December 2010 Archives

Use the Right Metaphor to Get Patients to Enroll in Clinical Trials

Released: 12/20/2010 2:50 PM EST
Source: Ohio State University

Newswise -- The language that doctors use with low-income, rural patients can help determine whether these patients agree to participate in clinical trials testing new cancer treatments, a new study found.

Researchers found that the metaphors doctors used to help explain what happens in such trials played a big role in whether patients would agree to participate.

"Physicians have to communicate about medicine and science to people who often don't have the education and experience to easily understand what they're being told," said Janice Krieger, lead author of the study and assistant professor of communication at Ohio State University [and Penn State Ph.D.].

"Talking to people about experimental designs is difficult, but the way we have been doing it has not been effective and we need to think more carefully about how to do it well."

The stakes are high, Krieger said. Low-income, rural people, like those who participated in the study, are disproportionately affected by cancer. But these groups have been especially difficult to recruit for trials testing new medication or therapies.

"We need to recruit more people from medically underserved populations for cancer trials, and it will help if we can find better ways to explain these trials to patients," she said.

Krieger conducted the study with Roxanne Parrott and Jon Nussbaum of Pennsylvania State University. The results appear online in the Journal of Health Communication and will be published in a future print edition.

The research was designed to help determine the best way to explain Phase III clinical trials to this low-income population. In Phase III trials, patients are randomly assigned to treatment groups for the purpose of testing whether a new medication or therapy outperforms the current standard of care.

In order to participate in such trials, patients must understand and agree to be randomized to their treatment. Randomization means that some patients will receive the new therapy or treatment, while others will receive the current standard of care.

The study involved 64 low-income, rural women over age 50 living in Appalachia. All of them watched a short video produced by the National Cancer Institute describing clinical trials.

They then watched an additional video further explaining randomization, featuring a local doctor. A third of the participants saw a video which explained randomization using the low-literacy definition recommended by the NCI: "Randomization is a method used to ensure the research study is fair. It means that patients are assigned by chance to different treatment groups."

A second group watched the NCI video, and then saw a video featuring a local doctor explaining randomization with a metaphor. The doctor explained that randomization was like "a flip of the coin" determining whether they would be in the treatment or standard-care group. "The chance of getting heads is the same as getting tails," the doctor said.

The third group saw a different video with a local doctor who explained randomization with a metaphor that it was "like determining the sex of a baby. The possibility of a boy is the same as the possibility of a girl."

After viewing the videos, all participants were asked to rate how carefully they listened to the doctors in the video, and were tested on their comprehension of randomization.

They were also asked, if they were diagnosed with cancer, if they would agree to participate in a clinical trial.

Overall, the study found that most participants did not understand randomization very well.

"We focus a lot of attention on helping people comprehend health information, but we found that this intervention didn't change comprehension levels much at all," Krieger said.

"We have to come up with better ways to explain clinical trials and randomization to people."

However, the language used to describe randomization did influence whether participants would agree to take part in a clinical trial, at least under some conditions.

For those people who said they paid close attention to what the doctor said, it didn't matter which video they watched - they were all about equally likely to agree to take part in a clinical trial.

"When people had trouble paying attention, that's when the role of language played a key role in whether they would agree to participate," Krieger said.

For participants who weren't paying close attention, they were more likely to say they would participate in a clinical trial if they heard the metaphor of how randomization is like determining the sex of a baby. They were less likely if randomization was described as like the flip of a coin, or if they just heard the standard definition.

"We believe that when people hear randomization described as a flip of a coin, they think of there being a winner and a loser," Krieger said. "They don't want to take part in a clinical trial if they think they may be risking something."

That's unfortunate, because participating in clinical trials is not a win or lose situation, she said.

"You don't know if one treatment is better than the other. That's why you're doing the study. In any event, even if you're not in the treatment group, you will get the accepted standard of care, which is the best that is currently available," she said.

On the other hand, the "sex of the baby" metaphor might be especially helpful for low-income, rural women like those in this study.

"For women with a cultural background that values family and childbearing, neither outcome - a boy or a girl - would be considered negative," Krieger said.

Overall, the results suggest that physicians need to provide messages that are realistically positive about what it is like to participate in a clinical trial, Krieger said.

"Patients shouldn't be overoptimistic about how they might be helped by participating, but they should feel good about the contribution they are making and know that they will get the accepted standard of care in any circumstance."

The study was supported by grants from the Appalachia Cancer Network and the Appalachia Community Cancer Network, both funded by the National Cancer Institute.

At the annual conference of the National Communication Association in San Francisco in November 2010, graduate student William Saas won a top paper award from the Basic Course division for his paper, "Bridging the Practical Gap: Imitation Pedagogy, Civic Engagement, and the Basic Public Speaking Course."


Students of the basic course are, usually, rhetorical amateurs. This is in part because the current model of higher education trains students for success in the workplace, rather than the public square. Recently, however, the focus of the basic course has shifted in many cases toward a civic engagement-centered pedagogy. This essay argues that the civic turn in basic course instruction should draw lessons from the citizen-oriented, mimetic pedagogy of the classical Roman classroom.

