One word can change a patient’s decision about treatment

The words physicians use and how they present risk significantly impacts whether actinic keratosis patients decide to have treatment or not, according to research published in JAMA Dermatology.

Physicians’ presentations of medical information has long been shown to be pivotal in the treatments and care patients choose.

“Even the modification of one word in a statement about medical management can alter the patient’s treatment decision significantly,” according to the authors.

While this research into physician-patient communication has been done in areas other than skin disease, the authors write this seems to be the first such study on skin conditions. Looking at doctor-patient discussions about actinic keratosis is especially important, they write, because it’s a complicated condition to manage.

Actinic keratosis is common in adults and can progress to squamous cell carcinoma at a rate estimated to be 0.1 to 0.6 percent per lesion, per year. Despite the relatively small risk of cancer progression, actinic keratoses can go away on their own - and often do. In one study cited, more than a quarter of actinic keratoses detected at baseline were not there a year later.

In this study, conducted from June 1 to July 31, 2016, researchers prospectively surveyed participants recruited online and at the Penn State Milton S. Hershey Dermatology Clinic, Hershey, Penn. Those responding did not necessarily have a history of skin cancer or actinic keratosis.

The study reflects completed surveys from 539 participants, who were asked about their demographic information, as well as how they would react to various presentations of information about actinic keratosis. The presentations on the skin condition ranged from “Actinic keratoses are spots of sun damage. About 0.5 percent of actinic keratoses turn into a non-life-threatening skin cancer and 25 percent go away without treatment,” to precancerous.

In each case, the presentation of information changed. In some descriptions, the statement used different versions of the same statistic. For example, “About 99.5 percent of actinic keratoses will not turn into skin cancer….”

The researchers found participants were most likely to prefer treatment when they were told that actinic keratoses are precancers. The choice of treatment was lowest when the statement was worded more optimistically, indicating that actinic keratosis could go away without treatment and does not turn into a life-threatening skin cancer.

The findings also suggested that first half of these survey question were more impactful on participants’ treatment decision making than the second half. 

Demographics, such as age, sex and previous skin cancer diagnosis, did not notably impact decision-making. This suggests physicians’ wording of information about actinic keratosis has a greater impact on patient decision making about treatment than does the person’s age, sex, history of actinic keratosis or of skin cancer.

Clinicians should be cognizant of the influence they have in actinic keratosis decision making and carefully consider how they phrase patient information, according to the authors.

References

Berry K, Butt M, Kirby JS. “Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis,” JAMA Dermatology. May 1, 2017. DOI: 10.1001/jamadermatol.2016.5245.