gms | German Medical Science

Background and state of research: Patient education is crucial for informed decision-making bevor any medical intervention. However, little is known about the psychological processes that take place during patient education and their impact on decision-making. Patient education usually occurs in the context of an illness, which in itself can create stress. Furthermore, communicating risks and side effects can exacerbate stress levels and contribute to negative emotions, which can impede information processing and decision-making.

Research question and objective, hypothesis: The objective of our study was to investigate stress responses elicited by patient information leaflets. We hypothesized that patient information leaflets induce stress and negative emotions, and that providing additional context information to better understand the risk information reduces these negative effects. Furthermore, we assumed that stress and negative emotions affect the final decision in favor or against a medical procedure.

Methods: A randomized, controlled online vignette study was conducted with a non-clinical sample (N = 865). Participants were randomly assigned to one of three groups: a standard information leaflet with unstructured risk information (control group), or one of two intervention groups that received patient information leaflets with structured risk information. The two intervention groups differed in that one group received additional contextual information to foster a better understanding of the risk context. A questionnaire was developed and validated to specifically assess stress, negative emotions, comprehensibility, satisfaction, cognitive load, and different risk expectations related to patient education.

Results: Participants in all three groups reported an average of 37.51 stress and negative emotions (on a scale from 0–100, SD = 26.03). Contrary to our hypothesis, additional risk context information did not reduce stress and negative emotions. Additionally, providing context information significantly reduced comprehension and increased feelings of being overloaded with information. However, regression analysis showed that stress and negative emotions significantly predicted the decision (F(831,1) = 205.40, p < .001, R2 = 19.7%), indicating that managing these effects is important for supporting informed decision-making.

Discussion: Our study provides new evidence that written patient information leaflets already induce stress and negative emotions in a non-clinical sample and affect decision-making. However, providing additional contextual information is not an effective strategy for reducing stress and negative emotions. Thus, further research is needed to determine optimal strategies for managing stress and negative emotions during patient education.

Implications for care: Our results highlight the importance of managing stress levels during patient education to support informed decision-making. Thus, healthcare professionals should consider strategies to manage stress and negative emotions, such as addressing patients’ concerns.