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Health communication - how language use influences medical outcomes

Prof. Enny Das, Professor in Communication and Information Studies

Health communication is one of the central CLS research themes, with a special focus on the design of both textual and interpersonal patient-directed communication. Specifically, CLS researchers aim to unravel how language use influences medical outcomes and via which psychological processes.

Minimizing risks
“In the beginning, we were primarily interested in the question of how to effectively inform cancer patients about the potential cognitive side effects of chemotherapy without aggravating these effects,” says Professor Enny Das. A major challenge is to provide patients with accurate information about the therapy while minimizing the risk of inducing nocebo responses, which occur when patients’ (unconscious) expectations or emotions negatively influence the actual impact of a treatment. For example, patients might experience cognitive impairment such as memory loss in reaction to the information that this is a possible side effect of chemotherapy, rather than as a reaction to the therapy itself. Such effects are called Adverse Information Effects.

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Across several studies among different patient groups (e.g., MS; breast cancer; gastrointestinal cancer), the researchers discovered that Adverse Information Effects are dependent on the degree to which patients perceive their illness as stigmatized, that is: their belief that other people have prejudices about them because of their illness. Patients vulnerable to stereotypes and with high stigma awareness, are more likely to experience cognitive impairment after being informed about cognitive side effects than patients less vulnerable to stereotypes. The researchers aim to examine how exactly, and under which conditions, this stigma awareness influences the relation between communication and medical outcomes. Their studies will provide answers to fundamental questions about the psychological processes underlying the effectiveness of health communication and help inform the design of optimal health interventions.

Successful intervention
The quest to understand the psychological processes underlying Adverse Information Effects has resulted in numerous successes over the past years. Das, “One of our biggest achievements over the past years is that we have been able to conduct a longitudinal study among breast cancer patients. These patients took part in a multiphase study from the moment they were diagnosed until after they had been treated with chemotherapy. By following and testing them over a period of 10.5 months, we were able to carefully assess the development of cognitive side effects over time, and the role of patient information therein.” The results show that Adverse Information Effects can persist over a long period of time and that a self-affirmation intervention attenuates their impact. In a self-affirmation intervention, communication is strategically employed to have patients affirm their positive traits. Das, “The fact that self-affirmation reduces Adverse Information Effects points to the importance of identity processes in the medical domain. Studying how these processes are influenced by patient-directed communication is therefore of major scientific and societal relevance.”

Enny Das

Unexplored territory
The results obtained over the past years have encouraged the researchers to further strengthen their collaboration with hospitals and medical centres and to broaden the scope of their research domain. “One of our ambitions for the near future is to enter unexplored territory by conducting large-scaled examinations of the characteristics of the communication between doctors and patients on medically unexplained symptoms. We have just started two different projects in which we analyse a large collection of videotaped interactions between doctors and patients that present medically explained versus unexplained symptoms,” says Das. The richness of these natural data will allow the researchers to closely examine subtle verbal and non-verbal variations on a large scale. Das, “Our goal is to connect these variations to medical outcomes. The results will be of relevance to both researchers and medical professionals; the latter can use the findings to shape and optimize their daily encounters with patients.”