Do personal stories make patient decision aids more effective? A critical review of theory and evidence (original) (raw)
Related papers
Personal stories in publicly available patient decision aids
Patient Education and …, 2008
Conclusions: Publicly available PtDAs vary in their use of stories. Most PtDAs balance the number of stories favouring and against the most intensive option presented; most PtDAs do not balance the number of stories portraying satisfaction or dissatisfaction with the outcome(s) of the decision.
Does narrative information bias individual's decision making? A systematic review
Social science & medicine (1982), 2008
Including narratives in health-care interventions is increasingly popular. However, narrative information may bias individual's decision making, resulting in patients making poorer decisions. This systematic review synthesises the evidence about the persuasiveness of narrative information on individuals' decision making. Seventeen studies met the review criteria; 41% of studies employed first person narration, 59% third person. Narrative information influenced decision making more than the provision of no additional information and/or statistically based information in approximately a third of the studies (5/17); studies employing first person narratives were twice as likely to find an effect. There was some evidence that narrative information encouraged the use of heuristic rather than systematic processing. However, there was little consistency in the methods employed and the narratives' content to provide evidence on why narratives affect the decision process and outcome, whether narratives facilitate or bias decision making, and/ or whether narratives affect the quality of the decision being made. Until evidence is provided on why and how narratives influence decision making, the use of narratives in interventions to facilitate medical decision making should be treated cautiously.
Patient Education and Counseling
Objective: To investigate people's views of using 'general facts' and information about other people's 'personal experiences' for health-related decision-making. Methods: Sixty-two people, who between them had experience of five different focal health issues, participated in 12 focus groups and 9 interviews. Exploration of uses of the two types of information was supported by discussion of illustrative excerpts. Results: There was less discussion of 'general facts'; participants thought it obvious that good decisions required these. Participants reported having used 'personal experiences' information to: recognise decisions that needed consideration; identify options; appraise options and make selections (including by developing and reflecting on their reasoning about possible choices); and support coping strategies. Their inclination to use 'personal experiences' information was apparently moderated by assessments of personal relevance, the motives of information providers and the 'balance' of experiences presented. Conclusion: People can use 'personal experiences' information in various ways to support their decisionmaking, and exercise some discrimination as they do. Practice implications: 'Personal experiences' information may help people in a number of ways in relation to decision-making. However, 'personal experiences' information does not replace the need for 'general facts' and care should be taken when it is used in resources for patients.
Patient Experience Journal
Consumers choosing a health-care provider have access to diverse information including narratives by patients about their prior experiences. However, little research has examined how narratives might improve or impede the use of information about the quality of providers' performance. This paper describes a conceptual framework for examining mechanisms by which narrative information might influence consumer judgments and decisions about providers. We conducted a conceptual review of risk communication and behavioral decision research. We synthesized the literature to form the foundation of a conceptual framework for assessing how narrative information about provider quality impacts consumer decisions about providers. We identified four key characteristics of narratives (convey emotion; explain logic; provide relational information; and capture naturalistic experience) that may address four consumer needs (avoid surprise and regret; recognize dominant options; motivate to act or not act; and make multi-attribute tradeoff decisions). We also identified three main functions of narratives (provide a simple, powerful cue; imbue quality information with meaning; and stimulate cognition and behavior) in four decision contexts (short-term treatments; external disruptions; chronic illness; problematic experiences). A rigorous research program can be derived from the conceptual framework to generate evidence-based recommendations about whether and how patient narratives might encourage: (1) more reasoned decisions; (2) consistency with a patient's own values/preferences; and (3) engagement with provider quality information. Research results can be used then to develop robust guidance for health communicators reporting diverse and often incommensurate performance metrics.
The Importance Of Integrating Narrative Into Health Care Decision Making
Health affairs (Project Hope), 2016
When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative an...
In recent years, many studies have been conducted on persuasive effects of narratives in a health context. A striking feature of this research area is the diversity of the narratives that are used in the various studies. Narratives that convey a health message differ widely on a large number of dimensions related to the content, form and context. We expect that these characteristics are potential explanatory factors in the effectiveness of the narratives. To provide an overview of the different characteristics of narratives in health effects research and of the persuasive effects that were found, we review 153 experimental studies on health-related narrative persuasion with a focus on the narrative stimuli. The results show that: a) with regard to the content, showing the healthy behavior in a narrative (as opposed to the unhealthy behavior with negative consequences) may be associated with effects on intention. Narratives that contain high emotional content are more often shown to have effects. b) With regard to the form, for print narratives, a first-person perspective is a promising characteristic in light of effectiveness. c) With regard to the context, an overtly persuasive presentation format does not seem to inhibit narrative persuasion. And d) other characteristics, like character similarity or the presentation medium of the narrative, do not seem to be promising characteristics for producing health effects. In addition, fruitful areas for further research can be found in the familiarity of the setting and the way a health message is embedded in the narrative. Because of the diversity of narrative characteristics and effects that were found, continued research effort is warranted on which characteristics lead to effects. The present review provides an overview of the evidence for persuasive narrative characteristics so far.
