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Pushing up daisies: implicit and explicit language in oncologist–patient communication about death

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Abstract

Goals of work

Although there are guidelines regarding how conversations with patients about prognosis in life-limiting illness should occur, there are little data about what doctors actually say. This study was designed to qualitatively analyze the language that oncologists and cancer patients use when talking about death.

Subjects and methods

We recruited 29 adults who had incurable forms of cancer, were scheduled for a first-time visit with one of six oncologists affiliated with a teaching hospital in Australia, and consented to having their visit audiotaped and transcribed. Using content analytic techniques, we coded various features of language usage.

Main results

Of the 29 visits, 23 (79.3%) included prognostic utterances about treatment-related and disease-related outcomes. In 12 (52.2%) of these 23 visits, explicit language about death (“terminal,” variations of “death”) was used. It was most commonly used by the oncologist after the physical examination, but it was sometimes used by patients or their kin, usually before the examination and involving emotional questioning about the patient’s future. In all 23 (100%) visits, implicit language (euphemistic or indirect talk) was used in discussing death and focused on an anticipated life span (mentioned in 87.0% of visits), estimated time frame (69.6%), or projected survival (47.8%).

Conclusions

Instead of using the word “death,” most participants used some alternative phrase, including implicit language. Although oncologists are more likely than patients and their kin to use explicit language in discussing death, the oncologists tend to couple it with implicit language, possibly to mitigate the message effects.

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Acknowledgements

This research was supported in part by a grant awarded to Phyllis Butow, Ph.D., from the National Health and Medical Research Council of Australia (NH&MRC grant no. 950461).

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Authors and Affiliations

  1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (151C-U), Rm. 1A115, Bldg. 28, University Drive C, Pittsburgh, PA, 15240-1000, USA

    Keri L. Rodriguez

  2. Division of General Internal Medicine, Department of Medicine, School of Medicine, Montefiore University Hospital, University of Pittsburgh, Suite 932 West, 3459 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Keri L. Rodriguez & Robert M. Arnold

  3. Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, USA

    Keri L. Rodriguez & Robert M. Arnold

  4. Department of English, Carnegie Mellon University, Pittsburgh, PA, USA

    Frank J. Gambino

  5. Medical Psychology Research Unit, School of Psychology, Mungo MacCallum Building (A17), The University of Sydney, Sydney, NSW, 2006, Australia

    Phyllis Butow & Rebecca Hagerty

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  1. Keri L. Rodriguez
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  2. Frank J. Gambino
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  3. Phyllis Butow
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Correspondence to Keri L. Rodriguez.

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Rodriguez, K.L., Gambino, F.J., Butow, P. et al. Pushing up daisies: implicit and explicit language in oncologist–patient communication about death. Support Care Cancer 15, 153–161 (2007). https://doi.org/10.1007/s00520-006-0108-8

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  • DOI: https://doi.org/10.1007/s00520-006-0108-8

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