Study: Most U.S. liver transplant centers use alcohol-shaming language

Feb. 8 (UPI) -- Widespread use of stigmatizing terms online by liver transplant and rehabilitation centers in the United States may be discouraging patients from seeking treatment, leading to delayed diagnosis and impacting transplant allocation priorities, according to a new study published Thursday.

The peer-reviewed research by Massachusetts General Hospital of more than 200 facilities, published in JAMA Network Open, found that 80% of transplant centers and 31% of rehab centers exclusively used words such as "alcoholism," "alcoholic" and "alcohol abuse" in breach of recommended best practice to choose non-stigmatizing language.

The overall proportion using stigmatizing language regarding alcohol use disorder and alcohol-associated liver disease on their websites rose to 88% for transplant centers and 46% for addiction psychiatric facilities, the research team said in a news release.

Researchers are calling for a large-scale awareness and education campaign to close the gap between online usage and the recommendations of medical societies by encouraging patient-facing materials that are more sensitive and non-stigmatizing.

"We learned that many of these websites use words that can be seen as judgmental, like 'alcoholic,' instead of more neutral, respectful terms like 'alcohol use disorder,''" lead author and Massachusetts General Internist Rachael Mahle said.

"This is important given that words used in healthcare can affect how patients feel and whether they seek clinical help. Our findings suggest there is a need for these websites to use kinder language which would help patients feel more comfortable and supported when they look for health information or treatment they need."

Driven by the premise that the stigma associated with alcohol use disorder and alcohol-associated liver disease can result in delayed disease detection and intervention strategies, with the potential to negatively impact liver transplant allocation decisions, the researchers aimed to determine the uptake of multiple professional societies' guidance to use non-stigmatizing language.

The team analyzed 114 liver transplant center websites and 104 addiction psychiatry websites across the country, validating their finding via a chi-squared test, a commonly used statistical hypothesis tool.

When it came to discussing alcohol-associated liver disease, 67 % of transplant websites used stigmatizing language only, 20% used non-stigmatizing language and 13% a combination of both.

"The gap between professional society recommendations and actual practice is concerning since patients frequently use these online resources for information which can significantly influence their behavior and perceptions about alcohol-associated liver disease," Massachusetts General gastroenterologist and senior author Dr. Wei Zhang said.

"Our findings underscore the need for hospitals to improve their communications by updating their language to align with patient-first, non-stigmatizing approaches, which we know from experience can lead to better health outcomes," he said.

The study recommends that healthcare institutions and professional bodies work together to development of educational initiatives to improve patient-centered communication and raise public understanding of the issue via patient education and awareness campaigns, as well as feedback mechanisms on websites and monitoring of language standards.

The researchers said they hope to build on their work by investigating doctors' choice of language in the notes they make on patients.

Zhang said the lag in the take up of non-stigmatizing language could be due to a failure to understand the correlation with healthcare and reluctance to change current norms.

But, he said, the study recommendations would help bring practice in line with language guidelines and deliver a "more empathetic and supportive healthcare environment for patients."