Strategies of persuasion in offers to participate in cancer clinical trials I: Topic placement and topic framing

Abstract

Clinical trials are the gold standard in medical research evaluating new treatments in cancer care; however, in the United States, too few patients enroll in trials, especially patients from minority groups. Offering patients the option of a clinical trial is an ethically-charged communicative event for oncologists. One particularly vexed ethical issue is the use of persuasion in trial offers. Based on a corpus of 22 oncology encounters with Caucasian-American (n = 11) and African-American (n = 11) patients, this discourse analysis describes oncologists' use of two persuasive strategies related to the linguistic structure of trial offers: topic placement and topic framing. Findings are presented in total and by patient race, and discussed in terms of whether these strategies may constitute ethical or unethical persuasion, particularly with respect to the ethical issue of undue influence and the social issue of underrepresentation of minorities in cancer clinical trials.

Persuasive Appeals in Genetic Biobank Recruitment Campaigns: Social and Ethical Implications

“…To be influential, the campaign messages should be understandable (explicit, simple, comprehensive, comprehensible) and come from credible sources, such as celebrities, public officials, or experts ( Rice & Atkin, 2012 ). However, certain campaign messages may cause ethical problems ( Barton et al, 2014 ; Snell & Tarkkala, 2021 ) as these may involve manipulative messages that interfere with people's autonomy (e.g., provocations, omissions) or privacy, and inadvertently harm the well-being of individuals and groups ( Guttman, 2017 ). While persuasion can be defined as influencing individuals through offering reasons, manipulation means influencing by reasons disguised as good, but known to be faulty or bad ( Rossi & Yudell, 2012 ).…”

“…Recruitment campaign messages may contain various persuasive appeals – rhetorical devices used to influence individuals to act in a particular way i.e., answers to the question ‘Why should something be done?’. Appeals in health-related recruitment campaigns have been studied in the context of blood donation, clinical trials, and direct-to-consumer genetic test marketing ( Barton et al, 2014 ; Hunter et al, 2012 ; Lee et al, 2020 ; Schaper & Schicktanz, 2018 ; Wang, 2018 ). In these contexts, individuals are often persuaded by arguing that the act of donation or using genetic testing services will benefit themselves (by offering them personal health information that empowers them to change their health behaviour) and others (by contributing to common good).…”

Communication research ethics and some paradoxes in qualitative inquiry

“…[ Witchalls 2006: 25] Notions of informed consent, risk, uncertainty, altruism are alluded to in the above segment -which comprise the key aspects of biomedical research ethics. With regard to recruitment for randomized controlled trials, there is a communicative tension in researchers being optimally informative while maximizing enrolment of participants (for discursive accounts, see Roberts 2002; Barton and Eggly 2009;Ness et al 2009;Wade et al 2009;Barton et al 2014aBarton et al , 2014bShipman et al 2014). Another dimension to clinical trials is what is referred to as 'therapeutic misconception' (Appelbaum et al 1982), which refers to the belief on the part of research subjects that researchers, like healthcare practitioners, are committed to safeguarding the best interests of the participants.…”