Jason N Batten1,2, Katherine E Kruse3,4, Stephanie A Kraft5,6, Bela Fishbeyn1, David C Magnus1. 1. Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA. 2. Stanford University School of Medicine, Stanford, CA. 3. Children's Respiratory and Critical Care Specialists, Minneapolis, MN. 4. Department of Clinical Ethics, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN. 5. Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA. 6. Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
Abstract
OBJECTIVES: To explore how nonphysicians and physicians interpret the word "treatable" in the context of critical illness. DESIGN: Qualitative study using in-depth interviews. SETTING: One academic medical center. SUBJECTS: Twenty-four nonphysicians (patients and community members) purposively sampled for variation in demographic characteristics and 24 physicians (attending physicians and trainees) purposively sampled from four specialties (critical care, palliative care, oncology, and surgery). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified two distinct concepts that participants used to interpret the word "treatable": 1) a "good news" concept, in which the word "treatable" conveys a positive message about a patient's future, thereby inspiring hope and encouraging further treatment and 2) an "action-oriented" concept, in which the word "treatable" conveys that physicians have an action or intervention available, but does not necessarily imply an improved prognosis or quality of life. The overwhelming majority of nonphysicians adopted the "good news" concept, whereas physicians almost exclusively adopted the "action-oriented" concept. For some nonphysicians, the word "treatable" conveyed a positive message about prognosis and/or further treatment, even when this contradicted previously stated negative information. CONCLUSIONS: Physician use of the word "treatable" may lead patients or surrogates to derive unwarranted good news and false encouragement to pursue treatment, even when physicians have explicitly stated information to the contrary. Further work is needed to determine the extent to which the word "treatable" and its cognates contribute to widespread decision-making and communication challenges in critical care, including discordance about prognosis, misconceptions that palliative treatments are curative, and disputes about potentially inappropriate or futile treatment.
OBJECTIVES: To explore how nonphysicians and physicians interpret the word "treatable" in the context of critical illness. DESIGN: Qualitative study using in-depth interviews. SETTING: One academic medical center. SUBJECTS: Twenty-four nonphysicians (patients and community members) purposively sampled for variation in demographic characteristics and 24 physicians (attending physicians and trainees) purposively sampled from four specialties (critical care, palliative care, oncology, and surgery). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified two distinct concepts that participants used to interpret the word "treatable": 1) a "good news" concept, in which the word "treatable" conveys a positive message about a patient's future, thereby inspiring hope and encouraging further treatment and 2) an "action-oriented" concept, in which the word "treatable" conveys that physicians have an action or intervention available, but does not necessarily imply an improved prognosis or quality of life. The overwhelming majority of nonphysicians adopted the "good news" concept, whereas physicians almost exclusively adopted the "action-oriented" concept. For some nonphysicians, the word "treatable" conveyed a positive message about prognosis and/or further treatment, even when this contradicted previously stated negative information. CONCLUSIONS: Physician use of the word "treatable" may lead patients or surrogates to derive unwarranted good news and false encouragement to pursue treatment, even when physicians have explicitly stated information to the contrary. Further work is needed to determine the extent to which the word "treatable" and its cognates contribute to widespread decision-making and communication challenges in critical care, including discordance about prognosis, misconceptions that palliative treatments are curative, and disputes about potentially inappropriate or futile treatment.
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