title: Heed or disregard a cancer patient's critical blogging? An experimental study of two different framing strategies.
abstract: We have examined healthcare staff attitudes of toward a blogging cancer patient who publishes critical posts about her treatment and their possible effect on patient-staff relationships and treatment decisions.
  
  
  
  We used two versions of a questionnaire containing a vignette based on a modified real case involving a 39-year-old cancer patient who complained on her blog about how she was encountered and the treatment she received. Initially she was not offered a new, and expensive treatment, which might have influenced her perception of further encounters. In one version of the vignette, the team decides to put extra effort into both encounters and offers the expensive new cancer treatment. In the other version, the team decides to follow the clinic's routine to the letter. Subsequently, blog postings became either positive or negative in tone. We also divided participants into value-neutral and value-influenced groups (regarding personal values) by asking how their trust in healthcare would be affected if the team's suggestion were followed.
  
  
  
  A total of 56 % (95 % CI: 51-61) of the respondents faced with a team decision to 'do something-extra' in encounters would act in accordance with this ambition. Concerning treatment, 32 % (95 % CI: 28-38) would follow the team's decision to offer a new and expensive treatment. A large majority of those who received the "follow-routine" version agreed to do so in encountering [94 % (95 % CI: 91-97)]. Similar proportions were found regarding treatment [86 % (95 % CI: 82-90)]. A total of 83 % (95 % CI: 76-91) of the value-neutral participants who received the "do-something-extra" version stated that they would act as the team suggested regarding encounters, while 57 % (95 % CI: 47-67) would do so in regard to treatment. Among the value-influenced participants who received the "do-something-extra" version, 45 % (95 % CI: 38-51) stated that they would make an extra effort to accommodate the patient and her needs, while the proportion for treatment was 22 % (95 % CI: 16-27). Among those who had received the "follow-routine" version, a large majority agreed, and no difference was indicated between the value-neutral and the value-influenced participants.
  
  
  
  The present study indicates that healthcare staff is indeed influenced by reading a patient's critical blog entries, largely regarding encounters, but also concerning treatment is concerned. Value-neutral healthcare personnel seem to exhibit a pragmatic attitude and be more inclined to heed and respond to a patient whose criticism may well be warranted. The study also indicates that healthcare staff is partly positive or negative to future blogging patients depending on how the issue has been framed. For future research we suggest as a bold hypothesis that the phrase "clinical routine" might conceal power aspects masquerading as adopted ethical principles.
authors.affiliation: Stockholm Centre for Healthcare Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden. niels.lynoe@ki.se.
authors.forename: Niels
authors.initials: N
authors.lastname: Lynøe
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: NattochDag
authors.affiliation: Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindskog
authors.affiliation: Stockholm Centre for Healthcare Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Juth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D057218:Blogging; D003657:Decision Making; D003695:Delivery of Health Care / Q000941:ethics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009014:Morals; D009369:Neoplasms / Q000628:therapy; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires
keywords: Blogging patients; Decision-making; Priority-setting; Social status; Tacit values