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.