Infinitive and gerund constructions in informed consent templates for dental treatment

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Infinitive and gerund constructions in informed consent templates for dental treatment

Kostenko V.H., Candidate of Philological Sciences, Associate Professor, Associate Professor; Solohor I.M., Candidate of Philological Sciences, Associate Professor, Associate Professor at the Department of Foreign Languages, Latin and Medical Terminology Poltava State Medical University

This article investigates the prevalence of infinitive and gerund subordinate clauses in the texts of informed consent templates for dental treatment, provides the analysis of their syntactic functions, and highlights their text-creating peculiarities, thus contributing to the studies of the current trends in dentistry formal writing. One of the most significant linguistic features of informed consents for dental treatment is their complex structural sentence configuration and length: even those having one main clause are often complicated with homogenous parts, verbal constructions, etc. This complexity arises due to the necessity to convey complicated ideas, to condense large amount of relevant information, and can be objectified by using non-finite verbal phrases. Gerund and Infinitive constructions organize the reduced part of semi-complex sentences, omitting such categories as number and person. The gerund constructions have been found out as the most prevalent (40.7%) compared with infinitive (37.4%) and participles constructions; in addition to their external nominal characteristics, they express the basic tendency to endure, in such way emphasizing on the existence or occurrence of the event or action for a long time span. Compared with the gerund, which mostly expresses progressive aspectual meaning, infinitive phrases in the informed consent templates emphasize the possibility or potential for something and therefore may be perceived more abstract.

Professional English discourse is demonstrating a tendency towards a mode of expressing special information more condensed syntactically and more complex intellectually. The use of non-finite verbs, on the one hand, helps create the conciseness, flexibility, and preciseness of expressions, but, on the other, this information package resulting in syntax complexity may impede quick and correct perception of health-relevant information by people who have to take voluntary and educated health-preserving decision.

Key words: informed consent for dental treatment, gerund, infinitive, constructions, semi-predication, syntactic function.

Інфінітивні та герундіальні конструкції у формах інформованої згоди на стоматологічне лікування

Неособові форми дієслова є об'єктом постійного аналізу в сучасній лінгвістиці. Стаття присвячена дослідженню інфінітива, герундія та їхніх конструкцій в англомовних текстах інформованої згоди на стоматологічне лікування, а саме проаналізована їхня поширеність, визначені синтаксичні функції та роль у текстотворенні, що слугує певним внеском у дослідження сучасних тенденцій функціонування професійних дискурсів. Випадки вживання одиничного герундія або інфінітива не чисельні, конструкції з цими неособовими формами значно переважають. Герундійні та інфінітивні конструкції складають 40,7% та 37,4% відповідно, решта припадає на дієприкметникові конструкції. Досліджувані неособові форми займають у реченні різні синтаксичні позиції: для герундійних конструкцій це найчастіше іменні слоти додатка, підмета, та прислівниковий слот обставини часу та способу дії; інфінітивні конструкції виконують здебільшого функції додатка, підмета в екстрапозицїї, комплемента, атрибута та обставини мети.

У текстах поінформованої згоди герундійні конструкції, маючи виражений субстантивний характер, репрезентують значення процесу в найзагальнішому вигляді, інфінітивні конструкції виражають потенційну дію з семантикою можливості чи необхідності. Професійний дискурс демонструє тенденцію до більш конденсованого синтаксично та більш складного інтелектуально способу вираження спеціальної інформації. Вживання герундійних та інфінітивних вторинно-предикативних конструкцій, з одного боку, допомагає створити лаконічність, гнучкість і точність виразів, але, з іншого, таке інформаційне ущільнення призводить до складності синтаксису і може перешкоджати швидкому та правильному сприйняттю необхідної медичної інформації не фахівцям у галузі медицини.

Ключові слова: інформована згода на стоматологічне лікування, герундій, інфінітив, звороти, напівпредикативність, синтаксична функція.

Background

Dentistry as any other professional domains encompasses a complex assemblage of social activities, language practices, interpersonal relationships, events, objects, and settings referring to oral health. The communication in the field of healthcare, characterized with specific goal-setting and necessity to solve particular professional tasks is “of continuing interest to philosophers, social scientists and anthropologists, as well as to those individuals who directly use it in administering health care, namely, doctors, nurses, and allied health professionals” [25, p.6]. Dental professionals communicate complex information with specialists and non-specialist clients using shared textual conventions and textual (oral or written) patterns applied in recognizably similar situations to accomplish their communication goals, known as genres. The latter can be the most generally conceptualised as “cognitive schemata and their context-dependent realization via linguistic devices [22, p.126], “shaping and shaped by the flux and flow of social life” [20, p.159], when brining together the most standing out strands of genre theory.

