Clinician use of ‘worry’ statements during surrogate decision making in the hospital

Objective

Current guidance of how to share a prognosis with patients or surrogate decision makers suggests the use of “I worry” statements. Despite this guidance, there is little known about how “worry” or “concern” statements are used in clinical settings. The purpose of this analysis was to examine the function of “worry” statements in clinician-surrogate decision-making conversations with life-or-death implications.

Methods

We audio recorded 27 clinician-surrogate conversations in two hospitals in one Midwest city in the USA. We used conversation analysis, a qualitative method, to analyze clinicians’ use of “worry” statements throughout the corpus and what course of action they were “doing” in the interaction.

Results

There were two distinct uses of “worry” statements. Clinicians’ use of “worry” statements to convey the gravity of the patient's situation of a poor prognosis seemed to forecast an introduction to limiting treatment as a potential option. When discussing treatment, “worry” statements seemed to have a persuasive function against pursuing treatment. Surrogates often resisted “worry” statements in the discussion of treatment, as these statements conveyed restricting choices that surrogates have the authority to make.

Conclusion

The balance of the clinician’s epistemic authority of the medical understanding of the patient’s situation with the surrogate’s authority in making a decision is worthy of further exploration.

Practice Implications

Surrogate resistance to “worry” statements in the discussion of treatment may be more a function of the persuasion to limit treatment than the “worry” statements themselves. Further research is necessary to determine best practice language during treatment deliberation.