Diagnostic staging and stratification in psychiatry and oncology: clarifying their conceptual, epistemological and ethical implications.

IF 2.3 2区 哲学 Q1 ETHICS
Medicine Health Care and Philosophy Pub Date : 2024-09-01 Epub Date: 2024-05-17 DOI:10.1007/s11019-024-10207-w
Julia Tinland, Christophe Gauld, Pierre Sujobert, Élodie Giroux
{"title":"Diagnostic staging and stratification in psychiatry and oncology: clarifying their conceptual, epistemological and ethical implications.","authors":"Julia Tinland, Christophe Gauld, Pierre Sujobert, Élodie Giroux","doi":"10.1007/s11019-024-10207-w","DOIUrl":null,"url":null,"abstract":"<p><p>Staging and stratification are two diagnostic approaches that have introduced a more dynamic outlook on the development of diseases, thus participating in blurring the line between the normal and the pathological. First, diagnostic staging, aiming to capture how diseases evolve in time and/or space through identifiable and gradually more severe stages, may be said to lean on an underlying assumption of \"temporal determinism\". Stratification, on the other hand, allows for the identification of various prognostic or predictive subgroups based on specific markers, relying on a more \"mechanistic\" or \"statistical\" form of determinism. There are two medical fields in which these developments have played a significant role and have given rise to sometimes profound nosological transformations: oncology and psychiatry. Drawing on examples from these two fields, this paper aims to provide much needed conceptual clarifications on both staging and stratification in order to outline how several epistemological and ethical issues may, in turn, arise. We argue that diagnostic staging ought to be detached from the assumption of temporal determinism, though it should still play an essential role in adapting interventions to stage. In doing so, it would help counterbalance stratification's own epistemological and ethical shortcomings. In this sense, the reflections and propositions developed in psychiatry can offer invaluable insights regarding how adopting a more transdiagnostic and cross-cutting perspective on temporality and disease dynamics may help combine both staging and stratification in clinical practice.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicine Health Care and Philosophy","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1007/s11019-024-10207-w","RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ETHICS","Score":null,"Total":0}
引用次数: 0

Abstract

Staging and stratification are two diagnostic approaches that have introduced a more dynamic outlook on the development of diseases, thus participating in blurring the line between the normal and the pathological. First, diagnostic staging, aiming to capture how diseases evolve in time and/or space through identifiable and gradually more severe stages, may be said to lean on an underlying assumption of "temporal determinism". Stratification, on the other hand, allows for the identification of various prognostic or predictive subgroups based on specific markers, relying on a more "mechanistic" or "statistical" form of determinism. There are two medical fields in which these developments have played a significant role and have given rise to sometimes profound nosological transformations: oncology and psychiatry. Drawing on examples from these two fields, this paper aims to provide much needed conceptual clarifications on both staging and stratification in order to outline how several epistemological and ethical issues may, in turn, arise. We argue that diagnostic staging ought to be detached from the assumption of temporal determinism, though it should still play an essential role in adapting interventions to stage. In doing so, it would help counterbalance stratification's own epistemological and ethical shortcomings. In this sense, the reflections and propositions developed in psychiatry can offer invaluable insights regarding how adopting a more transdiagnostic and cross-cutting perspective on temporality and disease dynamics may help combine both staging and stratification in clinical practice.

精神病学和肿瘤学中的诊断分期和分层:澄清其概念、认识论和伦理意义。
分期和分层是两种诊断方法,它们对疾病的发展提出了更动态的看法,从而模糊了正常与病理之间的界限。首先,诊断分期的目的是通过可识别的、逐渐加重的阶段来捕捉疾病在时间和/或空间上的演变过程,可以说是基于 "时间决定论 "的基本假设。另一方面,分层可以根据特定标记物确定各种预后或预测亚组,依赖于更 "机械 "或 "统计 "形式的决定论。这些发展在两个医学领域发挥了重要作用,有时甚至引起了深刻的命名学变革:肿瘤学和精神病学。本文以这两个领域为例,旨在对分期和分层提供亟需的概念澄清,以概述如何反过来产生若干认识论和伦理学问题。我们认为,诊断分期应脱离时间决定论的假设,尽管它仍应在根据阶段调整干预措施方面发挥重要作用。这样做有助于抵消分层本身在认识论和伦理方面的缺陷。从这个意义上说,精神病学的反思和命题可以提供宝贵的见解,说明如何采用一种更加跨诊断和跨领域的视角来看待时间性和疾病动态,从而有助于在临床实践中将分期和分层结合起来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.30
自引率
4.80%
发文量
64
期刊介绍: Medicine, Health Care and Philosophy: A European Journal is the official journal of the European Society for Philosophy of Medicine and Health Care. It provides a forum for international exchange of research data, theories, reports and opinions in bioethics and philosophy of medicine. The journal promotes interdisciplinary studies, and stimulates philosophical analysis centered on a common object of reflection: health care, the human effort to deal with disease, illness, death as well as health, well-being and life. Particular attention is paid to developing contributions from all European countries, and to making accessible scientific work and reports on the practice of health care ethics, from all nations, cultures and language areas in Europe.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信