Using patients’ narratives to promote colorectal cancer screening: a review and an experimental investigation

Background: Patients’ narratives have been suggested as a promising way to promote health, including colorectal cancer (CRC) screening, but evidence about their effectiveness is mixed. Aims: a) to provide a comprehensive review of the literature, and b) to investigate the effect of narratives conveying different emotions in promoting CRC screening. Methods: a) Systematic review of studies investigating narratives in CRC screening; b) Between-participant design comparing: usual leaflet (no-narrative condition), usual leaflet and one of three narratives: the character is waiting for the result (control narrative), had a negative result (reassurance-based narrative) or had a positive result and was successfully treated for early-stage cancer (anticipated regret-based narrative). Participants: 145 participants aged 45-65, with no CRC personal history (approved by local Ethic Committee). Measures: intention to undergo CRC screening, knowledge, risk perception, and informed choice. Analyses: Logistic regressions and ANOVAs. Findings: a) Thirteen studies were included; Most were quantitative, USA-based, recent (last 5 years). The content of the narratives varied widely. b) The reassurance-based narrative yielded to the highest intention to undergo screening (85.7% vs. no-narrative condition 51.4%, OR=5.684, p=.003; vs. regret-based condition 59.5%, OR=4.091, p=.017; vs. control narrative 66.7%, OR=3.000, p=.066). The four conditions did not differ in knowledge, risk perception, and proportion of informed choices (p>.578). Discussion: Our findings suggest that not all narratives are alike in promoting CRC screening, and that FOBT may be better promoted by reassurance-based narratives. Moreover, adding narratives to currently used information material did not affect knowledge, risk perception and the proportion of informed choices.