Key findings from individual studies
| Study | Primary outcome | Primary outcome by terminology | Primary outcome statistical significance* | Other outcomes | |
| Medicalised term | Non-medicalised term | ||||
| Copp 2017 (n=181)19 | Intention to have an ultrasound |
Polycystic ovary syndrome (n=90) mean=6.62 (on a 10-point Likert scale where 1=Definitely will not to 10=Definitely will) |
Hormonal imbalance(n=91) mean=5.76 (on a 10-point Likert scale where 1=Definitely will not to 10=Definitely will) | Primary outcome significant (p=0.033). Women who received ‘PCOS’ term in the scenario had significantly higher intentions to have an ultrasound than those who received the ‘hormonal imbalance’ term F(1, 176)=4.63, p=0.033. After women received information on overdiagnosis, both intention and perceived severity decreased, regardless of the terminology of the condition (both p<0.001). | Self-esteem: Women’s self-esteem was significantly lower for those given the term ‘PCOS’ than those given the term ‘hormonal imbalance’ F(1, 176)=4.74, p=0.031. Perception of severity: Women who were given the term ‘PCOS’ had significantly higher perceived severity about the condition than those given the term ‘hormonal imbalance’ F(1, 176)=5.64, p=0.019. Negative effect, credibility of doctor and interest in a second opinion: No difference between terms (all p>0.05). |
| McCaffery 2015 (n=269)15 | Treatment preference |
Preinvasive breast cancer cells (n=128) 40% (51) prefer treatment 60% (77) prefer watchful waiting Change in terminology 41% (52) prefer treatment 59% (76) prefer watchful waiting |
Abnormal cells (n=141) 33% (47) prefer treatment 67% (94) prefer watchful waiting Change in terminology 45% (63) prefer treatment 55% (78) prefer watchful waiting | Primary outcomes not significant; however, change in terminology shows a significant difference. There were no significant differences in treatment between arm A (women who were given the term ‘abnormal cells’ first and then were given the term ‘preinvasive cancer cells’) and arm B (women who were given the term ‘preinvasive cancer cells’ first and then were given the term ‘abnormal cells’) with 33% and 41% of women respectively favouring treatment, p=0.23. In arm A, 18% of women changed their preference to treatment while only 6% changed to watchful waiting (p=0.008). No significant treatment preferences were observed in arm B (9% vs 8%, p>0.99). | Level of concern: There was no significant difference between arms with 49% and 44% of women indicating they would be extremely concerned p=0.600. However, when the alternative term was used, women in arm A (‘abnormal cells’ terminology first and then ‘preinvasive cancer cells’ terminology) were significantly more likely to report increased concern than women in arm B (‘preinvasive cancer cells’ terminology first and then ‘abnormal cells’ terminology), 67% vs 52%, p=0.001. |
| Omer 2013 (n=394)14 | Treatment preference |
Cancer 47% (186) surgery 20% (79) medication 33% (129) active surveillance |
Lesion 34% (136) surgery 18% (70) medication 48% (188) active surveillance Abnormal cells 31% (124) surgery 21% (82) medication 48% (188) active surveillance | Primary outcome significant (p≤0.001) When DCIS was described as a ‘non-invasive cancer’ 53% (208 of 394) of participants preferred non-surgical options, whereas 66% (258 of 394) chose non-surgical options when it was described as ‘breast lesion’ and 69% (270 of 394) chose non-surgical options when it was described as ‘abnormal cells’ (p≤0.001). | |
| Scherer 2013 (n=175)18 | Parents’ interest in medicating their infant (three items pooled and mean reported) |
GERD term (n=87) mean=2.51 (on a 6-point Likert scale where 0=No, definitely not to 5=Yes, definitely) |
No label (n=88) mean=2.04 (on a 6-point Likert scale where 0=No, definitely not to 5=Yes, definitely) | Primary outcome significant (p<0.01) Parents who received the ‘GERD’ term in the scenario were more interested in medication than parents who did not receive that term, F(1, 165)=6.95, p<0.01. Parents not given the ‘GERD’ term were interested in medication only when they were not given information about medication effectiveness; therefore, they were allowed to assume that the medications are effective F(1, 165)=4.52, p<0.05. | Perception of illness severity: Findings were not influenced by the presence or absence of the ‘GERD’ term (all p>0.12). Appreciation of medication offer: Parents were least appreciative of medication when they were told that there medication was ineffective and were not given the ‘GERD’ term F(1, 165)=7.16, p<0.01 |
| Scherer, 2015 (n=158)**25 | Parents’ decision to give their child antibiotics |
Pink-eye (n=82) mean=2.43 (on a 6-point Likert scale where 0=No, definitely not to 5=Yes, definitely) |
Eye infection (n=76) mean=2.32 (on a 6-point Likert scale where 0=No, definitely not to 5=Yes, definitely) | Primary outcome not significant; however, when adjusted for information of medication effectiveness, outcomes are significant. Parents were less willing to give their child antibiotics when symptoms were referred to as an 'eye infection' information about antibiotic ineffectiveness significantly reduced F(1, 62)=14.67, p≤0.001. By contrast, when parents were told that the symptoms were ‘pink eye' interest in antibiotics was not reduced by information about antibiotic ineffectiveness F(1, 74)=0.93 p=0.33. | Beliefs about contagiousness: Parents who received the ‘pink-eye’ term thought that the symptoms were significantly more contagious than parents who received the ‘eye infection’ term, F(1, 137)=11.21, p=0.001. Feelings towards sending child to day care: Parents who received the ‘pink-eye’ term were less likely to believe that their child would be allowed to go to child care than parents who received the ‘eye infection’ term, F(1, 141)=9.70, p=0.002. |
| Azam 2010 (n=100)20 | Expected treatment |
Broken bone 3% heals on own 39% sling 56% cast 2% operation Greenstick fracture 47% heals on own 25% sling 22% cast 6% operation Fracture 14% heals on own 44% sling 36% cast 6% operation |
Crack in the bone 24% heals on own 57% sling 13% cast 6% operation Hairline fracture 45% heals on own 29% sling 26% cast 0% operation | t-tests which demonstrate significance: Crack versus break=p<0.0001 Crack versus hairline fracture=p<0.0001 Crack versus greenstick fracture=p<0.0001 Break versus hairline fracture=p=0.0001 Break versus greenstick fracture=p<0.0001 Fracture versus hairline fracture=p<0.0001 Fracture versus greenstick fracture=p<0.0001 | Patients perspectives of severity: (mean/median score, no SDs given): 3.28/3 for ‘a crack in the bone’ 3.58/3 for ‘a hairline fracture’ 4.95/5 for ‘a fracture’ 5.28/5 for ‘a greenstick fracture’ 6.64/7 for ‘a broken bone’ |
*As reported by original study authors.
**One case from total sample missing.
DCIS, ductal carcinoma in situ; GERD, gastro-oesophageal reflux disease; PCOS, polycystic ovary syndrome.