On the one hand, genres of dental professional discourse are fairly well-established, but, on the other, they are flexible and constantly evolving in order to meet contemporary reality, social and professional demands: thus, some genres, e. g. treatise, faded away, others, e. g., original research article, case report, considerably changed over the past halfcentury [2]; genres of informed consent for clinical photography, informed consent for clinical trials, informed consent for immunization, promotional videos of medical services, etc. are relatively new.

Exploring the genre repertoire of professional discourses enables to create consistency across time and provide a clearer and deeper insight into professional identity, professional and corporate culture, and interaction between professional and discursive practices. The medical and healthcare discourses encompass sets of genres for different purposes within the areas of intra-professional, doctor-lay person, and inter-professional communication that reflect discourse community standards and conventions in a particular sociocultural context. Although many medical and healthcare-related genres have been extensively explored, the genre of informed consent, which plays a critical legal, ethical, and clinical role in healthcare settings, has not been sufficiently elucidated yet. There are a few reports of Ukrainian and foreign researchers devoted to their generic peculiarities, rhetoric and linguistic characteristics, issues on their readability [1; 9; 16].

Review of recent publications

Informed consent is a bilateral document to provide the following issues for voluntary and conscious decision making: sufficient amount of special information (the Grice's maxim of quantity) about the character of proposed dental intervention, the risks and benefits of the proposed procedure, the potential advantages and disadvantages of no treatment, alternative treatment strategies, their risks and benefits, the potential for a successful outcome, the estimated recuperation time. The duty to disclose the information to patients is a part of the overall duty of medical staff. This document also covers the key points of prior communication between doctor and patient in order to obtain / give voluntary decisions concerning the exposure to invasive or irreversible procedures.

Professional discourse is often characterized by high information density, a greater complexity of grammatical forms and lexical units across languages and cultures [7, p. 24] that may pose doctor-patient communication obstacles (violation of the Grice S maxim of manner) and adversely affect patient access to health information, leading to poor satisfaction for both parties [21]. Studies of the comprehension of health education handouts show that typically only half of the recipients are able to comprehend health education materials [13, p.108]. In our study, the informed consent templates for dental treatment were processed by Text Readability Consensus Calculator [15; 24], a web tool, using 7 popular readability formulas to calculate the text difficulty of a sample text. Nearly all the templates were assessed as “difficult to read; college level”. The average word count of the texts is 820 words, but it can range from 540 to 1100 words that can be explained by the varying complexity of dental procedures.

Our previous studies demonstrated the syntax of informed consent templates for dental treatment is complicated for the sake of avoiding ambiguity, misunderstanding, or distortion of will [1; 16]. The analysis of the sentence types revealed the predominance of composite sentences over simple ones: the complex sentences make up 68.3 %, the compound-compound sentences, which consist of two or more co-ordinate clauses at least one of which has one or more subordinate clauses, and complexcompound sentences, which include one principal and two or more homogenous subordinate clauses, joined with each other by coordination, make up to 8.14%, while the share of compound sentences is relatively small, 2.06%. The percentage of simple sentences ranking the second position is 21.5% [16, p. 77].

Thus, one of the most significant linguistic features of informed consents is their complex structural sentence configuration and length: even those having one main clause are often complicated with homogenous parts and verbal phrases. This complexity arises due to the necessity to convey complicated ideas, to condense large amount of relevant information, and can be objectified by using non-finite verbal phrases [14; 18; 19]. This type of syntactic phrases is categorized as secondary predication constructions (semi-predicative constructions) with verbals (verbids) including gerunds, infinitives, and participles [3; 4; 5; 18]. A. Hanaa emphesizes that "we call them non-finite clauses because they are unable to express the predicative meanings of time and mood, still do express the so-called "secondary" or "potential" predication, forming syntactic complexes directly related to certain types of subordinate clauses” [12, p. 13]. While the finite verbs express predication in its genuine and complete form, the function of the verbal is to express semi-predication, building up semi-predicative complexes within different sentence constructions.

