Framing and Personalizing Informed Consent to Prevent Negative Expectations: An Experimental Pilot Study

Objective: Informing patients about medical treatments and their possible side effects is ethically and legally obligatory but may trigger negative expectations and nocebo-related side effects. This pilot study aims to investigate the effect of different informed consent procedures on treatment expectations for adjuvant breast cancer treatments (Study 1: endocrine therapy; Study 2: chemotherapy). Method: Using an experimental 2-factorial design, healthy women were informed about endocrine therapy (n = 60) or chemotherapy (n = 64) within a hypothetical scenario. Information was framed with or without treatment benefit information and delivered in a personalized or standardized interaction. Primary outcomes were necessity-concern beliefs about the treatment and side-effect expectations, secondary outcomes were decisional conflicts. Results: In Study 1, side-effect expectations (eta(2)(p) = .08) and decisional conflicts (eta(2)(p) = .07) were lower when framed treatment information was given. Providing personalized information resulted in more functional necessity-concern beliefs (eta(2)(p) = .06) and lower decisional conflicts (eta(2)(p) = .07). Personalizing and framing of information resulted in more functional necessity-concern beliefs (eta(2)(p) = .10) and lower decisional conflicts. In Study 2, necessity-concern beliefs were more functional with framing (eta(2)(p) = .06). Participants in the personalized groups reported lower decisional conflicts (eta(2)(p) = .06). No differences in side-effect expectations were revealed. Conclusions: This is the first study to provide evidence for optimized treatment expectations through altered informed consent strategies. The results emphasize that framing and personalizing informed consent can positively influence treatment expectations and reduce decisional conflicts. However, generalizations are impaired by the study's pilot character. The potential to prevent nocebo responses in clinical practice should be analyzed.