Spontaneous mental associations with the words “side effect”: Implications for informed and shared decision making

Objective To gain insight into patients’ medical decisions by exploring the content of laypeople's spontaneous mental associations with the term “side effect.” Methods An online cross-sectional survey asked 144 women aged 40–74, “What are the first three things you think of when you hear the words 'side effect?”' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. Results 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps > 0.05). Conclusion The term “side effect” spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. Practice implications Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making.