Framing the Clinical Encounter: Shared Decision-Making, Mammography Screening, and Decision Satisfaction

Abstract

The study examines whether physicians’ framing of clinical interactions is related to patient shared decision-making (SDM) satisfaction when using a clinical decision support tool (CDST) concerning mammographic screening. To answer this question, we combined (a) system log data from a CDST, (b) content coding of the physicians’ message framing while using the CDST, and (c) a post-visit patient survey to assess SDM satisfaction concerning screening mammography. Results suggest that two types of message frames — consequence frames and numerical frames — moderated the relationship of the CDST on SDM satisfaction. When the CDST displayed low risk of breast cancer for a patient, physicians were able to improve the cognitive aspects of SDM satisfaction by framing the consequences of mammography screening in positive terms. However, when the physician delivered the numerical information in relative, rather than absolute terms, the patient’s SDM satisfaction was reduced. Our study advances previous message framing effect research in health communication from experimental settings to clinical encounters. It also discusses the importance of delivering risk-congruent frames in clinical settings.

Acknowledgments

We thank Jordan Sallis who helped edit this manuscript. We also like to thank the editors and reviewers of Journal of Health Communication for their helpful comments.

Notes

¹ The level of breast density is confirmed to be an independent factor that influences risk of breast cancer (Schrager & Burnside, 2019).

² More information about the mechanism of tailored evaluation could be retrieved from https://www.healthdecision.org/tool#/tool/mammo. The estimated prediction from the tool is based on a competing risk model using the 2000 to 2010 SEER data for breast cancer incidence and 2010 vital statistics for competing mortality risk (refer to Tice et al., 2015).

³ The coding frame formula can be summarized as Category Score = $\sum i\in R_j{X}_{ij}$.X is the frame category, $i$ is the paragraph order number in$jth$ transcript.

⁴ The questionnaire for the five dimensions of SDM satisfaction is presented in Appendix.

Additional information

Funding

This work was supported by the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW CTSA grant 1UL1TR002373), grant 9 U54 500 TR000021 from the National Center for Advancing Translational Sciences, grant K24 CA194251 from National Cancer Institute, and the University of Wisconsin Carbone Cancer Center, support grant P30 CA014520.