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Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for
Mathijs R de Veer1, Merel Hermus1, Charlène J van der Zijden2
1Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Introduction:
Few studies have been conducted into how physicians use steering behaviour that may persuade patients to choose for a particular treatment, let alone to participate in a randomised trial. The aim of this study is to assess if and how surgeons use steering behaviour in their information provision to patients in their choice to participate in a stepped-wedge cluster randomised trial investigating an organ sparing treatment in (curable) oesophageal cancer (SANO trial).
Materials And Methods:
A qualitative study was performed. Thematic content analysis was applied to audiotaped and transcribed consultations of twenty patients with eight different oncological surgeons in three Dutch hospitals. Patients could choose to participate in a clinical trial in which an experimental treatment of 'active surveillance' (AS) was offered. Patients who did not want to participate underwent standard treatment: neoadjuvant chemoradiotherapy followed by oesophagectomy.
Results:
Surgeons used various techniques to steer patients towards one of the two options, mostly towards AS. The presentation of pros and cons of treatment options was imbalanced: positive framing of AS was used to steer patients towards the choice for AS, and negative framing of AS to make the choice for surgery more attractive. Further, steering language, i.e. suggestive language, was used, and surgeons seemed to use the timing of the introduction of the different treatment options, to put more focus on one of the treatment options.
Conclusion:
Awareness of steering behaviour can help to guide physicians in more objectively informing patients on participation in future clinical trials.
Insights
Surgeons subtly steered patients towards active surveillance (AS) in a clinical trial by framing treatment options positively and using suggestive language. Awareness of this steering behavior is crucial for objective patient information in future trials.
Area of Science:
- Oncology
- Medical Ethics
- Clinical Trial Design
Background:
- Limited research exists on physician steering behavior influencing patient treatment choices, especially regarding clinical trial participation.
- Understanding these persuasive techniques is vital for ethical patient recruitment in research.
Purpose of the Study:
- To investigate how surgeons employ steering behavior during information provision to patients considering participation in the SANO trial.
- The SANO trial is a stepped-wedge cluster randomized trial for curable esophageal cancer, comparing organ-sparing treatment with standard care.
Main Methods:
- A qualitative study utilizing thematic content analysis.
- Analysis of audiotaped and transcribed consultations between 20 patients and 8 oncological surgeons across 3 Dutch hospitals.
Main Results:
- Surgeons predominantly used steering techniques to guide patients towards active surveillance (AS).
- Techniques included imbalanced presentation of pros and cons (positive framing for AS, negative for surgery), suggestive language, and strategic timing of treatment option introductions.
Conclusions:
- Physicians utilize various steering behaviors, including framing and suggestive language, to influence patient choices in clinical trials.
- Increased awareness of these persuasive tactics can promote more objective patient information and ethical recruitment for future research.
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