Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions

Xafis, Vicki; Watkins, Andrew; Wilkinson, Dominic

doi:10.1016/j.pec.2015.10.025

Cited by 16 publications

(14 citation statements)

References 61 publications

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“…This paper is one of the first attempts that we are aware of to draw upon well-established theoretical work in pragmatics from the disciplines of linguistics and philosophy of language and apply these works to physician-patient communication. 19 Prior to our work, theoretical work in pragmatics has only been applied, in the biomedical context, to question empirical bioethics findings on the therapeutic misconception. 20,21,22 Paying attention to pragmatics sheds new light on the challenges physicians face in discussing treatment options with the seriously ill: physicians must discuss whether or not a condition is 'treatable' in order to achieve disclosure, informed consent, and shared decision making; yet, by invoking 'treatable,' physicians risk invisible miscommunications that threaten the very values they seek to uphold.…”

Section: Resultsmentioning

confidence: 99%

Treatability Statements in Serious Illness: The Gap Between What is Said and What is Heard

Batten¹,

Wong²,

Hanks³

et al. 2019

Camb Q Healthc Ethics

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Abstract:Empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements (e.g., “This is a treatable condition,” “We have treatments for your loved one”) in the context of serious illness. Patients often understand treatability statements as conveying good news for prognosis and quality of life. In contrast, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, though this may not be intended by physicians. This radical divergence in understandings may lead to severe miscommunication. This paper seeks to better understand this divergence through linguistic theory—in particular, H.P. Grice’s notion of conversational implicature. This theoretical approach reveals three levels of meaning of treatability statements: (1) the literal meaning, (2) the physician’s intended meaning, and (3) the patient’s received meaning. The divergence between the physician’s intended meaning and the patient’s received meaning can be understood to arise from the lack of shared experience between physicians and patients, and the differing assumptions that each party makes about conversations. This divergence in meaning raises new and largely unidentified challenges to informed consent and shared decision making in the context of serious illness, which indicates a need for further empirical research in this area.

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Section: Resultsmentioning

confidence: 99%

Treatability Statements in Serious Illness: The Gap Between What is Said and What is Heard

Batten¹,

Wong²,

Hanks³

et al. 2019

Camb Q Healthc Ethics

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“…In previous work, we have shown that major communicative and emotional issues arise when the maxims are violated in the clinical context. 16 Here we would like to draw on Grice's Cooperative Principle and the associated maxims to illustrate why intentional ambiguity is particularly damaging.…”

Section: Cooperative Principle (Cp) and Intentional Ambiguitymentioning

confidence: 99%

Commentary: Treating Ambiguity in the Clinical Context: Is what you hear the doctor say what the doctor means?

Xafis¹,

Wilkinson²

2019

Camb Q Healthc Ethics

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Linguistic theory helps in the understanding of how and why language operates in the manner it does. It provides insight into ways we can improve communication strategies to achieve deeply rooted communicative expectations. This is particularly important in the clinical context, where patients and their families rely heavily on the information exchange they have with health professionals (HPs). Linguistic theory also makes evident the strong link between communication and basic ethical principles that lie at the core of medicine, and which provide justification for the requirement of informed consent and other decision-making models such as shared decision-making. In their paper "Treatability Statements in Serious Illness: The Gap Between What is Said and What is Heard," Batten and colleagues take seriously the miscommunication that can occur between patients and their families, and health professionals (HPs); attempt to justify this with reference to linguistic theory; and consider the implications of such miscommunication on shared decision-making and informed consent, both of which are intricately related to and informed by ethical theory. We view Batten and colleagues' paper as a significant contribution to the limited literature in this area because it draws attention to the inherent communication deficiencies in the most serious of contexts: communication with patients and their families about life and death matters. While our interpretations differ from the authors', we welcome the opportunity to advance this important discussion in the hope that we will provide further insight into how and why such miscommunication may come about. 1 Batten and colleagues focus on what they call "treatability statements," and, more specifically, on miscommunication that may arise from the HPs' use of words such as 'treat', its derivatives, or synonymous phrases in discussions with patients suffering life-limiting conditions such as terminal cancer. They contend that some HPs' (specifically oncologists') use of the word 'treat' in treatability statements is "technical" and that, in using it, HPs do not intend to convey any information about the curability or amelioration of the patients' condition. Physicians assume that treatability statements are made to communicate that something can be done, and to clarify what that is; treatment is conceived of as a tool to accomplish particular clinical goals, defined in specific, technical terms. Hence, physicians use treatability statements to convey that they can "do something." In treatability statements, technical concepts masquerade in everyday language.

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“…Outcome and prognostic data are important to most parents even though some parents assert that such data played a secondary role in the decisions they made for their child . Furthermore, the role such data play in parental decision‐making is affected by the manner with which they are presented as well as broader clinician/parental communicative interactions …”

Section: Seeking Clarity Where No Clarity Exists: Should Clinicians Omentioning

confidence: 99%

“…44,47 Furthermore, the role such data play in parental decision-making is affected by the manner with which they are presented 52 as well as broader clinician/ parental communicative interactions. 53 Some common defining features of parental decision-making include the fact that:…”

Section: Differences In Clinician and Parental Decision-makingmentioning

confidence: 99%

Decision‐making at the borderline of viability: Who should decide and on what basis?

Gillam

Wilkinson

Xafis

et al. 2017

J Paediatrics Child Health

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Parents and medical staff usually agree on the management of preterm labour at borderline viability, when there is a relatively high risk of long‐term neurodevelopmental problems in survivors. If delivery is imminent and parents and staff cannot agree on the best management, however, who should decide what will happen when the baby is delivered? Should the baby be resuscitated? Should intensive care be initiated? Three ethicists, one of whom is also a neonatologist, discuss this complex issue.

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Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions

Cited by 16 publications

References 61 publications

Treatability Statements in Serious Illness: The Gap Between What is Said and What is Heard

Treatability Statements in Serious Illness: The Gap Between What is Said and What is Heard

Commentary: Treating Ambiguity in the Clinical Context: Is what you hear the doctor say what the doctor means?

Decision‐making at the borderline of viability: Who should decide and on what basis?

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