‘There’s Still A Long Way To Go’: Wei Zhang, MD, PhD, on Stigmatizing Language in Liver Transplant Centers

Although stigmatizing language for substance use disorders has emerged as a major topic of concern across multiple fields in recent years, in many instances, recommendations from medical societies advocating for patient-centered language have not been implemented in practice.

Findings from a recent Massachusetts General Hospital study are calling attention to the use of stigmatizing terminology for alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) on liver transplant center websites, using outdated terms like “alcoholism” and “alcoholic” that may hinder patient care and their willingness to seek treatment.¹

“It’s unexpected, but it’s also somewhat expected,” Wei Zhang, MD, PhD, transplant hepatologist at Massachusetts General Hospital and assistant professor at Harvard Medical School, said in an interview with HCPLive. “For addiction medicine, we have frequently been taking care of patients with substance use disorder and are at the forefront of this research. For GI and hepatology, alcohol-related liver disease has just emerged as the number one indication for a liver transplant, so the research in this field is just emerging.”

Of the 114 accredited liver transplant center websites included in the cross-sectional study, 82 (71.9%) described ≥ 1 of the following: AUD; ALD; alcohol-associated hepatitis; and alcohol-associated cirrhosis. Additional review of addiction psychiatry websites from the same institutions (n = 104) revealed 39 (37.5%) described AUD and none mentioned liver diseases. Notably, stigmatizing language was observed among 72 of the 82 transplant websites (87.8%) and 18 of the 39 addiction psychiatry websites (46.2%).¹

Zhang pointed out gastroenterologists and hepatologists may not be seeing patients with substance use disorder frequently or directly, which may hinder their knowledge of the disease and their subsequent comfort in dealing with this patient population. As a result, stigmatizing terms unintentionally linger, whereas they may not be used as frequently among psychiatrists or sociologists who have the background necessary to understand the need for nonstigmatizing, patient-centered language.

Results showed stigmatizing language regarding AUD on transplant center websites was observed 79.2% of the time compared to 20.8% using nonstigmatizing language, a significantly greater rate than on addiction psychiatry websites, which used stigmatizing language for AUD 30.8% of the time (P <.001). For ALD-related terminology, 66.7% of websites used stigmatizing language, 20.0% used nonstigmatizing language, and 13.3% used a mix of both.¹

Stigmatizing language was also observed when discussing alcohol-associated hepatitis, prevalent among the majority of websites (95.7%) compared to nonstigmatizing language (2.1%) and mixed language (2.1%). A similar trend was observed for websites discussing alcohol-associated cirrhosis, where 85.7% used “alcoholic cirrhosis,” 10.7% consistently used nonstigmatizing language, and 3.6% used mixed language.¹

“I think it's more about awareness of how stigmatizing language could actually harm patients’ care and hurt their outcomes,” Zhang explained, describing how individuals with AUD or ALD may not want to confess to their alcohol consumption habits or seek medical care, especially when they feel as though they are being stigmatized.

In order to avoid stigmatizing language and its negative impact on patient care and the overall relationship between doctors and their patients, Zhang suggested the implementation of educational initiatives to increase awareness of stigmatizing language and its consequences. He also called for patient involvement as healthcare providers attempt to rectify their discourse surrounding AUD and ALD, highlighting the importance of their input throughout this process: “I think it takes a lot of effort, but I think as long as we are trying our best, we'll eventually move in that direction and help in this already vulnerable population.”

Reference:

1. Brooks, A. The Power of Words: Liver Transplant Centers Continue to Use Stigmatizing Language. HCPLive. February 17, 2024. Accessed February 21, 2024. https://www.hcplive.com/view/the-power-words-liver-transplant-centers-continue-use-stigmatizing-language