MU researcher examines how stories influence decision-making among patients

Jun 5 2013

Narratives used in patient decision aids should inform, not persuade

Stories often appear in health communication in order to encourage individuals to change behaviors, such as smoking or not wearing sunscreen. A University of Missouri researcher studied how stories influence patients' decision-making when behavior change is not the desired outcome of the health communication.

"Patient stories can be very persuasive, and people tend to seek stories from others when they make health decisions," said Victoria Shaffer, an assistant professor of health sciences and psychological sciences at MU. "We were concerned about whether stories were appropriate in patient decision aids because the goal of decision aids is to inform, not persuade."

Shaffer and her colleagues studied how stories included in decision aids, informational tools such as videos or brochures designed to help individuals make informed health decisions, affected individuals' choices about medical treatments for early-stage breast cancer. Women diagnosed with early-stage breast cancer can opt for either a lumpectomy, which involves removing a piece of the breast tissue, and radiation therapy, or a mastectomy, which involves completely removing the breast tissue. Both treatment options have similar survival rates, which makes choosing between the two options difficult and necessitates patient decision aids, Shaffer said.

"Physicians used to be more paternalistic and would tell patients exactly what they should do," Shaffer said. "Now, health decisions more often are shared by medical providers and patients, and patients must digest a lot of complicated information in order to make the best decisions for their health. Understanding medical information can be especially challenging because much of it includes complicated terms and statistics as well as explanations of procedures."

The researchers told more than 200 healthy women to imagine that they had just received a diagnosis of early-stage breast cancer. Half of the women viewed an informational video about treatment options that included statistical information as well as stories from breast cancer survivors who had undergone lumpectomies and radiation or mastectomies. The other half of the women viewed the same video, except it omitted the patient stories. The researchers asked both groups of women to report which treatment option they would choose based on the video they watched.

"Interestingly enough, we found no difference in treatment preference between the two groups," Shaffer said. "The stories didn't make the women chose one treatment option over the other. However, women seemed to like the video with stories better, and the decision aid with stories was thought to be more trustworthy and more emotional."

Shaffer said future research should examine the persuasiveness of individual stories and the contexts in which the stories appear.

"We've tried to dig deeper and characterize the particular elements of stories that might make them persuasive in one context and not persuasive in another," Shaffer said. "Hopefully, the end result would be to characterize the different elements of patients' stories and for what health communication purposes the stories should be used."

Shaffer hopes her future work will lead to a "cheat sheet" for health communicators that would outline which types of stories to include in health messages depending on the context and communication intent.

Shaffer is an assistant professor in the Department of Health Sciences in the MU School of Health Professions and in the Department of Psychological Sciences in the MU College of Arts and Science.

Source: University of Missouri-Columbia