Optimizing presentation of expected treatment outcomes
Authors: Jeremy K. Bray, Matthew C. Johnson, E.J. Masicampo, Steven R. Feldman
Journal: Journal of the American Academy of Dermatology (2019)

To the Editor: Patients struggle with starting medications for various reasons, including inadequately understanding the direct personal benefits of treatment.1Storm A. Andersen S.E. Benfeldt E. Serup J. One in 3 prescriptions are never redeemed: primary nonadherence in an outpatient clinic.J Am Acad Dermatol. 2008; 59: 27-33Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 2Thorneloe R.J. Bundy C. Griffiths C.E.M. Ashcroft D.M. Cordingley L. Adherence to medication in patients with psoriasis: a systematic literature review.Br J Dermatol. 2013; 168: 20-31Crossref PubMed Scopus (110) Google Scholar Common marketing techniques in advertising emphasize attractive imagery, rather than informative data, to convince consumers to buy their product.3Bülbül C. Menon G. The power of emotional appeals in advertising.J Advert Res. 2010; 50: 169 LP-180Crossref Scopus (34) Google Scholar, 4Panda T. Panda T.K. Mishra K. Does emotional appeal work in advertising? The rationality behind using emotional appeal to create favorable brand attitude.IUP J Brand Manage. 2013; 10: 7-23Google Scholar We hypothesized that physicians could use similar techniques to enhance treatment adherence by creating an emotional connection between the patient and the medication. We compared willingness to take treatment after being presented with a personally relevant treatment goal versus after clinical data (or both) in people with acne, atopic dermatitis, and psoriasis. After Wake Forest School of Medicine Institutional Review Board approval (#IRB00057322), a randomized online survey study was performed in eligible individuals with a working knowledge of English, aged ≥18 years, and a self-reported diagnosis of acne, atopic dermatitis, or psoriasis. There were 305 individuals recruited through Amazon Mechanical Turk (Seattle, WA).5Buhrmester M. Kwang T. Gosling S.D. Amazon's Mechanical Turk: a new source of inexpensive, yet high-quality, data?.Perspect Psychol Sci. 2011; 6: 3-5Crossref PubMed Scopus (6693) Google Scholar Participants received a fact sheet and completed the survey in Qualtrics (Provo, UT) and were compensated $0.05 for completing the survey. Participants were randomized in a 1:1:1 double-blind, placebo-controlled ratio to assess their willingness to take treatment for acne, atopic dermatitis, or psoriasis if presented with one of the following: (1) clinical data, (2) a personally relevant treatment goal, or (3) both clinical data and a personally relevant treatment goal (Table I). Demographic information was also collected. Outcome measures were recorded as willingness to take treatment on a 10-point Likert scale. Groups were compared using one-way analysis of variance and 2-group t tests.Table ISurvey questions for presentation of treatment for acne, atopic dermatitis, and psoriasis∗Responses were recorded on a 1 (not willing) to 10 (completely willing) scale.Question 1 (clinical data)Your doctor presents a medication to you by saying the following, “This treatment has a 60% chance of nearly completely alleviating your skin disease (acne, eczema, psoriasis).”How willing would you be, on a 1 (not willing) to 10 (completely willing) scale, to take this medication?Question 2 (treatment goal)Your doctor presents a medication to you by saying the following, “This treatment is most likely going to clear your skin disease (acne, eczema, psoriasis) to the point you are comfortable enough to wear your favorite swimsuit to the pool this month.”How willing would you be, on a 1 (not willing) to 10 (completely willing) scale, to take this medication?Question 3 (clinical data with a treatment goal)Your doctor presents a medication to you by saying the following, “This treatment has a 60% chance of nearly completely alleviating your skin disease (acne, eczema, psoriasis), and there is a similar chance it would help you feel comfortable enough to wear your favorite swimsuit to the pool this month.”How willing would you be, on a 1 (not willing) to 10 (completely willing) scale, to take this medication?∗ Responses were recorded on a 1 (not willing) to 10 (completely willing) scale. Open table in a new tab Compared with respondents presented with only clinical data (mean, 7.4; SD, 4.1), participants presented with a personally relevant treatment goal reported greater willingness to take treatment (mean, 8.5; SD, 3.1; P = .0001); participants presented with both a personally relevant treatment goal and clinical data also reported greater willingness to take treatment (mean, 8.1; SD, 2.9; P = .02) compared with clinical data alone. More participants were nearly completely or completely willing to take treatment (score of 9 or 10) in the personally relevant treatment goal group (60%) than in the clinical data group (30%) or the clinical data with a personally relevant treatment goal group (44%, P = .005) (Fig 1). Presenting a medication with a personally relevant treatment goal increases reported willingness to take treatment for patients with acne, atopic dermatitis, or psoriasis. This might be because real-life concrete treatment goals provide patients with a sense of a direct personal benefit, which they can better appreciate than facts and statistics alone. Thus, providing patients with a personally relevant treatment goal may be a simple and cost-effective technique to improve patient outcomes. Presenting a personally relevant treatment goal alongside clinical data did not have as great of an effect as presenting a treatment goal alone. We cannot, however, conclude that we should not give patients clinical data. The potential benefit of improving adherence must be balanced with a patient's right to be informed of all pertinent information.