Discussing diabetes, palliative and end of life care: choosing the ‘right’ language

Dunning, Trisha; Martin, Peter; Milnes, Sharyn; Simpson, N. B.; Lee, Georgie B.; Orford, Neil

doi:10.21037/apm-20-1548

Cited by 2 publications

(5 citation statements)

References 26 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Word choice represents an opportunity for clinicians to honor patient and family preferences for communication. Interviews with patients and family members suggest that they want clinicians to use clear language 14 , 15 , 16 , 17 , 18 , 19 , 20 even when it is hard to hear in the moment. 21 However, many clinicians worry that words like die , death , or dying may be perceived as harsh 16 and prefer to match the language used by patients and families.…”

Section: Discussionmentioning

confidence: 99%

“… 21 However, many clinicians worry that words like die , death , or dying may be perceived as harsh 16 and prefer to match the language used by patients and families. 17 , 49 Our design did not allow for direct assessment of family preferences, including whether acknowledging death using the word itself a single time or mirroring the language used by family members is sufficient. Given that we found that most references to death made by family members were euphemistic, future work should prioritize assessing family preferences for language use.…”

Section: Discussionmentioning

confidence: 99%

“…Interviews with patients and family members suggest that they want clinicians to use clear language even when it is hard to hear in the moment . However, many clinicians worry that words like die , death , or dying may be perceived as harsh and prefer to match the language used by patients and families . Our design did not allow for direct assessment of family preferences, including whether acknowledging death using the word itself a single time or mirroring the language used by family members is sufficient.…”

Section: Discussionmentioning

confidence: 99%

“… 13 Similarly, data suggest that patients and families prefer that clinicians use clear, direct language when discussing death. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Despite these recommendations and preferences, hesitancy to reference death using the word itself is common. Studies in adult medicine have found few uses of words such as die , death , and dying in medical documentation, 22 standardized patient scenarios, 23 , 24 , 25 and recorded encounters between clinicians, patients, and families 26 , 27 , 28 when death is discussed at all.…”

Section: Introductionmentioning

confidence: 99%

“…Consensus guidelines emphasize the importance of clear communication, including avoiding euphemism use . Similarly, data suggest that patients and families prefer that clinicians use clear, direct language when discussing death . Despite these recommendations and preferences, hesitancy to reference death using the word itself is common.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Characterizing the Language Used to Discuss Death in Family Meetings for Critically Ill Infants

et al. 2022

View full text Add to dashboard Cite

ImportanceCommunication during conversations about death is critical; however, little is known about the language clinicians and families use to discuss death.ObjectiveTo characterize (1) the way death is discussed in family meetings between parents of critically ill infants and the clinical team and (2) how discussion of death differs between clinicians and family members.Design, Setting, and ParticipantsThis longitudinal qualitative study took place at a single academic hospital in the southeast US. Patients were enrolled from September 2018 to September 2020, and infants were followed up longitudinally throughout their hospitalization. Participants included families of infants with neurologic conditions who were hospitalized in the intensive care unit and had a planned family meeting to discuss neurologic prognosis or starting, not starting, or discontinuing life-sustaining treatment. Family meetings were recorded, transcribed, and deidentified before being screened for discussion of death.Main Outcomes and MeasuresThe main outcome was the language used to reference death during family meetings between parents and clinicians. Conventional content analysis was used to analyze data.ResultsA total of 68 family meetings involving 36 parents of 24 infants were screened; 33 family meetings (49%) involving 20 parents (56%) and 13 infants (54%) included discussion of death. Most parents involved in discussion of death identified as the infant’s mother (13 [65%]) and as Black (12 [60%]). Death was referenced 406 times throughout the family meetings (275 times by clinicians and 131 times by family members); the words die, death, dying, or stillborn were used 5% of the time by clinicians (13 of 275 references) and 15% of the time by family members (19 of 131 references). Four types of euphemisms used in place of die, death, dying, or stillborn were identified: (1) survival framing (eg, not live), (2) colloquialisms (eg, pass away), (3) medical jargon, including obscure technical terms (eg, code event) or talking around death with physiologic terms (eg, irrecoverable heart rate drop), and (4) pronouns without an antecedent (eg, it). The most common type of euphemism used by clinicians was medical jargon (118 of 275 references [43%]). The most common type of euphemism used by family members was colloquialism (44 of 131 references [34%]).Conclusions and RelevanceIn this qualitative study, the words die, death, dying, or stillborn were rarely used to refer to death in family meetings with clinicians. Families most often used colloquialisms to reference death, and clinicians most often used medical jargon. Future work should evaluate the effects of euphemisms on mutual understanding, shared decision-making, and clinician-family relationships.

show abstract