The Cost of a Word: Radiation Therapy Versus Radiotherapy and Public Treatment Preferences.

PURPOSE: Patient perceptions of radiation treatment may influence acceptance of this therapy, yet the impact of treatment terminology on these perceptions has not been experimentally tested. We aimed to determine whether labeling the treatment as "radiotherapy" versus "radiation therapy" affects treatment choice and psychological perceptions.

METHODS AND MATERIALS: We conducted a preregistered, parallel-group randomized survey experiment on a demographically representative sample of United States adults. Participants were randomly assigned to a standardized clinical vignette describing early stage cancer with 2 equivalent treatment options: radiation treatment versus surgery. Scenarios were identical except for the terminology used for the radiation treatment option: "radiotherapy" (control) versus "radiation therapy" (experimental). The primary outcome was treatment preference, compared using a chi-square test. Secondary outcomes included anticipated anxiety, safety, and aggressiveness, analyzed using linear mixed models with Holm-Bonferroni adjustment. Robustness of the framing effect was tested using multivariable logistic regression.

RESULTS

Among 1531 participants (mean [SD] age, 46.4 [16.3] years; 51.2% women; 63.0% White), exposure to "radiation therapy" reduced selection of radiation treatment compared with "radiotherapy" (62.6% vs 70.9%; difference, -8.3 percentage points [95% CI, -13.0 to -3.6]; P < .001). This effect persisted after adjustment (adjusted OR, 0.68 [95% CI, 0.54-0.84]; P < .001). "Radiation therapy" was associated with higher anticipated anxiety, lower perceived safety, and greater perceived aggressiveness of the radiation option, with no differences in perceptions of surgery.

CONCLUSIONS

In this randomized experiment, a single-word difference in terminology significantly altered stated treatment preference and perceptions of radiation treatment. Terminology may represent a modifiable factor shaping public perceptions of curative therapy.