Metaphor use and health literacy: a pilot study of strategies to explain randomization in cancer clinical trials.

Posted: Jan 27, 2011
J Health Commun. 16. 3-16.
KEYWORDS: Knowledge/Attitudes/Beliefs, Underserved, Low Literacy, Rural, Level of Clinical Trials Knowledge or Awareness, Attitudes, Randomization, Consent, Women, Older Adults, Minority Groups, Verbal Communications, Cancer


Clinical trial education may be best delivered before an individual is diagnosed with a disease.

Why this item may be useful

Metaphor use is an appropriate way to enhance the cultural sensitivity of a medical message; however, failure to understand the message can contribute to misunderstanding about diagnosis or uninformed decisions about what treatment to pursue. This study investigates the benefits and unintended effects of using metaphors to explain the randomization element of a Phase III cancer clinical trial to low-income, rural, elderly women. It was found that under conditions of low attention, participants who received a culturally derived metaphor experienced significantly higher intentions to participate in clinical trials as compared with participants who received a standard metaphor. However, as attention increased, differences in intentions between the two metaphor types diminished.


  • Common metaphors liken randomization to games of chance, such as “the toss of a coin,” “the lottery,” and “picking a number from a hat.”
  • However, gambling may not be an appropriate framework for understanding the role of chance in clinical trials for all participants. Social and cultural contexts must be considered when using metaphors with patients.