The Effect of Narrative Information in a Publicly Available Patient Decision Aid for Early-Stage Breast Cancer

Abstract

This study was designed to (1) evaluate the effect of narratives used in a popular, publicly available patient decision aid for early-stage breast cancer on hypothetical treatment decisions and attitudes toward the decision aid and (2) explore the moderating effects of participant numeracy, electronic health literacy and decision-making style. Two hundred women were asked to imagine that they had been diagnosed with early-stage breast cancer and viewed one of two versions of a video decision aid for early-stage breast cancer. The narrative version of the aid included stories from breast cancer survivors; the control version had no patient stories. After viewing the video decision aid, participants made a hypothetical treatment choice between lumpectomy with radiation and mastectomy, answered several questions about their decision, and evaluated the quality of the decision aid. Participants received $100 for completing the study. The two conditions differed in their motivations for the treatment decision and perceptions of the aid's trustworthiness and emotionality but showed no differences in preferences for surgical treatments or evaluations of the decision aid's quality. However, the impact of patient narratives was moderated by numeracy and electronic health literacy. Higher levels of numeracy were associated with decreased decisional confidence and lower ratings of trustworthiness for the decision aid in the narrative video condition but not in the control video condition. In contrast, higher levels of electronic health literacy were associated with increased decisional confidence and greater perceptions of trustworthiness and credibility of the decision aid in the narrative video condition but not the control video condition.

On the Usefulness of Narratives: An Interdisciplinary Review and Theoretical Model

“…the “Katie Couric effect”) or surprisingly benign (e.g. narratives in patient decision aids; [115]). And despite the widespread utilization of narratives in advertising, public health campaigns, and social media, as well as the vast amount of research on the topic in a wide variety of disciplines, until now no one has developed a comprehensive theory about how narratives work.…”

Qualitatively understanding patients' and health professionals' experiences of the BRECONDA breast reconstruction decision aid

“…As these galleries are optional, users can tailor the website to match their information processing style, thus deriving maximum benefit from the decision aid. Many women commended the inclusion of “Other women's stories.” Patient narratives have been shown to encourage greater information searching, and decision aids incorporating narratives have been perceived as more trustworthy, which may lead to greater use of the resource during decision making . The values clarification exercises facilitated women's decision making, and the relaxation segments helped in managing stress during a process that is often fraught with anxiety and uncertainty .…”

The Effect of Patient Narratives on Information Search in a Web-Based Breast Cancer Decision Aid: An Eye-Tracking Study

“…Although several recent studies have explored the role of narratives, there is still little consensus about how patient stories impact decisions about health care [3,15-22]. One likely reason for the discrepant findings is that many of these studies focused on outcomes such as treatment intentions or decisions.…”