Purpose: To examine the effect of narrative content and emotional valence on decisions about treatments for early stage breast cancer.
Method: 263 women were asked to imagine they had been diagnosed with early stage breast cancer, needed to choose between two surgical treatments (lumpectomy with radiation versus mastectomy), and were provided with one of five computer-administered sets of information about these two surgeries. In the control condition, participants viewed a table containing descriptions of the surgeries, the length of recovery time, need for radiation, and other decision relevant facts. In the four remaining conditions, participants viewed the same table plus four videotaped narratives, which varied in structure by a 2 (narrative content: process or experience) x 2 (emotional valence: positive or mixed) factorial design. Process narratives discussed the factors a woman considered when making her surgical decision, whereas experience narratives described what it was like to go through the surgery itself. Two narrative conditions used only positive narratives while the other two contained equal numbers of positive and negative narratives. After reviewing all materials, participants were asked to make a hypothetical treatment decision and complete several measures of reactions to the narratives and confidence in the decision process. Participants also completed the Subjective Numeracy Scale, the Need for Cognition scale, the Decision Quality Index and the Decision Conflict Scale.
Result: Providing narratives to participants had no effect on treatment decisions; approximately two-thirds of participants in all groups preferred lumpectomy and radiation. However, participants in the narrative conditions reported somewhat less uncertainty than participants in the control condition, F (1, 261) = 3.66, p = .057. Experience narratives were better than process narratives at increasing decisional confidence, feelings of preparedness, and the ability to imagine what it would be like to have a lumpectomy Fs (1, 205) >4.65, ps < .05. The mix of positive and negative narratives was perceived to be more emotional, t (206) = -2.78, p = .006, and produced a greater connection to the breast cancer survivors, t (206) = -1.96, p = .05, than positive narratives alone.
Conclusion: While providing narratives did not change participants’ treatment intentions, narratives appeared to lower decisional uncertainty, and a mixture of positive and negative experience narratives may be most helpful to decision makers.