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Metaphors Help Patients Understand Clinical Trials

Metaphors are a powerful tool for communicating important and complex information. Metaphors can help researchers communicate with patients about clinical trials, according to new research by Dr. Janice Krieger, director of the Stem Translational Communication Center at the University of Florida College of Journalism and Communications. A patient’s ability to understand medical information, however, may influence which metaphor works best.

By dividing up patients into groups that receive different types of treatments and comparing outcomes, RCTs help doctors develop empirical evidence as to which treatments are more effective. But getting cancer patients – some of whom are overwhelmed with the news of their diagnosis and others who struggle to understand medical information – to enroll in RCTs can be a struggle.

Partially, this is because RCTs are highly technical and difficult to explain to audiences unfamiliar with research. But proper understanding of the RCT process is critical not just for encouraging patients to enroll, but also making sure that they know enough to consent to the procedure.

Dr. Krieger and her colleagues at the University of Florida and Texas Tech University, examined how medical researchers can use plain language (devoid of jargon) and metaphors to better inform cancer patients about RCTs. Their experiment involved 500 patients recently diagnosed with cancer and four different messages about the risks and benefits of RCTs.

The first set of patients were simply told that cancer patients sometimes participate in RCTs and were not given additional background information. The second group saw a brief description about RCTs with the technical jargon stripped away.

The third group and fourth groups read a metaphor about RCTs in addition to the jargon-free description. The third group of patients saw RCTs described as a bit like gambling (a popular metaphor), in that just like there is an equal chance of a coin landing on heads or tails, there is an equal chance that they would be assigned to a given treatment. The last group of patients saw a metaphor about the sex of a baby, i.e. just like a woman has an equal chance of giving birth to a boy or girl, the patient has an equal chance of receiving a specific treatment.

After reading the description of RCTs, the patients were asked a series of questions regarding their understanding of medical information in general and their understanding of RCTs. They were also asked how anxious they would feel about enrolling in an RCT and whether they themselves would themselves enroll in an RCT if they were to get cancer again.

The results of the study suggest that the addition of metaphors can help patients understand what an RCT is and how it works. However, different groups of patients responded to the gambling and the baby metaphors differently. Patients who reported having more trouble understanding medical information benefitted more from the baby metaphor, while patients who were more at ease with medical information benefitted more from the gambling metaphor.

“Taken together, these results show that metaphors can be more useful than plain language strategies for overcoming challenges associated with health literacy,” the researchers write. “Importantly, however, not all metaphors are equally effective across the health literacy spectrum, and messages should be customized to the needs of the patient.”


This research was published in volume 9, issue 3 of the Journal of the National Cancer Institute. It is one of the few, if not only, health communication research articles published by JNCI. The full article is available for free through the Journal.

Posted: December 16, 2016