Language and Societies

ANT/LIN 5320 at Wayne State University

Physicians’ use of persuasive techniques as a verbal tool to increase colorectal cancer screening adherence

Physicians’ use of persuasive techniques as a verbal tool to increase colorectal cancer screening adherence

Lauren Schleicher

In the twentieth century healthcare providers have shifted their focus from acute patient care to prevention and health maintenance counseling. Consequently, physicians have been increasingly required to be better health communicators as the demand for health promotion continues to grow. And yet, patients, as medical consumers, often choose not to comply with their doctor’s expert medical advice, resulting in low screening adherence rates. Screening rates for colorectal cancer, by means of colonoscopy, have been markedly low across the United States. Colorectal cancer is the third most prevalent cancer in America affecting 130,200 men and women annually and is the second leading cause of cancer deaths nationally. However, when the cancer is discovered early and treated there is a 90% survival rate.

Given the devastating nature of this disease, this paper attempts to understand how physicians communicate to their patients the importance of screening tests like colonoscopy with a focus specifically on physician’s use of persuasive techniques, a type of social influence intended to strengthen, build or even alter patients’ beliefs or concerns. The ultimate goal was to determine whether or not persuasion was an effective tool for increasing colonoscopy screening adherence.

Thirty-nine primary care transcripts were conveniently sampled and coded. The Siminoff Communication Content and Affect Program, or SCCAP, was chosen as the model for this investigation because this model is specifically designed to capture social influence in healthcare settings. Using the SCCAP model to code for persuasion types, two patient populations were identified-19 cases where persuasion was present and 20 cases where persuasion was not present. Cases where the use of persuasion was unnecessary were omitted; meaning, the patient had either been screened prior to their visit, or verbally consented to be screened without hesitation. This study found that patients who were not subjected to a persuasive attempt by their physician were more likely to adhere to a colonoscopy recommendation. 89% of patients who were not persuaded were adherent, whereas, only 68% of patients who were persuaded were adherent. The results of this study seem to suggest that persuasive techniques are at best irrelevant, and at worst, possibly detrimental to colorectal cancer screening adherence.

It is not surprising that physicians would try to persuade their patients to undergo screening given the devastating nature of colorectal cancer and how preventable this disease has become with the advent of technologies like colonoscopy. Persuasion is a predictable response to perceived reluctance. But, unfortunately, screening rates remain too low and physicians need to be equipped with more effective communication skills as persuasion does not seem to consistently have the desired effect.

April 16, 2011 - Posted by | abstract


  1. Rebecca Skloot’s ‘The Immortal Life Of Henrietta Lacks’ is a fantastic journalistic account of the history of the HELA cells, and race and class disparities in health care. At one point in the book a doctor explains to a poorly educated Black woman that her dead mother’s cells have been used to test the effects of nuclear radiation on human tissues. This woman thinks the doctor has just blown up her mother–that her mother actually felt pain. My point is that they are speaking two different languages. Persuasion may be an effective communication style for doctors communicating with certain patients–from your research it looks like it may have worked 68% of the time. It would be interesting to know what those patients in the 68% group look like. Does SCCAP code patients by race, class, education, religion, etc.?

    Comment by Elizabeth Engles | April 18, 2011 | Reply

  2. Thanks for you question. SCCAP doesn’t look at demographic information, but I did (with the exception of religion).

    There were nine patients included in this study who declined to be screened following their visit with the primary care physician. Of those nine, seven were white and only two were African American. I theorize in my paper that this may be the result of high levels of racial concordance between doctors and patients at Henry Ford Hospital in Detroit. 88% of patients in this sample were seen by racially concordant physicians, which seems to have a positive impact on screening adherence regardless of persuasion usage.

    Overall, physician and patient gender had very little impact on the use of persuasion and the effectiveness of persuasive techniques. There was, however, a positive association noted for female patients and MD gender concordance. Female patients were 55% more likely to be screened after seeing a female physician, whereas, male patients were only 34% more likely to be screened when there was MD gender concordance.

    Socio-economic data and education level did have an impact on persuasion usage by physicians and how effective their persuasive attempts were at increasing screening adherence. When persuasion was used on patients with a high school diploma or GED they were less likely to be screened. When persuasion was used on this population they were 75% more likely to be non-adherent. Patients with more than a four year degree were more likely to be persuaded by their physician and these persuasive attempts are more likely to have the desired effect. Of the six patients that had more than a four year college degree only one was not persuaded by their doctor. Based on these results it appears that doctors are more likely to attempt to persuade patients who have more than a four year degree and when they attempt to persuade these patients they are generally more successful.

    When persuasion was used on patients who earned less than $20,000 per year they were 25% less likely to be screened. Based on this sample, there appears to be a negative correlation between persuasion and low-income earners. Patients who earned $20,000-$39,999 were more likely to not be screened overall whether persuasion was present or not. Patients who earned $40,000-$79,999 were more likely to be screened overall whether persuasion was present or not. Patients who earned $80,000 dollars or more a year were more likely to be persuaded and persuasion attempts were more likely to be successful

    Again, than you for your interest. I hope the above information, which is included in my paper, answered your question.

    Comment by | April 18, 2011 | Reply

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