More Than a Touch of Gray: Embracing Uncertainty in the Intensive Care Unit

Walter, James M.; Singer, Benjamin D.; Corbridge, Thomas C.

doi:10.1164/rccm.201608-1568oe

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Foundational work on hedge language is clear that there is a multiplicity of possible reasons for using hedge language (1,(4)(5)(6). While some portion of the hedge language observed in our study reflects physician attempts to convey the clinical uncertainty that is prevalent in critical care (27,28), this cannot account for all instances of hedge language we observed. First, some types of hedge language are unrelated to uncertainty and instead convey other types of vagueness (e.g., attribution shields).…”

Section: Discussionmentioning

confidence: 59%

Vagueness in Goals-of-Care Conferences for Critically Ill Patients: Types of Hedge Language Used by Physicians*

Mittal

Hakes

Magnus

et al. 2023

Critical Care Medicine

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OBJECTIVES: Hedge language is a category of language that refers to words or phrases that make statements “fuzzier.” We sought to understand how physicians use hedge language during goals-of-care conferences in the ICU. DESIGN: Secondary analysis of transcripts of audio-recorded goals-of-care conferences in the ICU. SETTING: Thirteen ICUs at six academic and community medical centers in the United States. PATIENTS: Conferences were between clinicians and surrogates of incapacitated, critically ill adults. INTERVENTIONS: Four investigators performed a qualitative content analysis of transcripts using deductive followed by inductive methods to identify types of hedge language used by physicians, then coded all instances of hedge language across 40 transcripts to characterize general patterns in usage. MEASUREMENTS AND MAIN RESULTS: We identified 10 types of hedge language: numeric probabilistic statement (“there’s an 80% chance”), qualitative probabilistic statement (“there’s a good chance”), nonprobabilistic uncertainty statement (“hard to say for her”), plausibility shield (“we expect”), emotion-based statement (“we’re concerned”), attribution shield (“according to Dr. X”), adaptor (“sort of”), metaphor (“the chips are stacking up against her”), time reference (“too soon to tell”), and contingency statement (“if we are lucky”). For most types of hedge language, we identified distinct subtypes. Physicians used hedge language frequently in every transcript (median: 74 hedges per transcript) to address diagnosis, prognosis, and treatment. We observed large variation in how frequently each type and subtype of hedge language was used. CONCLUSIONS: Hedge language is ubiquitous in physician-surrogate communication during goals-of-care conferences in the ICU and can be used to introduce vagueness to statements in ways beyond expressing uncertainty. It is not known how hedge language impacts decision-making or clinician-surrogate interactions. This study prioritizes specific types of hedge language for future research based on their frequency and novelty.

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Section: Discussionmentioning

confidence: 59%

Vagueness in Goals-of-Care Conferences for Critically Ill Patients: Types of Hedge Language Used by Physicians*

Mittal

Hakes

Magnus

et al. 2023

Critical Care Medicine

View full text Add to dashboard Cite

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Diagnostic uncertainty: from education to communication

2019

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Diagnostic uncertainty is common in clinical practice and affects both providers and patients on a daily basis. Yet, a unifying model describing uncertainty and identifying the best practices for how to teach about and discuss this issue with trainees and patients is lacking. In this paper, we explore the intersection of uncertainty and expertise. We propose a 2 × 2 model of diagnostic accuracy and certainty that can be used in discussions with trainees, outline an approach to communicating diagnostic uncertainty with patients, and advocate for teaching trainees how to hold such conversations with patients.

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More Than a Touch of Gray: Embracing Uncertainty in the Intensive Care Unit

Cited by 2 publications

References 14 publications

Vagueness in Goals-of-Care Conferences for Critically Ill Patients: Types of Hedge Language Used by Physicians*

Vagueness in Goals-of-Care Conferences for Critically Ill Patients: Types of Hedge Language Used by Physicians*

Diagnostic uncertainty: from education to communication

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