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Improving communication in decision-making is a worthy goal and the choice of words is crucial. Sayma and colleagues (1) have not considered the implications of some of their choices.
Firstly, throughout the article they have used the word ‘advanced’ when describing decisions and care plans. This is a common misspelling but such issues are not superior formats but are care plans and decisions made in advance. Secondly, the authors mention ‘ceilings of care’ but do not explain that there are no ethical or legal permissions that allow care to be limited. This term is often misused when what is meant is a limit to treatment options. Finally the use of ‘escalation’ in care plans has been shown to be threatening to patients.(2) The term is too often used by clinicians without considering how this might be considered by patients.
None of this should not detract from the value of the information provided during the study, but perhaps the authors will think carefully in future about their choice of words.
1. Sayma M et al. Improving the use of treatment escalation plans: a quality improvement study. Postgrad Med J, 2018; doi: 10.1136/postgradmedj-2018-135699.
2. Fritz Z, Fudd JP. Development of the Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a cross disciplinary approach. J Evaluation in Clinical Practice 2014; 21: 109-117.