At the annual conference of the National Communication Association in San Francisco in November 2010, graduate student John Minbiole won a top paper award from the Political Communication Division for his paper, "Narratives of Power: Historical Factors and Initial Decisions in George W. Bush's Interviews on the Iraq Surge, 2007"


 Justifications for war are often forward-looking, probabilistic statements that outline their arguments in terms of necessity - usually understood to be the need to protect a nation from a serious threat.  In January of 2007, President George W. Bush delivered a nationally televised speech in which he outlined the justifications and operational details for a "surge" strategy for the war in Iraq, a war that was mired in difficulty and becoming unpopular with American citizens.  Around this time, Bush gave interviews to three major news organizations (the Washington Post, CBS News' 60 Minutes, and NPR).  This study uses methods of textual analysis and rhetorical criticism to analyze these interview texts for three components of persuasive discourse: narrative devices such as characterization, metaphor and forward-looking, conditional statements that emphasize certain consequences and entailments; metanarrative, or those narratives which encompass larger historical and social perspectives (Clarke, 1996); and structuring absences, or concepts that a text avoids but at the same time cannot ignore (Dyer, 1993). 

Through the use of narrative, Bush makes a discursive claim on the nature of the threat from extremists and terrorists as well as future events.  A metanarrative of paternalism towards Iraq combines with a metanarrative that calls for the automatic support of the troops, extending the conceit of a long, ideological struggle.  Structurally absent from the texts is the historical and contextual nature of the situation in Iraq, as well as the fact that Bush's decision for the surge is subordinate to the most crucial decision, the one to go to war in Iraq in the first place.


Peter Miraldi (Ph.D. Kent State), Lecturer in Communication Arts & Sciences, has agreed to serve as the internship coordinator for the Department of Communication Arts & Sciences. He will begin as coordinator with the beginning of spring semester 2011. 


*Sponsored by the Graduate Student Association* 


5:15 P.M. - 6:15 P.M.


An INFORMATION SESSION for all graduate students interested in entering this year's Graduate Exhibition will be held on Tuesday, January 18, 2011 from 5:15 to 6:15 p.m. in 112 Kern Graduate Building.  Students who are unable to attend may log on to the following website to view the video of the Information Session:

The Graduate Student Association will be providing pizza and soda refreshments  

Judges and award-winning entrants from previous years will be available to answer questions from their unique perspectives. 

There will be an opportunity to ask general questions about the Exhibition.

Dates for the Twenty-sixth Annual Graduate Exhibition are March 25 and 27, 2011.  The Performance Option will be held March 25 from 7:00 p.m. to 10:00 p.m.  The Poster Option and Visual Arts Option are scheduled for March 27, from 11:00 a.m. to 3:00 p.m. (with the event open to the general public from 12:00 to 3:00 p.m.). 

All participants must register on-line to participate in the Exhibition.  Registration forms and guidelines can be found on The Graduate School's web site at  All entries must be submitted online.  Applications will be available for submission online beginning January 3, 2011 and continue through 3:00 p.m. February 18, 2011.   

a hard copy of the application signed by the student's advisor, program chair or department head must be received by the office of the dean of the graduate school, 114 kern building by 5:00 p.m. on February 18, 2011


Assistant Professor Jeremy Engels is the author of Enemyship: Democracy and Counter-Revolution in the Early Republic (East Lansing: Michigan State University Press, 2010).

From the Michigan State University Press announcement:

"The Declaration of Independence is usually celebrated as a radical document that inspired revolution in the English colonies, in France, and elsewhere. In Enemyship, however, Jeremy Engels views the Declaration as a rhetorical strategy that outlined wildly effective arguments justifying revolution against a colonial authority -- and then threatened political stability once independence was finally achieved. Enemyship examines what happened during the latter years of the Revolutionary War and in the immediate post- Revolutionary period, when the rhetorics and energies of revolution began to seem problematic to many wealthy and powerful Americans. To mitigate this threat, says Engels, the founders of the United States deployed the rhetorics of what he calls "enemyship," calling upon Americans to unite in opposition to their shared national enemies."

Congratulations to the following undergraduate students who won prizes in the Civic Engagement Public Speaking Contest.  The event was held on December 6 at the Nittany Lion Inn.

First Place: Kevin Shaffer (Eric Fuchs)

Second Place: Chris Nation (Aaron Bacue)

Third Place: Jacqueline Van Grouw (Aaron Bacue)

Honorable Mention: Katie Basalla (Bridget Long)

Honorable Mention: Grant Elledge (Brian Amsden)

Honorable Mention: Mark Hewlett (Bridget Long)

Please extend your congratulations to these students and their instructors.

Mary K. Haman, Ph.D.
Department of Communication Arts and Sciences
The Pennsylvania State University

At its annual conference in San Francisco in November, the National Communication Association awarded Jennifer S. Priem (PhD Penn State 2008, Communication Arts & Sciences) the 2010 NCA Gerald R. Miller Outstanding Doctoral Dissertation Award for "The Illocutionary Force of Hurt and Support in Young Adult Romantic Relationships: Message Features, Message Perceptions, and Physiological Stress," which was directed by Professor and Associate Dean Denise Solomon. The award was one of three association-wide awards for the best doctoral dissertation in the field of communication. This year Jennifer is a postdoctoral fellow in Human Development and Family Sciences at the University of Texas, Austin.

The Department of Communication Arts & Sciences, The New York Times, Pearson Custom Publishing, and the Center for Democratic Deliberation invite you to the Fall 2010

Civic Engagement
Public Speaking Contest

7:00 p.m.
December 6, 2010
The Nittany Lion Inn, Boardroom

Reception to follow

Kandace Rusnak, The New York Times
Jeffrey Goldman, Pearson Custom Publishing
Damon Sims, Vice President for Student Affairs
Thom Brewster, Executive Director, CentrePeace

Six of the best speakers from Communication Arts & Sciences 100A -- Effective Speech -- will speak on issues of civic importance
Announcing a public debate:


Join us as the Penn State Parliamentary Debate Society debates this question.

December 1, 2010

7:00 p.m.

10 Sparks Building

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