Ilona Fridman1, Paul A Glare2, Stacy M Stabler2, Andrew S Epstein2, Alison Wiesenthal2, Thomas W Leblanc3, E Tory Higgins4. 1. Fuqua, Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA. Electronic address: Ilona.fridman@duke.edu. 2. Department of Medicine, Memorial Sloan Kettering Cancer Center, Palliative Medicine Service, New York, New York, USA. 3. Duke Cancer Institute, Duke University, Durham, North Carolina, USA. 4. Department of Psychology and Columbia Business School, Columbia University, New York, New York, USA.
Abstract
BACKGROUND: Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or the avoidance of harm. Behavioral research has demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option. OBJECTIVE: Our study tests this communication technique with cancer patients, aiming to reduce negative attitudes toward a potentially beneficial but often-disliked option, that is, hospice care. METHODS: Patients (n = 42) with active cancer of different types and/or stages completed a paper survey. Participants read a vignette about a patient with advanced cancer and a limited prognosis. In the vignette, the physician's advice to enroll in a hospice program was randomized, creating a congruent message or an incongruent message with patients' underlying motivational focus (e.g., a congruent message for someone most interested in benefits focuses on the benefits of hospice, whereas an incongruent message for this patient focuses on avoiding harm). Patients' attitudes toward hospice were measured before and after receiving the physician's advice. RESULTS: Regression analyses indicated that information framing significantly influenced patients with strong initial negative attitudes. Patients were more likely to reduce intensity of their initial negative attitude about hospice when receiving an incongruent message (b = -0.23; P < 0.01) than a congruent one (b = -0.13; P = 0.08). CONCLUSION: This finding suggests a new theory-driven approach to conversations with cancer patients who may harbor negative reactions toward hospice care.
BACKGROUND: Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or the avoidance of harm. Behavioral research has demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option. OBJECTIVE: Our study tests this communication technique with cancer patients, aiming to reduce negative attitudes toward a potentially beneficial but often-disliked option, that is, hospice care. METHODS: Patients (n = 42) with active cancer of different types and/or stages completed a paper survey. Participants read a vignette about a patient with advanced cancer and a limited prognosis. In the vignette, the physician's advice to enroll in a hospice program was randomized, creating a congruent message or an incongruent message with patients' underlying motivational focus (e.g., a congruent message for someone most interested in benefits focuses on the benefits of hospice, whereas an incongruent message for this patient focuses on avoiding harm). Patients' attitudes toward hospice were measured before and after receiving the physician's advice. RESULTS: Regression analyses indicated that information framing significantly influenced patients with strong initial negative attitudes. Patients were more likely to reduce intensity of their initial negative attitude about hospice when receiving an incongruent message (b = -0.23; P < 0.01) than a congruent one (b = -0.13; P = 0.08). CONCLUSION: This finding suggests a new theory-driven approach to conversations with cancer patients who may harbor negative reactions toward hospice care.
Authors: Shi-Yi Wang; Jane Hall; Craig E Pollack; Kerin Adelson; Elizabeth H Bradley; Jessica B Long; Cary P Gross Journal: J Geriatr Oncol Date: 2016-01-15 Impact factor: 3.599
Authors: Mara van Osch; Milou Sep; Liesbeth M van Vliet; Sandra van Dulmen; Jozien M Bensing Journal: Health Psychol Date: 2014-08-04 Impact factor: 4.267