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Article published In:
Argumentation and Patient Centered Care
Edited by Francisca Snoeck Henkemans, Roosmaryn Pilgram and Nanon Labrie
[Journal of Argumentation in Context 7:2] 2018
► pp. 209–227

Implicit persuasion in medical decision-making

An overview of implicitly steering behaviors and a reflection on explanations for the use of implicitly steering behaviors

| VU Medical Center
| Leiden University Medical Center
| Leiden University Medical Center

If the arguments to support a recommendation are partly implicit, the free exchange of ideas between discussants can be hampered. In this paper, we will focus on the potential pitfall for clinicians when informing patients about treatment options: implicit persuasion. We will describe a set of implicitly persuasive behaviors observed during decision-making consultations, and reflect on how these behaviors could undermine efforts to stimulate patient participation in decision-making. We will also reflect on possible explanations for why clinicians exhibit such behaviors.

Keywords: implicit persuasion, unbalanced information provision, preference-sensitive decisions, shared decision making
Article outline
  • 1.Information provision is a key component of the decision-making process
    • 1.1Implicit persuasion: Definition and its prevalence in clinical practice
    • 1.2Is implicit persuasion inherently wrong?
  • 2.Implicitly persuasive behaviors
    • 2.1Clinical context
    • 2.2Category 1: Unbalanced presentation of benefits and side-effects
      • 2.2.1Minimal number of side-effects presented
      • 2.2.2Emphasizing the benefits or downplaying the side-effects of treatment
      • 2.2.3Minimizing the treatment’s impact
      • 2.2.4Emphasizing the ability to control the side-effects of the treatment
      • 2.2.5Presenting the side-effects after the final treatment decision has been made
    • 2.3Category 2: Presenting treatment recommendations as authorized decisions
      • 2.3.1Presenting treatment as an authorized decision
    • 2.4Category 3: Creating the illusion of decision control
      • 2.4.1From mild to serious treatment – a gradual decision
      • 2.4.2Having one treatment implicitly tag along with another
      • 2.4.3The illusory power to decide
    • 2.5Category 4: Persuading patients using (clinical) experience
      • 2.5.1Making assertions about the patients' personality
      • 2.5.2Deterring vs. encouraging: using others as examples
      • 2.5.3Giving the impression that undergoing or foregoing treatment is quite unusual
  • 3.Reflection on potential explanations for the use of implicit persuasion
    • 3.1Attempts to prevent information overload
    • 3.2Lack of awareness of the gap in knowledge between doctors and patients
    • 3.3Lack of awareness of own preferences
    • 3.4Overcorrecting patients’ perception of treatment burden
    • 3.5Overestimation of patient’s assertiveness
  • 4.Conclusions
  • References
  • Key publications
Published online: 12 October 2018
DOI logo
https://doi.org/10.1075/jaic.18032.eng
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Key publications

Engelhardt, EG, A. H. Pieterse, A. van der Hout, H. J. de Haes, J. R. Kroep, P. Quarles van Ufford-Mannesse, J. E. Portielje, E. M. Smets and A. M. Stiggelbout
2016 “Use of implicit persuasion in decision making about adjuvant cancer treatment: A potential barrier to shared decision making”. European Journal of Cancer 661:55–66. DOI logoGoogle Scholar
Stiggelbout, A. M., A. H. Pieterse and J. C. De Haes
2015 “Shared decision making: Concepts, evidence, and practice”. Patient Education and Counseling 981:1172–1179. DOI logoGoogle Scholar
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2020. Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems. Frontiers in Psychiatry 11 DOI logo
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