Is Your Plain Language Summary Ethically Sound?

Plain language summaries (PLS or Lay summaries) help bridge the gap between scientists and the public, by providing the public easy-to-understand, quick-to-read synopses of research. PLS(Lay summary) can increase diversity and inclusion within Societies and promote patient empowerment. PLS(Lay summary) also benefit researchers because they force them to zero in on the take-home message of their paper and sharpen their arguments on why their research is necessary. As PLS(Lay summaries) gain popularity, it’s important to realize certain ethical considerations related to how PLS(Lay summary) are created and their contents:

Authorship

PLS(Lay summaries) are part of the article and hence all authors should sign off on them, as recommended by the International Committee of Medical Journal Editors’ guidelines for authorship. In case the authors lack the skills to draft the PLS, they should use an accredited vendor who involves the authors in the process of creating the PLS(Lay summary). This ensures that the PLS(Lay summary) accurately captures the authors’ intent and reflects their voice. At the NISO Plus 2021 conference, Harini Calamur, Head, Impact Science, pointed out: “it is the researcher’s research; it is something that they have dreamt of, it’s something that [they have] lived with; and therefore, their input, their tone of voice, their overall use at every step of the way becomes a very important part of the process.” Using a vendor also improves the overall readability and clarity of PLS(Lay summary).

Accuracy

Scientific content needs to be summarized and condensed for PLS(Lay summary), but not at the expense of accuracy. Take the sentence “A significant correlation was found between high blood pressure and insufficient calcium intake (p < .05).” In a PLS(Lay summary), this should NOT be phrased as “Consuming too little calcium was significantly related to high blood pressure” as the researcher is talking about statistical significance, whereas a lay reader would interpret “significant” as “large” or “important.” Instead, depending on the correlation coefficient, the PLS could read as “Consuming too little calcium was strongly/weakly/moderately related to high blood pressure.” Similarly, if the research paper reports that “33/60 of the sepsis patients recovered rapidly without sequelae,” the PLS shouldn’t say “A majority of the sepsis patients recovered rapidly without any further disease or injuries related to sepsis.” Instead, the sentence should contain the actual numbers, so that readers understand that a marked number of patients (27) didn’t have such an outcome.

Freedom from Bias

Like journal articles, especially original articles, PLS(Lay summary) need to be impartial and non-promotional. They should state upfront who funded the study and whether the authors have any conflicting interests. Readers need to know, for example, that a study showing that cheese consumption speeds up weight loss was funded by a conglomerate including a dairy products company. Limitations should be discussed at least briefly, especially if they restrict the generalizability of the findings: for instance, readers should be informed if the study findings are yet be verified among children, elderly adults, pregnant women, etc. PLS(Lay summary) should contain generic names, rather than brand names, of drugs even if the brand names are well known.

Scientific Integrity

Naturally, PLS(Lay summary) need to give broader context so that the study is understood by a wider audience. However, PLS should not provide results or implications beyond what is in the original paper. Take, for example, a research paper showing increased suicide ideation among nurses. The PLS(Lay summary) should not state, “More nurses are going to commit suicide!” A more accurate statement would be “Nurses report thinking about suicide more frequently than previously.” The PLS(Lay summary) should also not omit key details such as study location, sample size, and participant demographics. Further, all outcomes need to be separately reported for each study group, as recommended in the CONSORT statement.

Artwork Considerations

Any images or artwork that accompanies the PLS(Lay summary) must follow ethical guidelines similar to those for figures in a scientific paper. For example, patients should not be identifiable. If a figure has been previously published, the authors must cite that source and provide written permission from the original authors and publishers. Artwork should also not give false impressions about the magnitude or impact of the findings: a minor increase should not be represented by a large upward-pointing arrow with a slope of 45°. Authors must pay attention to whether the graphics could perpetuate stereotypes, such as by using a white male figure to represent doctors and a white female figure to represent nurses.

Conclusion

Journals in an increasing variety of fields—including ecology, psychology, and astronomy—are adopting PLS(Lay summary) as a standard part of the publishing workflow. They now need to come up with measures to maintain the quality and integrity of PLS. Some of these could be (1) having PLS undergo regular peer review along with the rest of the paper, (2) requiring authors who can’t draft their own PLS to at least answer a set of questions on their work in plain language, (3) having PLS reviewed by patients or members of the public, or (4) directing authors to a list of verified vendors that can assist in drafting PLS. Research does need to be communicated to the public, but if communicated wrongly, it can do more harm than good.