Metaphors to Describe Complex Cardiac Device Data
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In 2020, I (Carly Daley) began my dissertation work to understand what metaphors, if any, may help people with cardiac resynchronization (CRT) devices understanding how biventricular (BiV) pacing works. Cardiac implantable electronic devices (CIEDs), such as CRT devices, are capable of capturing and transmitting a multitude of data points that are useful for monitoring device function as well as cardiac health. These data, however, require a trained clinical professional to be able to interpret. Additionally, understanding the data requires established knowledge of the device purpose and function. This research aimed to bridge the knowledge gap for people who have a CIED (herein referred to as patients) and who want to be able to receive and understand their device data but who don’t have the extensive clinical training and experience required to be able to interpret the data.
Metaphor, or simply comparing one thing in terms of another, more familiar thing, has been used in health communication as a tool for understanding people’s lived experience with their health, and for making complex health concepts easy to understand. Metaphors are also a way to establish common ground, and create shared understanding. To identify metaphors to describe BiV pacing for CRT devices, I first interviewed 14 clinicians who have expertise with CRT devices to understand what metaphors they would use to describe BiV pacing. I then created six descriptions of BiV pacing to present to patient participants and gather their feedback. Five descriptions used metaphors, and one did not use metaphor (plain language). A total of 15 participants were recruited to review and provide feedback on the metaphors. This study was reviewed by Parkview’s Institutional Review Board and determined to be Exempt. The clinician participants did not receive compensation, and the participants with CRT devices received a $10 gift card.
The feedback from people who have CRT devices was divided. Overall, participants wanted to have simplified language rather than complex medical terms. While most participants appreciated having a metaphor in the description, such as comparing BiV pacing to a conductor leading the orchestra, a couple of participants preferred to have plain language, to keep the explanation straightforward.
The descriptions using metaphors were all created in the English language from participants in the United States, and were around a 9th grade reading level according to an established assessment tool. Metaphors may be used differently from how they were presented in this study based on cultural background, language, and communication styles. The interviews do not represent opinions of all clinicians or patients, and there is not enough data to draw conclusions about when and how to use which metaphors for explaining how biventricular pacing works. However, this study suggests that it is worthwhile to explore using different ways of explaining, such as metaphors that resonate for people, when describing complex health data. More work is needed to understand when and how to use metaphors, if any, in communication about devices and device data.
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