Choose Your Words Wisely: The Impact of Message Framing on Patients' Responses to Treatment Advice

Other people's words can have a powerful influence on how we interpret our environment, what we expect and experience, what we value, how we feel, what we choose, and how we behave. Placebo (and nocebo) effects are a dramatic example of this. The way in which healthcare professionals discuss, describe, and inform patients about the characteristic effects of a given disease and it prevention, diagnosis and treatment influence patients' feelings and expectations which in turn affects their psychobiological responses to, and subjective experiences and outcomes of the disease and its treatment effects. The effect of clinicians' words on patients' responses to treatments and procedures, both active and inert or sham is nothing less than incredible. The way in which information about treatment effects is delivered to patients can even reverse the clinically proven effects of an active treatment, or increase the adverse effects of it. In this chapter, we begin by presenting the data on the impact of message framing on affect and expectations of health care in experimental situations followed by the evidence that indicates how various patient, disease and clinician related factors modify framing effects in the clinic. Finally we discuss how framing effects affect clinical practice. They can be leveraged to enhance placebo effects and minimize nocebo effects. They can provide strategies to assist shared-decision making in the face of complex uncertainty. Going forward, automation of health care and artificial intelligence may change the delivery of health care but patients will continue to be humans seeking health gains while avoiding health losses and how the information is presented will always be susceptible to framing effects.