Use of Persuasive Language in Communication of Risk during Prostate Cancer Treatment Consultations
Authors: Naser-Tavakolian Aurash , Gale Rebecca , Luu Michael , Masterson John M. , Venkataramana Abhishek , Khodyakov Dmitry , Anger Jennifer T. , Posadas Edwin , Sandler Howard , Freedland Stephen J. , Spiegel Brennan , Daskivich Timothy J. 
Published: February 2024

Background Physician treatment preference may influence how risks are communicated in prostate cancer consultations. We identified persuasive language used when describing cancer prognosis, life expectancy, and side effects in relation to a physician’s recommendation for aggressive (surgery/radiation) or nonaggressive (active surveillance/watchful waiting) treatment. Methods A qualitative analysis was performed on transcribed treatment consultations of 40 men with low- and intermediate-risk prostate cancer across 10 multidisciplinary providers. Quotes pertaining to cancer prognosis, life expectancy, and side effects were randomized. Coders predicted physician treatment recommendations from isolated blinded quotes. Testing characteristics of consensus predictions against the physician’s treatment recommendation were reported. Coders then identified persuasive strategies favoring aggressive/nonaggressive treatment for each quote. Frequencies of persuasive strategies favoring aggressive/nonaggressive treatment were reported. Logistic regression quantified associations between persuasive strategies and physician treatment recommendations. Results A total of 496 quotes about cancer prognosis ( n = 127), life expectancy ( n = 51), and side effects ( n = 318) were identified. The accuracy of predicting treatment recommendation based on individual quotes containing persuasive language ( n = 256/496, 52%) was 91%. When favoring aggressive treatment, persuasive language downplayed side effect risks and amplified cancer risk (recurrence, progression, or mortality). Significant predictors ( P < 0.05) of aggressive treatment recommendation included favorable side effect interpretation, downplaying side effects, and long time horizon for cancer risk due to longevity. When favoring nonaggressive treatment, persuasive language amplified side effect risks and downplayed cancer risk. Significant predictors of nonaggressive treatment recommendation included unfavorable side effect interpretation, favorable interpretation of cancer risk, and short time horizon for cancer risk due to longevity. Conclusions Physicians use persuasive language favoring their preferred treatment, regardless of whether their recommendation is appropriate. Implications Clinicians should quantify risk so patients can judge potential harm without solely relying on persuasive language. Highlights Physicians use persuasive language favoring their treatment recommendation when communicating risks of prostate cancer treatment, which may influence a patient’s treatment choice. Coders predicted physician treatment recommendations based on isolated, randomized quotes about cancer prognosis, life expectancy, and side effects with 91% accuracy. Qualitative analysis revealed that when favoring nonaggressive treatment, physicians used persuasive language that amplified side effect risks and downplayed cancer risk. When favoring aggressive treatment, physicians did the opposite. Providers should be cognizant of using persuasive strategies and aim to provide quantified assessments of risk that are jointly interpreted with the patient so that patients can make evidence-based conclusions regarding risks without solely relying on persuasive language.