Metaphor Use and Health Literacy: A Pilot Study of Strategies to Explain Randomization in Cancer Clinical Trials

Abstract

Patients often have difficulty understanding what randomization is and why it is needed in Phase III clinical trials. Physicians commonly report using metaphorical language to convey the role of chance in being assignment to treatment; however, the effectiveness of this strategy as an educational tool has not been explored. Guided by W. McGuire's (1972) information-processing model, the purpose of this pilot study was to explore effects of metaphors to explain randomization on message acceptance and behavioral intention to participate in a Phase III clinical trial among a sample of low-income, rural women (N = 64). Participants were randomly assigned to watch a video that explained randomization using 1 of 3 message strategies: a low-literacy definition, standard metaphor (i.e., flip of a coin), or a culturally derived metaphor (i.e., sex of a baby). The influence of attention on behavioral intentions to participate in clinical trials was partially moderated by message strategy. Under conditions of low attention, participants in the culturally derived metaphor condition experienced significantly higher intentions to participate in clinical trials compared with participants in the standard metaphor condition. However, as attention increased, differences in intentions among the conditions diminished. Having a positive affective response to the randomization message was a strong, positive predictor of behavioral intentions to participate in clinical trials. The authors discuss the theoretical and practical implications of these findings.

Power of an Effective Clinical Conversation: Improving Accrual Onto Clinical Trials

“…Although metaphors can be a helpful tool, they can also be problematic when greater sensitivity should be paid to different social and cultural contexts. 15 For example, the frequently used "flip of the coin" metaphor was clearly disliked by women and older members of the public in a 2002 study. 16 An unintended effect of its use was that some patients perceived this term as trivializing their situation.…”

Community Engagement as a Process and an Outcome of Developing Culturally Grounded Health Communication Interventions: An Example from the DECIDE Project

“…The idea for the current study originated while the principal investigator (PI) was conducting another research project on social influence in the healthcare provider-relationship in rural Appalachian areas of Pennsylvania (Krieger et al 2011;Krieger 2013). Various stakeholders in the community (e.g., community coalition members, cancer patients, healthcare providers) suggested a broader focus on improving both clinical and family communication about cancer treatment decisions, especially clinical trials.…”

“…To address this inequity, CT information must be adapted to rural populations to reflect the unique culture of the region (Krieger et al 2011;Krieger 2013;Colby et al 2013;Ndiaye et al 2008). Using a culturally sensitive and centered approach in the development of health interventions has been suggested in response to criticism that public health interventions have failed to sufficiently address health disparities (Dutta 2007).…”

Dancing Around Infertility: The Use of Metaphors in a Complex Medical Situation

“…The current study also shows how our culture and experiences guide and therefore limit the metaphors we use (Krieger, 2013;Krieger, Parrott, & Nussbaum, 2011). For example, job was used to emphasize pressure, stress, and performance.…”