Diagnostic staging and stratification in psychiatry and oncology: clarifying their conceptual, epistemological and ethical implications

Julia Tinland, Christophe Gauld, Pierre Sujobert, Élodie Giroux
Med Health Care and Philos. 2024-05-17; 27(3): 333-347
DOI: 10.1007/s11019-024-10207-w

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1. Med Health Care Philos. 2024 Sep;27(3):333-347. doi:
10.1007/s11019-024-10207-w. Epub 2024 May 17.

Diagnostic staging and stratification in psychiatry and oncology: clarifying
their conceptual, epistemological and ethical implications.

Tinland J(1), Gauld C(2)(3), Sujobert P(4)(5), Giroux É(6).

Author information:
(1)Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de
la Santé & Traitement de l’Information Médicale, ISSPAM ; Chaire Démocratie en
santé et engagement des personnes concernées par le cancer, Marseille, France.
.
(2)Service de Psychopathologie de l’Enfant et de l’Adolescent, Hospices Civils
de Lyon, Lyon, F-69000, France.
(3)Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université
Claude Bernard Lyon 1, Lyon, F-69000, France.
(4)Équipe Lymphoma Immunobiology, Centre international de recherche en
infectiologie, université Lyon 1, Faculté de médecine et de maïeutique Lyon Sud,
Lyon, France.
(5)Service d’hématologie Biologique, Hospices civils de Lyon, hôpital Lyon Sud,
Lyon, France.
(6)Professeure des Universités en philosophie des sciences à l’université Jean
Moulin Lyon 3, Institut de recherches philosophiques de Lyon (IRPHIL), Lyon,
France.

Staging and stratification are two diagnostic approaches that have introduced a
more dynamic outlook on the development of diseases, thus participating in
blurring the line between the normal and the pathological. First, diagnostic
staging, aiming to capture how diseases evolve in time and/or space through
identifiable and gradually more severe stages, may be said to lean on an
underlying assumption of « temporal determinism ». Stratification, on the other
hand, allows for the identification of various prognostic or predictive
subgroups based on specific markers, relying on a more « mechanistic » or
« statistical » form of determinism. There are two medical fields in which these
developments have played a significant role and have given rise to sometimes
profound nosological transformations: oncology and psychiatry. Drawing on
examples from these two fields, this paper aims to provide much needed
conceptual clarifications on both staging and stratification in order to outline
how several epistemological and ethical issues may, in turn, arise. We argue
that diagnostic staging ought to be detached from the assumption of temporal
determinism, though it should still play an essential role in adapting
interventions to stage. In doing so, it would help counterbalance
stratification’s own epistemological and ethical shortcomings. In this sense,
the reflections and propositions developed in psychiatry can offer invaluable
insights regarding how adopting a more transdiagnostic and cross-cutting
perspective on temporality and disease dynamics may help combine both staging
and stratification in clinical practice.