611 - Euphemisms predominate discussions of death in family meetings

Poster Number: 611
Publication Number: 611.306

Margaret H. Barlet, Duke University School of Medicine, Durham, NC, United States; Mary C. Barks, Duke University School of Medicine, Durham, NC, United States; Peter Ubel, Duke University School of Medicine, Durham, NC, United States; J. Kelly Davis, Duke University, Durham, NC, United States; Monica E. Lemmon, Duke University School of Medicine, Durham, NC, United States

Background: Clear communication during conversations about death and dying is critical, but little is known about the language clinicians and families use to discuss death.

Objective: The goals of this study were (1) to characterize the way death is discussed and avoided in family meetings and (2) to explore how this differs between clinicians and family members.

Design/Methods: In this longitudinal, mixed-methods study, we enrolled families of infants with neurologic conditions who were hospitalized in the intensive care unit and had a planned family meeting. Family meetings were recorded, transcribed, and de-identified before being screened for discussion of code-status, prior near-death event(s), or future death. Conventional content analysis was used to derive a codebook, which was applied by two independent team members using NVivo 12 and resolved in consensus (MHB, MCB, JKD, MEL).

Results: A total of 68 family meetings involving 36 parents of 24 infants were screened; 33 family meetings involving 20 parents of 13 infants included discussion of death (Table 1). Though death was referenced over 400 times throughout these family meetings, the words “die,” “death,” or “dying” were only used 4.7% of the time by clinicians (13/275 total references) and 15% of the time by family members (19/131 total references). We identified four types of euphemisms that clinicians and family members used to avoid directly referencing death: (1) survival-framing (e.g., not live), (2) colloquialisms (e.g., pass away), (3) medical jargon, including both obscuring technical terms (e.g., code event) and talking around death with physiologic terms (e.g., irrecoverable heart rate drop), and (4) pronouns (e.g., it) (Table 2). The most common type of euphemism used by clinicians to replace death was medical jargon, which was used almost half the time (118/275, 43%). The most common type of euphemism used by family members to replace death were colloquialisms, which were used over one-third of the time (44/131, 34%). Clinicians and families also commonly used survival-framing and pronouns to avoid directly referencing death (Figure 1).Conclusion(s): Direct language is rarely used to refer to death in family meetings, especially by clinicians. However, while families most often use colloquial euphemisms to reference death, clinicians most often use medical jargon. Future work should evaluate the impact of euphemism use on mutual understanding, decision-making, and clinician-family relationships.
BarletCV.pdf
Table 2. The Language of Death in Family Meetings