Patient decisions on dysplastic nevus management vary based on information framing

How clinicians frame the information presented to patients about dysplastic nevi diagnosis and management affects patient decision-making on surgical options, according to researchers in Journal of the American Academy of Dermatology.

“It is crucial for clinicians to understand the influence of the words used to discuss DN with patients,” Chelsey Straight, MD, of the department of dermatology at Penn State Health Milton S. Hershey Medical Center, and colleagues wrote. “Also, more data about the risk of malignant transformation is needed to inform patients’ and clinicians’ discussions of DN management.”

A patient survey investigated the influence of framing patients’ decisions on surgical management of dysplastic nevi (DN). The survey was made up of demographic items and scenarios with a description of DN and the risk for cutaneous melanoma. In each scenario, participants ranked their likelihood of choosing surgical excision.

Out of 658 surveys included in the analysis, the scenarios that presented DN as “pre-cancer” or “pre-melanoma” had the greater proportion of participants selecting treatment, at 90.2% and 92%, respectively.

Negatively framed items in all scenarios had a higher proportion of being selected for treatment, according to researchers. Negative framing showed significant odds of treatment (P < .0001; 4.00, 3.25-4.91). Malignancy rate was also significantly associated with treatment.

Moreover, sex, prior DN diagnosis and prior skin cancer diagnosis were not significantly associated with treatment.

The researchers recommended using both positive and negative framing in conversations with patients to highlight the risk or lack of risk instead of using phrases such as “pre-melanoma” or “pre-cancer.”

The use of hypothetical scenarios in the survey may not represent actual patient decision-making, according to researchers. Also, participants’ understanding of scenarios was not assessed in this study.

“Recognition of the impact of information framing is crucial for providers, especially to ensure balanced delivery of health-related information as patients participate in their health care,” Straight and colleagues wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.