In a world where health care is defined by consumerism, positive health care campaigns like “Redefining Possible. The profound and unstoppable power of yes” and “Making Cancer History” have been directly targeting consumers in an effort to thrive in an increasingly competitive marketplace. Health care reform is partly responsible for the increase in hospital advertising, as customers now have a greater agency to choose where they seek care. But how common is this practice of positive health care marketing and how does it affect patients?
A 2014 systematic content analysis of cancer center advertisements appearing in television and magazines found that 85 percent of the 409 advertisements included in the study resorted to emotional appeals by using language that evoked hope or fear. These emotional appeals were more commonly (85 percent) related to survival or potential for cure. In contrast, only 43 percent of emotional appeals highlighted patient comfort, quality of life and patient-centered care, which are especially important for patients undergoing aggressive treatment. Furthermore, of the advertisements that used testimonials (44 percent), only 15 percent indicated that not all patients experience the same positive outcome thus promoting unrealistic expectations regarding treatment benefit.
In a recent blog post by Sam Harnett, we were introduced to Lori Wallace, a mother who has been living with metastatic breast cancer for the past seven years. Wallace objects to positive health care marketing campaigns because they promote false hope and “for a patient like her, they are a slap in the face.” While Wallace’s attitude might be shared by a multitude of patients diagnosed with cancer, research about the public’s views towards hospital advertising has been extremely limited.
A 2014 questionnaire-based cross-sectional study conducted in 10 metropolitan areas of Tennessee found that participants did not perceive hospital advertisement as more deceptive than other forms of advertising. Overall, respondents agreed that “the public looks for and favors advertising as a means of obtaining information about hospital services,” a finding that was consistent with results of a similar study conducted in Arkansas in 1985. However, comparison of these two studies show a declining trend on the percentage of participants who would like to see more advertising by hospitals, 39.7 percent of respondents in the 1985 study compared to 16.8 percent of the 2010 respondents. Results from this study suggest that additional research is needed to understand a hospital’s market and public’s perception on health care advertising by hospitals.
In addition to assessing how positive health care advertising impacts patient decision-making, research can help guide policy regarding advertising by hospitals. Unlike the drug advertisement industry, which has to follow guidelines set forth by the Food and Drug Administration and the Federal Trade Commission, direct-to-consumer hospital advertising is not regulated by any federal agency.
If product claim ads are required to provide balanced information about the benefits and risks of a prescription drug, shouldn’t hospitals also be required to provide balanced information about the services they provide? Some critics of hospital advertising propose that, instead of using emotional appeal to highlight the few extraordinary cases that achieved a cure, hospitals should provide unbiased information about the success rate and the risks associated with the procedures they advertise. For ads that rely on testimonials, this may mean including disclaimers indicating that not all patients experience the same positive outcomes.
While these direct-to-consumer advertising practices among cancer centers may promote unrealistic expectations regarding treatment benefit, they also provide patients with multiple options to choose from and, in some cases, may even encourage patients to take action. A diagnosis of cancer is an extremely frightening and sometimes paralyzing experience for patients and their loved ones. In the middle of so many questions and unknowns, a message of hope can have a very powerful impact on a patient’s decision to seek multiple professional opinions and become informed about treatment options.
The role of advertising is to attract patients to treatment centers. Once a patient makes it to one of these treatment centers, it is the role of the treating physician to equip patients with information about treatment options, risks, and expected outcomes. For this reason, arming physicians with information to either support or discredit claims made in ads, rather than undertaking the daunting endeavor of creating and enforcing strict guidelines for health care marketing, might pose a more realistic and actionable alternative.
Physicians have the challenging task of presenting treatment options and their potential benefits and risks in a way that empowers patients without providing false hope. In a world where technology has made it possible for patients to have access to a limitless amount of information at their fingertips, physicians are pressed to be completely candid regarding a grim prognosis, often presenting possible outcomes from best-case to worst-case scenario. In many cases, physicians are pushed to provide a life-expectancy estimate.
For patients dealing with a terminal disease, a time-tied prognosis not only represents a death sentence but it also dictates many of the decisions patients make regarding personal and financial matters.
However, time and time again, studies have demonstrated that physicians are not great are predicting life expectancy. This means that many terminally ill patients will outlive their physician’s prognosis and many will die sooner than expected. For those who die sooner than predicted, loved ones might be left unprepared to deal with a precipitous loss. On the other hand, patients who are given “false hopelessness” and are prognosticated to live for only a few months, may live in despair for years, believing that this month may be the last one. Therefore, presenting a clear-cut prognosis, even when it aligns with the patient’s wishes, has the potential to cause more harm than good. For patients that are diagnosed with a terminal illness, having frequent conversations with their physicians about their changing prognosis can give them a more realistic picture of what to expect and allow them to have evolving goals for their care, from receiving aggressive treatment to improve survival to focusing on symptom management and spiritual health.
Elina Serrano is a medical student.
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