Communication in the ICU: An Unintended Nocebo Effect?

Irene Riestra Guiance; Lindsey Wallace; Katalin Varga; Alexander Niven; Megan Hosey; Jillene Chitulangoma; Kemuel Philbrick; Ognjen Gajic; Madeline Weiman; Emily Schmitt; David Pasko; Lioudmila Karnatovskaia

doi:10.1177/23743735241272148

Communication in the ICU: An Unintended Nocebo Effect?

J Patient Exp. 2024 Aug 9:11:23743735241272148. doi: 10.1177/23743735241272148. eCollection 2024.

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
² Department of Critical Care Multidisciplinary Program, Mayo Clinic, Rochester, MN, USA.
³ Department of Affective Psychology, Eötvös Loránd University, Budapest, Hungary.
⁴ Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Nursing, Mayo Clinic, Rochester, MN, USA.
⁸ Department of Respiratory Care, Mayo Clinic, Rochester, MN, USA.

Abstract

To identify medical phrases utilized by the critical care team that may have an unintended impact on the critically ill patient, we administered an anonymous survey to multi-professional critical care team members. We elicited examples of imprecise language that may have a negative emotional impact on the critically ill. Of the 1600 providers surveyed, 265 offered 1379 examples (912 unique) which were clustered into 5 categories. Medical jargon (eg, "riding the vent") was most prevalent (n = 549). There were 217 negative suggestions (eg, "you will feel a stick and a burn"). Hyperboles (eg, "black cloud") were common (n = 198) while homonyms (ie "he fibbed") accounted for 150 examples. Phrases such as "code brown in there" were categorized as metonyms (n = 144). 121 metaphors/similes (eg, "rearranging deck chairs on the Titanic") were provided. Phrases that have the potential to negatively impact critically ill patient perceptions are commonplace in critical care practice. Whether these everyday communication habits lead to an unintended nocebo effect on mental health outcomes of the critically ill deserves further study.

Keywords: ICU; PTSD; communication; nocebo effect; psychology.