Objectives

The purpose ofthis study is to identify the prevalence of infinitive and gerund subordinate clauses in the texts of informed consent templates, to analyze their syntactic functions and reveal their text-creating peculiarities and, thus, to uncover the current trends in dentistry formal writing. The reason to choose the above mentioned clauses as units of analysis is grounded in the fact that they help reveal “how the flow of events is construed in the development of text at the level of semantics” [11, p. 63].

Methodology

We studied 20 original informed consent (IC) templates for dental treatment retrieved from the sites of the USA healthcare settings authorized to provide oral and dental services (New York City Metropolitan Hospital Center, Alliance for Dental Care PLLC (Rochester, NH)), and those given by medical insurance companies (Dentists Benefits Insurance Company (DBIC), MedPro Group). The templates were searched for using Google search engine and downloaded from internet sources Open Dental Softwear, American Dental Association dental records reference, Delta Dental Incorporation.

The methodology of this study includes syntactic parsing to identify the syntactic structures (the trunk and branches of the sentence with more complex structure) and production units of sentences (we used the Stanford parser online tool to automate this process); identification and classification of the patterns of the semi-predicate verbal groups, and exploring the functionality of the dominant patterns; elements of discourse analysis (taking into account contextual parameters of a typical communicative situation of obtaining / giving consent, the status of communicators); elements of genre analysis, as the genre determines the structural framework, linguistic and rhetoric features of the text. This study takes the systemic functional approach that conceptualizes grammar as a functional meaning-making resource and thus contributes to reflect and construct the situational and cultural contexts [10].

Results and discussion

While the finite verbs express predication in its genuine and complete form, the function of the non-finite forms is to express semipredication, or secondary predication, providing additional information to the host predicator, or giving new information about one of its arguments. In other words, verbals are always in connection with the finite form of the verb and express a state or property to either the subject or the object in the main clause. The verbals when forming non-finite verb phrases can include nominal expressed by noun or pronoun and a verbal itself expressed by a participle, a gerund or an infinitive: in such way the verbal is connected with the nominal element by means of predication. Non-finite verb phrases can function nominally, adjectivally, or adverbially. Non- finite verb phrases are reported to appear more often in texts written in a higher register [10, p. 78] that is in complete agreement with our findings, and are typically employed when there is high event or fact integration that is characteristic of informed consent forms [16, p. 77].

This study has demonstrated that out of four types of verbals, the gerund constructions consisting of either a single word or phrases of a gerund and modifiers or objects associated with it, are the most commonly used (40.7%) compared to all non-finite constructions. The single gerund (Example 1) is inferior to gerund phrases (Exampes 2 and 3) in their prevalence over the IC texts:

(1) That makes the tooth subject to fracturing, or breaking [39].

(2) Laceration or tearing of the gums may occur and might require suturing.Some extractions require cutting into the gums and removing bone and/or cutting the tooth into sections prior to removal [38].

(3) I understand that by doing nothing, I run the risk of developing a severe infection, and losing the tooth [31].

The gerund and gerundial phrases in the text studied most commonly occupy a noun phrase slot as subject (Example 4), or objects, direct or indirect object (Example 5), object of preposition (Example 6), attribute (Example 7), or an adverbial element slot (Examples 8, 9):

(4) Cracking or stretching of the lips or corners of the mouth during treatment is possible [38].

(5) I authorize sending correspondence, reports, chart notes, photos, x-rays and other information pertaining to my treatment <...> my dentist, and any other health care provider [38].

(6) If you want to stop your teeth from becoming loose in your gums to prevent them from falling out of your mouth <...> [35].

(7) During that time, you may experience some soreness and discomfort in and around the tooth being treated. In order to increase the chance of achieving optimal results <...> [30].

(8) This is accomplished using local anesthetic to numb the tooth. Access is gained to the canals by drilling a small hole in the top or back of the tooth [37].

(9) Similarly, instruments tips occasionally break off within the canal preventing sealing of the root end [34].

The gerundial adverbial modifies of manner (Example 8) have been found as the most commonly used for the sake of elaborating propositional meaning to make it clear and accessible to the patients. The gerundial phrases as an adverbial modifier of time can also be quite often seen (Examples 10, 11, 12).

(10) You should consider all of the above, including the option of declining treatment, be fore deciding whether to proceed with the planned procedure [29].

(11) I must not operate a motor vehicle or any other hazardous equipment while taking these drugs [29].

