Marketing versus evidence: Which helps patients decide?

Gary Schwitzer summarized a study a couple of weeks ago.  Perhaps it should be required reading by Dr. Stifelman and others at NYU Langone Medical Center.

Meantime, a paper published in the journal Surgical Innovation – “The impact of marketing language on patient preference for robot-assisted surgery” – describes a little experiment.  38 patients were asked to make two treatment decisions between robotic surgery and conventional laparoscopic surgery. One time, the robotic procedure was described as a “state-of-the-art, innovative new technology” – the marketing frame.  The other time it was termed a “promising new technology, which has not been used extensively and with research regarding its safety and effectiveness ongoing” – the evidence-based frame.  The methodology used is more thoroughly explained in the paper.

The results?  No surprise:

• With the marketing frame, 20 of 38 chose the robotic approach.  Of those, 12 switched to conventional laparoscopy when the evidence-based frame was used.
• 17 of 18 who chose conventional laparoscopy in the marketing frame made the same choice when the evidence-based frame was used.
• Among the 13 patients who made discordant treatment decisions under opposing frames, the robotic approach was significantly more likely to be chosen under the marketing frame.

The researchers conclude:

“Our findings suggest that marketing strategies unrelated to the presentation of potential risks and benefits of a surgical technology may influence patient preference…This effect may be contributing to rising trends in the number of robot-assisted surgery procedures performed.”

They point out that “the evidence in favor of robot-assisted surgery is controversial” and “Robotic surgical systems typically cost between $1 million and $2.5 million, with $100, 000 to $200,000 in annual maintenance fees.”

Take home message:  “When patients are confronted with decisions regarding their care, they have a number of resources available to them.  Some of these resources misrepresent evidence relating to risk and benefits.”