How the doc should (not) talk: when breaking bad news with negations influences patients' immediate responses and medical adherence intentions

Abstract

Objective: We investigate the role of specific formulations in a doctor's bad news delivery. We focus on the effects of negations and message framing on patients' immediate responses to the message and the doctor, and long-term consequences including quality of life and medical adherence intentions.

Methods: Two lab experiments with 2 (language use: negations vs. affirmations)×2 (framing: positive vs. negative) between-subjects designs. After reading a transcription (experiment 1) or seeing a film clip (experiment 2), participants rated their evaluation of the message and the doctor, expected quality of life, and medical adherence intentions.

Results: Positively framed bad news with negations score more negative on these dependent variables than positively framed affirmations (both experiments). For negatively framed negations, these results are reversed (experiment 2). Furthermore, the evaluations of the message (experiment 1) and the doctor (both experiments) mediate the interaction of framing and language use on medical adherence intentions.

Conclusions: Small linguistic variations (i.e., negations vs. affirmations) in breaking bad news can have a significant impact on the health message, doctor evaluation and medical adherence intentions.

Practice implications: Doctors should refrain from using negations to break positively framed news, and employ negations when breaking negatively framed news.