Background:
Although critics have expressed concerns about cancer center advertising, analyses of the content of these advertisements are lacking.
Objective:
To characterize the informational and emotional content of direct-to-consumer cancer center advertisements.
Design:
Content analysis.
Setting:
Top U.S. consumer magazines (n = 269) and television networks (n = 44) in 2012.
Measurements:
Types of clinical services promoted; information provided about clinical services, including risks, benefits, costs, and insurance availability; use of emotional advertising appeals; and use of patient testimonials were assessed. Two investigators independently coded advertisements using ATLAS.ti, and κ values ranged from 0.77 to 1.00.
Results:
A total of 102 cancer centers placed 409 unique clinical advertisements in top media markets in 2012. Advertisements promoted treatments (88%) more often than screening (18%) or supportive services (13%). Benefits of advertised therapies were described more often than risks (27% vs. 2%) but were rarely quantified (2%). Few advertisements mentioned coverage or costs (5%), and none mentioned specific insurance plans. Emotional appeals were frequent (85%), evoking hope for survival (61%), describing cancer treatment as a fight or battle (41%), and inducing fear (30%). Nearly one half of advertisements included patient testimonials, which were usually focused on survival, rarely included disclaimers (15%), and never described the results that a typical patient may expect.
Limitation:
Internet advertisements were not included.
Conclusion:
Clinical advertisements by cancer centers frequently promote cancer therapy with emotional appeals that evoke hope and fear while rarely providing information about risks, benefits, costs, or insurance availability. Further work is needed to understand how these advertisements influence patient understanding and expectations of benefit from cancer treatments.
Primary Funding Source:
National Institutes of Health.
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Author, Article, and Disclosure Information
From the University of Pittsburgh Graduate School of Public Health, Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute, Palliative and Supportive Institute, University of Pittsburgh Medical Center, and Clinical Research, Investigation and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania, and Indiana University School of Medicine, South Bend, Indiana.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Acknowledgment: The authors thank Sara Einhorn for her assistance with coding and Greer Tiver for her assistance with ATLAS.ti and codebook development.
Grant Support: By the National Center for Advancing Translational Sciences of the National Institutes of Health (award KL2TR000146). Dr. Schenker was also supported by the Junior Scholar Award from the University of Pittsburgh Department of Medicine.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0500.
Reproducible Research Statement: Study protocol: Available from Dr. Schenker (e-mail, [email protected]
Corresponding Author: Yael Schenker, MD, MAS, Division of General Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213; e-mail, [email protected]
Current Author Addresses: Ms. Vater: Indiana University School of Medicine, East Angela Boulevard, South Bend, IN 46617.
Dr. Donohue: University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, A613, Pittsburgh, PA 15261.
Dr. Arnold: Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, University of Pittsburgh Medical Center Montefiore Hospital, Suite 932W, 200 Lothrop Street, Pittsburgh, PA 15213.
Dr. White: Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, Scaife Hall, Room 608, HPU010604, Pittsburgh, PA 15261.
Dr. Chu: Division of Hematology-Oncology, University of Pittsburgh Medical Center Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA 15232.
Dr. Schenker: Division of General Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213.
Author Contributions: Conception and design: L.B. Vater, R. Arnold, D.B. White, E. Chu, Y. Schenker.
Analysis and interpretation of the data: L.B. Vater, J.M. Donohue, R. Arnold, D.B. White, E. Chu, Y. Schenker.
Drafting of the article: L.B. Vater, E. Chu, Y. Schenker.
Critical revision of the article for important intellectual content: L.B. Vater, J.M. Donohue, R. Arnold, D.B. White, Y. Schenker.
Final approval of the article: L.B. Vater, J.M. Donohue, D.B. White, E. Chu, Y. Schenker.
Provision of study materials or patients: Y. Schenker.
Obtaining of funding: Y. Schenker.
Administrative, technical, or logistic support: R. Arnold, Y. Schenker.
Collection and assembly of data: L.B. Vater, Y. Schenker.
This article was published online first at www.annals.org on 27 May 2014.
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