How physicians describe outcomes to HCV therapy: Prevalence and meaning of "cure" during provider-patient in-office discussions of HCV

Abstract

BACKGROUND: How physicians convey information about hepatitis C virus (HCV) impacts patients' perceptions of treatment outcomes and informed therapy decisions. However, HCV patients reported difficulties communicating with their physicians in a recent study. Another study showed that 45% of patients did not understand projected response rates conveyed by providers, and patients with unfavorable projected treatment outcomes were more likely to lack understanding. GOALS: This article analyzes naturally occurring patient-provider interactions to evaluate physicians' use of the word cure, and framing of HCV response as optimistic, pessimistic, or neutral, to suggest possible reasons why patients with unfavorable projected sustained virologic response rates might perceive their odds as more favorable than they are. STUDY: Gastroenterologists, allied health professionals, and HCV patients were video and audio-recorded during regular scheduled visits. Recordings were transcribed and analyzed using validated sociolinguistic techniques. RESULTS: Sixty-three percent of physicians used the word cure in 38% of visits involving response discussions. Cure most frequently meant absolute cure and occurred more commonly in visits conducted before therapy initiation, and with patients having favorable genotypes. Physicians hedged the meaning of cure in 29% of visits. Moreover, 69.5% of response-related utterances were framed optimistically. CONCLUSIONS: HCV dialogs are characterized by the prevalence of cure and optimistic framing. These positive language attributes could potentially contribute to the misunderstanding regarding the projected response rates. During treatment outcome discussions, the physicians should attempt to (1) operate using the same definition of the therapy outcome as the patient, (2) balance medically accurate information with patient comprehension, and (3) consider possible consequences of discussing treatment options on the basis of message framing. © 2008 Lippincott Williams & Wilkins, Inc.