CLINICAL QUESTION: Does a pessimistic prognosis alter how patients view their physician?
BACKGROUND: Although terminally ill patients often prefer honest prognostic information, physicians have historically hesitated, largely due to concerns about harming the therapeutic relationship.
STUDY DESIGN: Double-blinded, randomized, clinical trial
SETTING: Outpatient supportive care center in a cancer center in Houston, Texas
SYNOPSIS: In a study of 100 adults with advanced cancer, patients viewed videos of physicians delivering identical information with empathetic tone and posture but differing in optimism. The more optimistic video received higher compassion scores (median 15 versus 23; P <.001), and greater perceived compassion was linked to higher trust, regardless of message type. Though limited by sample size and delivery variability, the findings suggest that message tone impacts patient perception.
BOTTOM LINE: Even with empathy and body language held constant, optimistic messages lead patients to perceive physicians as more compassionate.
CITATION: Tanco K, et al. Patient perception of physician compassion after a more optimistic vs a less optimistic message: a randomized clinical trial. JAMA Oncol. 2015;1(2):176-83. doi: 10.1001/jamaoncol.2014.297.
Dr. Esakky
Dr. Pallante
Drs. Esakky and Pallante are hospitalists in the division of hospital medicine at The Ohio State University Arthur G. James Cancer Hospital and assistant professors at The Ohio State University College of Medicine, both in Columbus, Ohio.
This is the power of framing bias. Physicians can provide the same information, ethically and statistically, but with two different framing (40% chance of full recovery vs. 60% chance of some disability). If the optimistic framing is percieved favorably by patients, then we should use it more. Nevertheless, we need to be clear that patients understood the other pesimistic part as well and what it means.