(12) The purpose of crown lengthening surgery is to provide my general dentist or prosthodontist better access and visualization <...> tooth structure to work with when restoring/repairing my tooth/teeth [26].

As for the gerundial adverbial modifies of purpose, condition, or cause (reason), only few examples have been detected. Gerund phrases can function as a dangling adverbial modifier (usually with overt subordinators) and mostly precede sentences in the IC texts, describing, clarifying, or giving more detail about a main concept:

(13) By signing this document, I am freely giving my consent to allow and authorize my Doctor to render any treatment necessary [37].

(14) By signing this document, I acknowledge and accept the possible risks and complications of the procedure and agree to proceed [35].

In terms of tense, voice, and aspect, Indefinite Active Gerund is the most commonly employed in the IC text, and the Passive Gerund is slightly below (Example 15), while Perfect Gerund (either Active or Passive) (Example 16) emerge rarely:

(15) Post-treatment infection also can result from calculus being lodged in the tissue, which also can require surgical intervention. Ultrasonic instrumentation is noisy and the water used may cause cold sensitivity during treatment on nonanesthetized teeth not being treated [36].

(16) Use of the material may therefore be suggested having been previously unplanned [32].

Thus, gerund phrases serve to make a verbal form function as a noun phrase that fit in with the nominal paradigm of professional formal writing. In addition to the external nominal characteristics, gerund phrases, nevertheless, express the basic tendency to endure, in such way emphasizing on the existence or occurrence of the event or action. The gerund phrases establish a syntactic subordination between the verb in the mail clauses and the gerund itself, thus the different semantic values expressed by the gerund phrases are not conveyed by the gerund itself but depend on the combination of these linked verbs.

The single infinitive and infinitive phrases rank the second position after the gerund and gerund phrases in their prevalence over the IC texts, making the share of 37,4 %; their functions, however, overlap. The infinitive phrases outnumber the infinitives without attached words over the IC texts. The nominal character of the infinitive phrases manifests through their occupying a noun phrase slot as subject, object and complement.

According to our findings, infinitive clauses as subjects are quite rare and are mainly used as extraposed (postponed) subjects (Examples 17, 18):

(17) It may be necessary to retrieve the broken instrument surgically [27].

(18) I understand that it is important to continue to see my regular dentist for routine care [33].

Functioning as a direct object (Examples 19 - 22), infinitive clauses are usually used after reporting verbs (ask, tell), verbs of cognitive states (consider, understand, believe), decision or intention (decide, authorize, plan), effort (try, fail), modality, or after some adjectives (glad, happy). F. Salager and Z. Kozacikova emphazise that Infinitive clauses can replace a that-clause [23, p. 70; 17, p.58], but as R. Close remarks, "an infinitive clause is only possible if the subject and time reference are the same in both clauses" [8, p. 97].

(19) I have elected to proceed with the anesthesia(s) indicated below [29].

(20) Your doctor will be happy to answer any questions you may have and provide additional information before you decide whether to sign this document and proceed with the procedure [31].

(21) If a problem develops, it is my responsibility to notify the doctors and/or staff of Advanced Dental Concepts [30].

(22) The doctors and/or staff at Advanced Dental Concepts will take every action to provide the highest level of care [26].

Object predicative, also known as object complement, is used in sentences, in which the main verb is complex transitive, and mostly such verbs are cognition verbs (believe, consider, understand):

(23) In light of the above, I hereby authorize Dr.

to proceed with the root canal therapy [36].

(24) Any of the complications and problems may require me to have an additional treatment or surgery [27].

The infinitive and infinitive phrases are used as an attribute, modifying nouns, and often have a modal significance thus expressing an action thought of as obligatory or possible:

(25) <...> there is a risk of failure of the implant to be integrated into the jawbone o f approximately 1% to 5%, for ideal patients with ideal bone sites [29].

(26) No refund will be given for failure of the implant to osseointegrate [29].

Infinitive clauses functioning as subject predicative (in more traditional terminology, e.g. by L. Alexander [3], this position is referred to as subject complement) (Examples 27 - 28) are relatively common in written registers and often used to specify the nouns aim, objective, plan, goal, purpose, strategy, task, or idea (Examples 29).

(27) The purpose of crown lengthening surgery is to provide my general dentist or prosthodontist better access and visualization <...> tooth structure to work <...> [33].

