Equivocation in patients' decisional preference about life-sustaining treatments

Area of Science:

• Medical Communication
• Conversation Analysis
• Bioethics

Background:

• Effective communication is crucial for shared decision-making in healthcare.
• Patients' preferences regarding life-sustaining treatments (LST) require careful articulation and understanding.
• The phenomenon of 'equivocation' in patient responses needs further examination.

Purpose of the Study:

• To analyze how patients formulate decisional preferences when allowing or declining life-sustaining treatments (LST).
• To investigate the practice of 'equivocation,' where patients express dual preferences in response to singular requests.
• To understand the nuances of patient decision-making in critical care contexts.

Main Methods:

• Conversation analysis of 89 recorded patient-physician interactions.
• Focus on conversations where patients discuss allowing or declining life-sustaining treatments (LST).
• Categorization of patient preference expression formats.

Main Results:

• Three types of decisional preference formats were identified: unequivocal, implicitly equivocal, and explicitly equivocal.
• Unequivocal preferences show a clear stance for or against an intervention.
• Equivocal preferences involve conditional statements or the expression of two contrasting options.

Conclusions:

• Patient communication regarding LST is complex and scenario-dependent, often deviating from binary physician requests.
• Physicians may not always recognize or acknowledge equivocal patient responses.
• Inadequate documentation of patient preferences can result from unacknowledged equivocation, affecting patient understanding and literacy.