical Writers and Editors CONFERENCE Table 1. Definitions of Key Terms Diversity Focuses on identities that correspond to societal differences in power and privilege and therefore the marginalization of some groups based on specific attributes; involves the representation of various social identity groups Race Generally regarded as a means of differentiating between people by phenotypic characteristics such as skin color; it is a societal construct that has historically been used as a tool for oppression Ethnicity A multifaceted component of one’s identity that can encompass the nationality, tribal affiliation, religion, language, and traditions of a particular group, among other aspects; as with race, it has been a basis for discrimination Unconscious bias Social stereotypes about certain groups of people that individuals form in an unconscious manner Othering To view, treat, depict, and/or refer to a person or group of people as intrinsically different from or inferior to oneself using an “us versus them” mentality Gender A set of sociocultural norms and expectations about behaviors and characteristics regarding what is considered “masculine” or “feminine” in a given society or context Gender identity One’s innermost concept of self as male, female, neither male nor female (eg, nonbinary), a blend of genders, or no gender; how one identifies based on these characteristics (eg, gay, lesbian, bisexual, pansexual, queer) Sex assigned at birth The assignment (male, female, or intersex) that a doctor or midwife uses to describe a child at birth based on anatomy and chromosomes Sexual orientation Emotional, romantic, and/or sexual attraction Adaptation of Emery and Hicks1 reprinted with permission from RTI. http://www.amwajournal.org AMWAJournal.org 25Inclusive Language: Best Practices and Practical Applications turn impacts health equity. It also signals to clients that you have expertise in this skill and that you (or your company) are keeping up with evolving terminology standards. HOW TO START USING INCLUSIVE LANGUAGE To start using inclusive language, the speakers encour- aged all medical writers to ask themselves the following questions when writing or reviewing documents: is the ter- minology or language used relevant, accurate, inclusive, respectful, and thoughtful?2 If it does not meet all 5 criteria, Hicks asked writers to consider whether it belongs in the document at all, and if so, can the language be massaged to meet these criteria? She goes on to note that “Incorporating inclusive language into our work requires conscious deci- sions that call for conscious actions.” Table 21 lists specific examples provided by the speakers of language that is generalizing and stigmatizing, as well as their recommendations for preferred alternatives. Emery and Hicks provided additional advice on how writ- ers can start using inclusive language in their work, including • Respecting how individuals self-identify and allowing them to select more than one race and/or ethnicity when possible. • Creating an inclusive language style guide that offers alternatives to generalized terms such as “minorities” and “non-White.” • Being aware of stigmatizing language such as “mixed race” or “at-risk patients.” • Avoiding “othering” language by expanding race, ethnicity, and gender identity response options in surveys. • Changing “Other” to “A race or ethnicity not listed” or “A gender identity not listed.” • Alphabetizing survey options to avoid creating a perceived hierarchy among surveyed groups. OFFERING FEEDBACK AND MANAGING CLIENT CONCERNS Efforts to employ inclusive language are relatively new, and you may find yourself in the position of needing to offer feedback regarding it to clients, colleagues, or other writers. The speakers offer several tips on how to approach this in a thoughtful and nonjudgmental way, including: • Being constructive and collegial. • Approaching the interaction as a learning opportunity. • Thinking about how terminology is perceived by the reader. • Collaborating with your client to create an inclusive language guide for the project. • Linking to appropriate resources, such as the AMA Manual of Style 11 th edition section on inclusive language. • Keeping a log of frequently used feedback to use as stock text. • Customizing software (such as PerfectIt) to scan for keywords or phrases for use in every project. Additionally, clients might be concerned about uninten- tionally offending others or that the language is not inclu- sive enough. Emery advised writers to express confidence in being able to handle the client’s inclusive language con- cerns, to be humble, and to “recognize that you’re human, and the client is too. Inclusive language practices are new to many people, and we are all co-learning.” Table 2. Examples of Preferred Terminology Avoid Preferred At-risk patients, at-risk youth, at-risk communities Patients at risk of developing… (a specific disease, such as diabetes) Communities of color at risk of developing… Black patients at risk of developing… Minorities, minority Best practice is to name the specific group(s) being referenced Minority communities Communities of color Historically underserved communities Historically marginalized groups Mixed race Biracial Multiracial Non-White(s) Best practice is to name the specific group(s) being referenced If the group is unknown, use the above alternatives for “minority com- munities” Homosexual(s) Be specific when possible (eg, “men who identify as gay”) Members of the LGBTQ+ community People who identify as LGBTQ+ Sex change Gender-affirming surgery Gender-affirmation surgery Gender-confirmation surgery Sexual preference/ lifestyle Sexual orientation “Preference” and “lifestyle” errone- ously suggest that sexual orientation is a choice Transgendered (used as an adjective) Transgender (used as an adjective, eg, “a transgender patient”) Adaptation of Emery and Hicks1 reprinted with permission from RTI. Definition: LGBTQ+, Lesbian, Gay, Bisexual, Transgender, Queer, and many other terms. http://www.amwajournal.org AMWAJournal.org 26Inclusive Language: Best Practices and Practical Applications THE IMPACT OF CHANGE If Emery and Hicks made one concept exceedingly clear, it is this: words matter. Words have the power to draw us together or rip us apart, and medical writers can help achieve a more equitable, diverse, and inclusive society by adopting the principles of inclusive language. They summa- rized the enormous potential impact of embracing inclusive language by sharing an eloquent sentiment that appeared in a journal editorial on racial and ethnic disparities in research: “Scientists and scientific journals have the oppor- tunity to facilitate best practices and ultimately impact racial and ethnic disparities. The written interpretations of science by a few shape the future creation of history and science for many.” Rebecca Moran, MD, is a freelance medical writer and practicing physician in Phoenix, AZ. Author declaration and disclosures: The author notes no commercial associations that may pose a conflict of interest in relation to this article. Author contact: rebecca@moranmedicalinsights.com References 1. Emery L, Hicks JC. Inclusive language: best practices and practical applications for medical writers and editors. Presented at: 2022 AMWA Medical Writing & Communication Conference; November 5, 2022, Denver, CO. 2. PerfectIt. It makes sense to use sensitive language. PerfectIt. Published September 29, 2020. Accessed April 2022. https://web- test.intelligentediting.com/blog/it-makes-sense-to-use-sensitive- language/ Common Acronyms ABIDE: Accessibility, Belonging, Inclusion, Diversity, and Equity DEI: Diversity, Equity, and Inclusion EDIB: Equity, Diversity, Inclusion, and Belonging JEDI: Justice, Equity, Diversity, and Inclusion RJE: Racial Justice and Equity AMWA LIVE WEBINARS Tools, tips, and tricks for medical communicators. www.amwa.org/events Only $20 for Members Can’t attend a live webinar? You won’t miss out! All registrations for live webinars include access to the recorded video in AMWA Online Learning. http://www.amwajournal.org https://web-test.intelligentediting.com/blog/it-makes-sense-to-use-sensitive-language https://web-test.intelligentediting.com/blog/it-makes-sense-to-use-sensitive-language