(28) The goal of root canal treatment is twofold: to destroy and remove bacteria and diseased nerve tissue and to seal the resulting empty canals <...> [37].

(29) The intended benefit of this treatment is to relieve my current symptoms and/or permit further planned treatment [31].

The infinitive phrases in the IC texts can also function as an adverbial modifier, mostly of purpose (Examples 30 - 31) and are often introduced by in order.

(30) In order to increase the chance of achieving optimal results, I have provided an accurate and complete medical history [36].

(31) To maintain my results, I understand it is best for me to use the Sinsational Smile home care treatment pen each night starting with the first evening after my treatment [36].

(32) Dr.has explained to me that a root canal involves the use of a local anesthetic to numb the tooth and surrounding gum and bone [37].

The high proportion of the adverbial infinitive clauses could be explained by the communicative tasks of IC genre. Almost all of these clauses fall into the grammatical category of the adverbial clause of purpose, which is a basic common structure to use when healthcare professionals provide patients with the necessary information explaining what to be done during the treatment.

In terms of grammar characteristics as tense, voice, aspect, the active form of the infinitive is more common than the passive in the IC texts; the Indefinite Infinitive is the most widely used as it may refer to the present, past or future, though Perfect Infinitive can also be seen (Examples 33, 34).

(33) More difficult wisdom teeth that need to be cut into pieces to remove can take around 20 minutes [38].

(34) I consent to allow my clinical photographs and other records to be used for dental research, [31].

No cases of Perfect Continuous or Continuous were found. This result can be supportet by the argument that the continuous aspect is not commonly exploited in formal writing as “it tends to convey an informal tone” [6, p.6]. The Continuous aspect is natural in narrative descriptions or accounts of past events and often useful for positioning events in relation to one another that is not relevant for the genre of informed consent for dental treatment.

Our results support the statement of Biber et al., who have intensively discussed the coneept of the infinitive across registers, that “infinitive clauses are more common in the written registers than in conversations” [5, p. 328]. Compared with the gerund, which mostly expresses progressive aspectual meaning, infinitive phrases emphasize the possibility or potential for something and therefore may be perceived more abstract. The infinitive clauses as object and purpose adverbial modifier are the most prevailing in the IC texts.

infinitive gerund dental treatment syntactic

Conclusion

Professional English discourse is demonstrating a tendency towards a mode of expressing special information in more factual and more impersonal manner, more condensed syntactically and more complex intellectually. This tendency has been supported by investigating the syntactic characteristics of the texts of informed consent templates for dental treatment. The gerund and infinitive clauses are the most commonly exploited to condense special information compared to hypotactically or paratactically linked finite clauses. Gerund and Infinitive constructions organize the reduced part of semi-complex sentences, omitting such categories as number and person. The gerund constructions have been found out as the most prevalent compared with infinitive and participles constructions; in addition to their external nominal characteristics, they express the basic tendency to endure, in such way emphasizing on the existence or occurrence of the event or action. Compared with the gerund, which mostly expresses progressive aspectual meaning, infinitive phrases emphasize the possibility or potential for something and therefore may be perceived more abstract. The use of non-finite verbs, on the one hand, helps create the conciseness, flexibility, and preciseness of expressions, but, on the other, this information package resulting in syntax complexity may impede quick and correct perception of health-relevant information by people who have to take voluntary and educated health-preserving decision.

The findings presented in this study are based on only a limited number of texts, and it cannot be claimed that they are typical for all genres of dentistry discourse. The results obtained might have practical implications for healthcare settings prompting them to create more patient-friendly documents, and for medical ESP classes providing deeper understanding of the syntactic and morphological variety of medical texts.

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26. Consent for Filling.

27. Consent Form for Endodontic Treatment

28. Informed Consent Composite (Tooth-Colored) Fillings.

29. Informed Conset: Dental Implants.

30. Informed Consent Endodontic (Root Canal) Treatment.

31. Informed Consent for Bone Grafting Procedure.

32. Informed consent for composite fillings.

33. Informed Consent for Crown Lengthening Surgery

34. Informed Consent for Endodontic Treatment.

35. Informed Concent for General Dental Procedure.

36. Informed Consent For Periodontal Root Planing and Scaling.

37. Informed Consent for Root Canal Treatment.

38. Informed consent for tooth extraction.

39. Patient Consent to Begin Orthodontic Treatment.

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