Objective: To synthesize experimental research on the impact of narrative point of view (POV) on message processing and persuasion outcomes in health promotion. Moderators examined included characteristics of study design, participants, and experimental stimuli. Design and Main Outcome Measures: Random effects model meta-analysis of 16 health promotion experiments, using the metafor package in R. Studies included compared the effects of firstand third-person POV on risk perceptions, attitudes, behavioral intention, identification and transportation. Results: There was no evidence of publication bias. Narratives told in the first-person POV led to higher levels of perceived susceptibility (d = 0.10, 95% CI [0.01, 0.20]) and identification feelings (d = 0.10, 95% CI [0.10, 0.21]) than third-person narratives. The effects of first-person POV narratives were significantly stronger for stories that were written in the past-tense and that depicted the protagonist as being similar to message recipients. Conclusion: Findings support a theoretical model of POV impact in which a first-person perspective increases identification with the character, thereby leading to higher levels of perceived susceptibility to the health threat. The practical implication is that the effectiveness of narrative persuasion is enhanced by using the first-person point of view, emphasizing target audience-protagonist similarities, and telling stories in the past tense. The strategic use of narratives in health promotion and disease prevention messaging has become increasingly common in health communication research and practice. 'Narrative' refers to any cohesive and coherent story with an identifiable structure that provides information about scenes, characters, and conflicts (Bilandzic & Busselle, 2013; Hinyard & Kreuter, 2007). In public health communications, narratives usually take the form of stories, testimonials, and anecdotes. A health narrative most often depicts an individual experiencing a health threat and then delivers a lesson derived from the story about adopting healthier behaviors and lifestyles. Research has shown
Health Stories: Examining the Role of Emotions in the Narrative Persuasion Process (PhD-proposal)
For several decades researchers aim to discover which techniques are effective in changing peoples’ health beliefs and behaviors. Since a few years narratives have attracted the interest of different scholars, since they seem to be a promising strategy in the context of health communication. Now that there is evidence that the use of narratives can be an effective strategy to change health attitudes and behaviors, at least one important question remains: which exact cognitive or affective mechanisms provide narrative persuasion? Although researchers agree that the extent to which a person is transported into a story and identifies with the main characters is essential, the role emotions play in this process remains unclear. Are emotions a result of transportation and identification or is it the other way around? Furthermore, which emotions are produced by health narratives and do different emotions produce different persuasive effects? And do several motivations to seek for narratives evoke other emotions? The main objective of this proposal is to provide an answer to these questions.
Providing information about options in patient decision aids
BMC Medical Informatics and Decision Making, 2013
Background: Legal, ethical, and psychological arguments indicate that patients need to receive information about their health situations before their care decisions are made. Patient decision aids (PtDAs) are designed to help patients make decisions; therefore, they should provide information that results in patients understanding their health situation. We reviewed studies that assessed the impact of PtDAs on patient knowledge and on their feeling of being uninformed. Methods: Our data sources were a published Cochrane Collaboration review that included randomized controlled trials (RCTs) published before 2010 and a systematic review we conducted of RCTs published in 2010. We included trials that compared 1) PtDAs to usual care, and 2) PtDAs with simple information to PtDAs with more detailed information. Outcomes included patients' knowledge and their feeling of being uninformed. Data were analyzed quantitatively and qualitatively. Meta-analyses of similar studies estimated the size of differences. Results: Thirty-nine RCTs compared a PtDA to usual care and all showed higher knowledge scores for patients in the PtDA groups; a meta-analysis estimated the advantage at 14 (of 100) points. Sixteen (of 39) studies used the Feeling Uninformed subscale; a meta-analysis estimated a reduction of 7 (of 100) points in the PtDA group over usual care. Twenty-one studies compared simple-to more-detailed information in PtDAs. There was a small overall advantage for more detailed information on knowledge scores; a meta-analysis estimated the advantage at 5 (of 100) points. Only one study found higher mean knowledge scores for simpler information. Nine (of 21) studies reported using the Feeling Uninformed subscale and a meta-analysis suggested a reduction of 3 (of 100) points for the more-detailed PtDAs over those with simpler information. Only one study found that simpler information resulted in patients feeling more informed.
Journal of Health Communication, 2020
Audiovisual and narrative information are often used in online decision aids. However, few studies have tested whether these strategies are more effective compared to other types of information. We tested the effect of these strategies on satisfaction with the information, recall and informed decision-making in a 2 (Modality: audiovisual vs. textual) x 2 (Narration style: narrative vs. factual) experimental design. Data was collected in an online experiment among 262 analogue cancer patients. Since most cancer patients are older people, we also assessed if the effectiveness of these strategies differs depending on the patient's age. Data was analyzed using Structural Equation Modeling. Findings showed audiovisual modality had a positive effect on satisfaction. Moreover, audiovisual modality improved recall, both directly and indirectly via satisfaction, which subsequently resulted in better-informed decision-making. Narratives resulted in more satisfaction, but not better recall or informed decision-making. These effects were found in patients of all ages.