Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Many approaches used by physicians during the medical encounter have the potential to affect patient adherence to recommendations for preventive health services. Persuasion is one approach defined as a principal method of inducing compliance (Chayes et al. 1995). However, more recent findings suggest that the use of persuasion may be detrimental (Barton et al. 2009). We evaluate the frequency with which physicians use persuasion when recommending colorectal cancer (CRC) screening, patients’ perceptions of physician use of persuasion, and how each impacts adherence to physician-recommended CRC screening.
Method: Direct observation of periodic health exams (N=415) in 2007-2009 among primary care patients aged 50-80 due for CRC screening. Qualitative content analyses were used to code office visit audio-recordings for physician use of persuasion (Siminoff et al. 2011). A post-visit survey collected patient perceptions of the use of persuasion by their physician (Burgoon et al. 1984). Post-visit CRC screening use was compiled via claims data. Generalized estimating equations were used to evaluate the association of coded and perceived persuasion with each other as well as with CRC screening.
Result: Content analyses revealed that persuasion occurred in 73% of the visits. Among visits with observer-coded persuasion, most frequently used was argument (45%), followed by argument and refutation combined (21%). Patient perceptions of physician persuasion were significantly (p<0.05) associated with coded physician use of persuasion. Regardless of whether persuasion was observer-coded or patient-reported, neither was associated with subsequent CRC screening use.
Conclusion: While persuasion is frequently used when physicians recommend CRC screening and patients acknowledge when their physician attempts to persuade them, our findings indicate that persuasion is not associated with screening use. Further research is needed to better understand patient perceptions of physician persuasion and better ways to communicate recommendations for potentially life-saving preventive services.