New Research Helps Doctors Deliver Bad News to Patients

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When doctors are forced to deliver negative and life-altering information to patients, they should deliver the news in a way that patients do not expect to hear it, according to new research from Columbia Business School. Providing challenging information in a way that patients do not expect to hear it – or counter to a patient’s “motivational focus” – will disrupt a patient’s expected response, which in turn improves the patient’s ability to process critical information and make more informed and effective decisions regarding their treatment.

“The doctor-patient relationship is among the most important to an individual’s well-being,” said E. Tory Higgins, a professor of management at Columbia Business School.  “However, when it comes to delivering bad news, a patient’s emotional reaction can often blind them to absorbing pertinent information, such as the efficacy of the treatment options and medical recommendations. Our findings can help physicians deliver counsel to patients in a way that will help those patients make more informed decisions.”

The research, “Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice,” is based on a motivational theory by Professor Higgins.  The theory says that some people, when making decisions, focus on what they could achieve (promotion focus), while other people focus on what losses they could avoid (prevention focus). If information does not match an individuals’ motivational focus, they feel that something is “wrong.” That in turn lowers their confidence in their initial judgments and facilitates more thoughtful information processing because when someone is confident in their thinking they don’t want to change their opinion and consider other options.

The researchers offer this example: a patient is diagnosed with terminal cancer but has a negative attitude toward hospice care. The doctor observes that the patient has a “prevention focus,” and thus is emotionally prepared to hear that hospice will help prevent losses.  If the doctor talks about hospice care’s ability to prevent pain and prevent burdening their family, that will play into patients’ existing mentality of preventing losses and confirm their negative perception of hospice care.

Instead, in order for the patient to have the best chance of objectively hearing and understanding the doctor’s recommendation, the doctor should highlight ways hospice can help the patient attain a better state of well-being, rather than ways hospice can prevent negatives things happening.  In this regard, the doctor could highlight how hospice can improve quality of life and help a patient gain meaningful time with loved ones.

“Individuals attitudes and choices are influenced by many factors and can be affected by decision-making biases; such as strong fears or negative experiences in the past,” said Ilona Fridman, a PhD student at Columbia Business School and co-author of the study. “In our research, we developed a tool that can help patients and physicians better deal with making decisions, specifically, when patients have to choose among options that provoke negative emotional reactions.”

Research In-depth

Through a series of five studies, the authors evaluated the changes in participants’ attitudes toward hospice care or treatment options like chemotherapy after receiving a hypothetical cancer diagnosis. Researchers concluded that patients were more likely to respond more positively to an unpleasant or frightening option if they were presented with advice in a way that was opposite to their usual motivational focus (achieving gains vs. avoiding losses).  This approach helped patients think more thoroughly about their options and increased the likelihood that they would select a frightening but beneficial option.

The research was conducted by Fridman and Higgins, with Karen A. Scherr from the Fuqua School of Business at Duke University, and Paul A. Glare from the University of Sydney. The hypothetical scenarios and choices that were used were validated by clinical oncologists and administered online to participants in the United States.

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