Different stories play different roles in patients' health decision-making, researcher says

September 18, 2013, University of Missouri-Columbia

Individuals often turn to others for advice when making choices. Perhaps, it seems fitting then, that individuals would seek out others when they are faced with important health decisions. Yet, health communicators have debated whether stories should be included in patient decision-aids (which are informational materials designed to help patients make educated choices about their health) because they worry stories are too biased. Now, an MU researcher has found that stories used in decision-aids don't necessarily bias patients' decision-making; rather, certain types of stories can help patients confidently make informed decisions that fit their individual health needs.

"Stories are not all the same, and they don't all have the same effect on patients' decision-making; therefore, calls to avoid using stories in patient decision-aids is not advisable," said Victoria Shaffer, an assistant professor of and at MU. "Different types of narratives have different effects on patients' decision-making processes. The question isn't whether it's good or bad to include patient stories in decision aids; rather, the question is what type of stories should communicators use to have the intended effect?"

Shaffer and her colleagues examined two types of stories in their study: process narratives and experience narratives. Process narratives are stories that include details about how a patient made a particular health care decision. Experience narratives include details about what it is like to have particular treatments or procedures.

The researchers told more than 300 healthy women to imagine they had received diagnoses of early-stage . The women randomly were assigned to a process narrative condition, an experience narrative condition or a control condition with no patient stories. Participants in the narrative conditions then viewed four videotaped stories. Afterward, the women were asked to choose a : , which includes complete removal of the breast tissue, or radiation and lumpectomy, which includes partial removal of the breast tissue.

"We found that neither type of story affected patients' treatment decisions," Shaffer said. "About two-thirds of the women chose lumpectomy and radiation and one-third of the women chose mastectomy regardless of which type of narrative they viewed."

In addition, the researchers found that women who viewed process narratives spent more time searching for information. Women who viewed experience narratives reported they could better envision what it would be like to undergo the treatments, and the women also evaluated their decisions more favorably.

Both early-stage breast cancer treatment options have similar survival rates, which means patients' treatment options really depend on the patients' individual preferences and lifestyles, Shaffer said.

"Previous research has shown that people make healthcare decisions based on their predictions about how these choices will affect their lives in the future," Shaffer said. "The problem is that most of us aren't very good at predicting how we'll feel in the future, which can lead us to make poor decisions or decisions that we later regret. Our results suggest that experience narratives increased patients' confidence in their treatment decisions. Perhaps, using experience narratives in future decision-aids can help patients make more confident ."

Most of the controversy related to using stories in patient decision-aids focuses on outcome narratives, which are stories that evaluate the results of individuals' decisions. Previous research has shown that outcome stories are persuasive. However, process and experience narratives can inform patients' decision-making without biasing their treatment decisions, Shaffer said.

"After receiving a cancer diagnosis, patients may focus on survival or recurrence while making their and don't always consider the long-term tradeoffs associated with different treatment choices," Shaffer said. "Process narratives, in these instances, might help consider other treatment attributes, such as appearance, they wouldn't have otherwise considered."

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. The study, "The Effects of process-focused versus experience-focused narratives in a breast cancer treatment decision task," was published online earlier this month by Patient Education and Counseling. Co-authors included Lukas Hulsey from Wichita State University and Brian Zikmund-Fisher from the University of Michigan. The Informed Medical Decisions Foundation and the American Cancer Society funded the research.

Explore further: Stories help patients make health decisions, researcher says

Related Stories

Stories help patients make health decisions, researcher says

June 4, 2013
(Medical Xpress)—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 ...

Patient choice at heart of new online decision aids

August 28, 2013
A health website has launched a range of free online health decision aids, allowing patients to make more informed treatment choices, thanks to the work of a Newcastle University academic.

Digital diagnostic tools lead to patient dissatisfaction, says MU expert

January 24, 2013
Health care practitioners now can access patients' data using electronic medical records, which often include information systems that assess individuals' medical histories and clinical research to facilitate doctors' diagnoses. ...

Future issues important for fertility preservation decisions

September 11, 2013
(HealthDay)—Future decisions and issues must be considered by cancer patients in their fertility preservation decision-making process, according to a clinical opinion piece published in the August issue of the American ...

Irrelevant information in medical testimonials may lead to poor consumer choices

August 14, 2013
Medical testimonials on the Internet and elsewhere present powerful personal stories and useful information, but they can also be dangerous to your health if distracting, irrelevant information leads to inappropriate treatment ...

Cancer patients want more shared-decision making about their treatment

August 6, 2013
A new study of cancer patients indicates that certain patient groups have unmet needs for greater involvement in decisions about their treatment.

Recommended for you

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Teens likely to crave junk food after watching TV ads

January 15, 2018
Teenagers who watch more than three hours of commercial TV a day are more likely to eat hundreds of extra junk food snacks, according to a report by Cancer Research UK.

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

Your dishwasher is not as sterile as you think

January 13, 2018
(HealthDay)—Your dishwasher may get those plates spotless, but it is also probably teeming with bacteria and fungus, a new study suggests.

Study reveals what sleep talkers have to say

January 12, 2018
A team of researchers with members from several institutions in France has conducted a study regarding sleep talking and has found that most sleep talking is not only negative in nature, but involves a large amount of swearing. ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.