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Gain–loss framing and patients’ decisions: a linguistic examination of information framing in physician–patient conversations

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Abstract

When discussing risks and benefits with cancer patients, physicians could focus on losses such as mortality rates and cancer recurrence or, alternatively, gains such as survival rates and curing cancer. Previous research has shown that the way health information is framed influences individuals’ preferences and choices. We operationalized gain–loss framing as physicians’ choice of words related to gains (cancer survival), or losses (cancer mortality). In an exploratory analysis, we investigated (a) whether physicians used gain or loss words as a function of their recommendation, (b) whether physicians’ choice of words was associated with patients’ treatment choices. We analyzed transcribed consultations with male patients who had intermediate-risk prostate cancer. Using an iterative process of gathering and evaluating words, we created gain- and loss-dictionaries. The loss-dictionary included words related to cancer death and cancer progression. The gain-dictionary included words related to survival and cure. Using Linguistic Inquiry and Word Count software, we calculated the number of words related to gains and losses in each transcript. We found that physicians who recommended immediate cancer treatment for prostate cancer (vs. active surveillance) used slightly fewer words related to losses and significantly fewer words related specifically to death from cancer. Further analysis showed that loss words were associated with the patient’s choice of immediate cancer treatment. A novel method of automated text analysis showed that physicians’ use of loss words was correlated with physicians’ recommendations for cancer treatment versus active surveillance. Additionally, loss words in consultations were associated with patients’ choice of cancer treatment.

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Authors and Affiliations

  1. Fuqua School of Business, Duke University, 100 Fuqua Drive, Durham, NC, 27708, USA

    Ilona Fridman, Hanna Huffstetler & Peter A. Ubel

  2. Duke Margolis Center for Health Policy, Duke University, Durham, NC, 27708, USA

    Ilona Fridman

  3. Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA

    Angela Fagerlin

  4. Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA

    Angela Fagerlin

  5. Family Medicine and Community Health, Duke School of Medicine, Durham, NC, USA

    Karen A. Scherr

  6. Adult and Child Consortium of Health Outcomes Research and Delivery Science (ACCORDS), Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA

    Laura D. Scherer

  7. Center of Innovation for Veteran-Centered and Value-Driven Care, VA Denver, Denver, CO, USA

    Laura D. Scherer

  8. Sanford School of Public Policy, Duke University, Durham, NC, USA

    Peter A. Ubel

  9. Duke School of Medicine, Durham, NC, USA

    Peter A. Ubel

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  1. Ilona Fridman
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  3. Karen A. Scherr
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Correspondence to Ilona Fridman.

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Ilona Fridman, Angela Fagerlin, Karen A. Scherr, Laura D. Scherer, Hanna Huffstetler, and Peter A. Ubel declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Fridman, I., Fagerlin, A., Scherr, K.A. et al. Gain–loss framing and patients’ decisions: a linguistic examination of information framing in physician–patient conversations. J Behav Med 44, 38–52 (2021). https://doi.org/10.1007/s10865-020-00171-0

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