Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-22T23:27:18.254Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  12 July 2019

JASON N. BATTEN ,
BONNIE O. WONG ,
WILLIAM F. HANKS  and
DAVID C. MAGNUS
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

treatability statementsmiscommunicationlinguistic theoryH.P.Griceliteral meaningintended meaningreceived meaning
Type
Symposium: New Challenges to Clinical Communication in Serious Illness
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Issue 3 , July 2019 , pp. 394 - 404
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Acknowledgement: SA Kraft JD, KE Kruse MD, and B Fishbeyn MS played integral roles in data collection and analysis for the initial empirical work which ultimately inspired this paper.

PL Kunz MD supplied a clinical case that we de-identified and altered to illustrate the main points of this paper.

References

Notes

1. Batten, JN, Kruse, KE, Kraft, SA, Fishbeyn, B, Magnus, D. What does the word ‘treatable’ mean? Implications for communication and decision making in critical illness. Critical Care Medicine 2019;47(3):369–76.CrossRefGoogle ScholarPubMed

2. Hanks, WF. Language and Communicative Practice . Boulder: Westview Press; 1996.Google Scholar

3. Levinson, S. Pragmatics . New York: Cambridge University Press; 1983.CrossRefGoogle Scholar

4. Davis, S. Pragmatics: A Reader. New York: Oxford University Press; 1991.Google Scholar

5. See note 1, Batten et al. 2019.

6. See note 1, Batten et al. 2019.

7. See note 1, Batten et al. 2019.

8. Davis W. Implicature. In: Zalta EN, ed. The Stanford Encyclopedia of Philosophy. Fall 2014 edition; available at https://plato.stanford.edu/archives/fall2014/entries/implicature (last accessed on 23 Mar 2018).

9. See note 8, Davis 2014.

10. Grice, HP. Logic and Conversation. In: Grice, HP, ed. Studies in the Way of Words. Cambridge, MA: Harvard University Press; 1989;86–116.Google Scholar

11. Hanks, WF. Exemplary natives and what they know. In: Cosenza, G, ed. Paul Grice’s Heritage. Turnhout: BREPOLS; 2002:207–34.Google Scholar

12. Oxford English Living Dictionary. Treat, definition; available at https://en.oxforddictionaries.com/definition/treat (last accessed 1 Jan 2018).

13. Kon, AA, Davidson, JE, Morrison, W, Danis, M, White, DB. Shared Decision decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine 2016;44(1):188–201.CrossRefGoogle ScholarPubMed

14. Dzeng, E, Colaianni, A, Roland, M, Chander, G, Smith, TJ, Kelly, MP, Barclay, S, Levine, D. Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life. JAMA Internal Medicine 2015;175(5):812–9.CrossRefGoogle ScholarPubMed

15. See note 1, Batten et al. 2019.

16. Beauchamp, TL. Informed consent: Its history, meaning, and present challenges. Cambridge Quarterly of Healthcare Ethics 2011;20(4):515–23.CrossRefGoogle ScholarPubMed

17. Keirns, CC, Goold, SD. Patient-centered care and preference-sensitive decision making. JAMA 2009;302(16):805–6.CrossRefGoogle ScholarPubMed

18. See note 13, Kon et al. 2016.

19. Xafis, V, Watkins, A, Wilkinson, D. Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions. Patient Education and Counseling 2016;99(4):555–61.CrossRefGoogle ScholarPubMed

20. Kim, SY, De Vries, R, Holloway, RG, Kieburtz, K. Understanding the “therapeutic misconception” from the research participant’s perspective. Journal of Medical Ethics 2016;42(8):522–3.CrossRefGoogle ScholarPubMed

21. Weinfurt, KP, Sulmasy, DP, Schulman, KA, Meropol, NJ. Patient expectations of benefit from phase I clinical trials: Linguistic considerations in diagnosing a therapeutic misconception. Theoretical Medicine and Bioethics 2003;24(4):329–44.CrossRefGoogle ScholarPubMed

22. Weinfurt, KP. Understanding what participants in empirical bioethical studies mean: Historical cautions from William James and Ludwig Wittgenstein. American Journal of Bioethics Primary Research 2013;4(3):49–54.Google Scholar