Clinicians’ use of metaphoric language in conversations with families of critically ill patients in the intensive care unit

Objectives: During conversations with families of critically ill patients in intensive care units (ICUs), clinicians’ metaphoric language use may facilitate families’ understanding, but also has potential drawbacks. We sought to obtain insights regarding how ICU clinicians use metaphors regarding patients’ disease and treatment trajectory. Methods: We identified clinicians’ metaphor use in N=101 audio-recorded neonatal, pediatric, and adult ICU family conversations about life-sustaining treatments. Using qualitative content analyses, each metaphor's semantic domain, disease phase, and dialogical function were coded. Overarching themes and patterns were analyzed. Results: Journey metaphors (N = 140 in N = 54 conversations) most frequently referred to the semantic domains boundary, path and bridge. Although most functioned to convey clinical information (72 %), metaphors were mainly presented in an emotionally charged way, serving to manage families’ perceptions. As patients’ conditions deteriorated, metaphors more often functioned to prepare families for medical limits. Metaphors were sometimes potentially unclear. Others suggested high patient agency, starkly contrasting with patients’ unconscious state. Conclusions: Metaphors related to ICU patients’ disease and treatment trajectory are common. They may clarify information or strengthen clinicians’ arguments but can also cause confusion and thereby hinder decision-making. Practice implications: Enhancing clinicians’ awareness about their metaphor use may promote more effective information exchange and decision-making.