Disclosures: Lala and Mentz report no relevant financial disclosures.
April 16, 2022
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Editors of HF journal question use of the word ‘candidate’

Disclosures: Lala and Mentz report no relevant financial disclosures.
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The word “candidate” is often used when determining whether a patient with HF will benefit from a particular therapy, but an editorial in the Journal of Cardiac Failure states the term may be too judgmental.

Anuradha (Anu) Lala
Robert J. Mentz

“Imagine for a moment that you are a patient, being told you are not a ‘candidate’ for a given therapy,” wrote Anuradha (Anu) Lala, MD, associate professor of medicine (cardiology) and population health and science policy at Icahn School of Medicine at Mount Sinai and deputy editor of the Journal of Cardiac Failure, and Robert J. Mentz, MD, associate professor of medicine and population health science at Duke University School of Medicine and editor-in-chief of the Journal of Cardiac Failure. “Would this phrasing lend itself toward making you feel marginalized? Ill-fated? Denied? Such issues have come into the spotlight recently as they pertain to requirements of vaccination against COVID-19 to afford ‘candidacy’ prior to listing for heart transplantation.”

Built in to the definition of “candidate” is the idea that someone’s fate is being decided by others, Lala and Mentz wrote.

“Our intention is not to determine fate. It is not to choose one patient over another or deny lifesaving treatments to any individual,” they wrote. “Rather, our intention and responsibility are to both serve as stewards of resources, and also help determine the extent to which (based on aggregated experience and data) a patient will derive benefit from a given therapy. So, we’ve been thinking ... if that is the intention, why not word it that way?”

“Instead of saying ‘candidate,’ which sounds judgmental, maybe we should say, ‘You may or may not derive benefit from this therapy,’” Lala told Healio.

In the editorial, Lala and Mentz offered examples of wording where “is not a candidate for” can be replaced by “is unlikely to benefit from.”

“Articulating why an individual may or may not derive benefit from a therapy at a given time allows us to communicate better — to patients and their loved ones but also among ourselves as clinicians,” Lala and Mentz wrote. “Further, rather than relaying sentiments of judgment, this approach emphasizes nonmaleficence, wherein decisions are weighed against all benefits, risks and consequences.”

Lala and Mentz told Healio that language matters greatly when communicating with patients with HF and their families, who are likely undergoing stress because of the gravity of the diagnosis.

“I say things differently in clinic now as a direct result of these areas where we have learned from each other, such as focusing on ‘heart function’ and ‘heart success’ in how we communicate with patients,” Mentz told Healio. “I’ve stopped introducing myself as a heart failure clinician. I tell the patient we are focusing on their heart function. It’s changed how I practice, which is exciting.”

For more information:

Anuradha (Anu) Lala, MD, can be reached at anu.lala@mountsinai.org; Twitter: @dranulala.

Robert J. Mentz, MD, can be reached at robert.mentz@duke.edu; Twitter: @robmentz.