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What Does the Word “Treatable” Mean? Implications for Communication and Decision-Making in Critical Illness

Batten, Jason N., MA1,2; Kruse, Katherine E., MD3,4; Kraft, Stephanie A., JD5,6; Fishbeyn, Bela, MS1; Magnus, David C., PhD1

doi: 10.1097/CCM.0000000000003614
Clinical Investigations

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.

1Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA.

2Stanford University School of Medicine, Stanford, CA.

3Children’s Respiratory and Critical Care Specialists, Minneapolis, MN.

4Department of Clinical Ethics, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN.

5Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA.

6Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.

Mr. Batten received funding from Stanford Medical Scholars for research time (Project No 11635, “What Does ‘Treatable’ Mean? An Empirical Study of Physician-Patient Communication”). The Stanford Center for Biomedical Ethics provided funds for transcription of audio recordings. Mr. Batten received funding from The Social Science Matrix at the University of California, Berkeley for collaborative interdisciplinary discussions that informed this work (Prospecting Team, “Expert Language, Native Language: Toward a Framework for Translation in Clinical (Mis)communication”). The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Stanford Hospital and Clinics.

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