Article Text

Download PDFPDF

Words do matter: a systematic review on how different terminology for the same condition influences management preferences
  1. Brooke Nickel1,
  2. Alexandra Barratt1,
  3. Tessa Copp1,
  4. Ray Moynihan1,2,
  5. Kirsten McCaffery1
  1. 1 Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
  1. Correspondence to Ms. Brooke Nickel; brooke.nickel{at}


Objectives Changing terminology for low-risk, screen-detected conditions has now been recommended by several expert groups in order to prevent overdiagnosis and reduce the associated harms of overtreatment. However, the effect of terminology on patients’ preferences for management is not well understood. This review aims to synthesise existing studies on terminology and its impact on management decision making.

Design Systematic review.

Methods Studies were included that compared two or more terminologies to describe the same condition and measured the effect on treatment or management preferences and/or choices. Studies were identified via database searches from inception to April 2017, and from reference lists. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias of included studies.

Results Of the 1399 titles identified, seven studies, all of which included hypothetical scenarios, met the inclusion criteria. Six studies were quantitative and one was qualitative. Six of the studies were of high quality. Studies covered a diverse range of conditions: ductal carcinoma in situ (3), gastro-oesophageal reflux disease (1), conjunctivitis (1), polycystic ovary syndrome (1) and a bony fracture (1). The terminologies compared in each study varied based on the condition assessed. Based on a narrative synthesis of the data, when a more medicalised or precise term was used to describe the condition, it generally resulted in a shift in preference towards more invasive managements, and/or higher ratings of anxiety and perceived severity of the condition.

Conclusions Different terminology given for the same condition influenced management preferences and psychological outcomes in a consistent pattern in these studies. Changing the terminology may be one strategy to reduce patient preferences for aggressive management responses to low-risk conditions.

Trial registration number PROSPERO: CRD42016035643.

  • terminology
  • management preferences
  • treatment preferences
  • decision making
  • overtreatment

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors BN, AB and KM contributed to study concept and design. BN conducted the systematic literature search. BN and TC evaluated the eligibility of studies, performed the study quality assessment, extracted the data and conducted the evidence synthesis. BN, AB, TC, RM and KM interpreted the findings. BN drafted the manuscript and all authors critically reviewed and approved the manuscript.

  • Funding This paper was written with support from the Wiser Healthcare CRE grant from the National Health and Medical Research Council (NHMRC) #1104136. BN was supported by the Sydney Catalyst Research Scholar Award. KM was supported by an NHMRC fellowship (1029241). The funders had no role in the design or conduct of the study; in the collection, analysis and interpretation of the data; or in the preparation or approval of the manuscript.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; AB and RM are co-chairs of the steering group for the Preventing Overdiagnosis scientific conferences; no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.