Epidemiology and prognosis of coma in daytime television dramas
1 Center for Health Equity Research and Promotion, Philadelphia VA Medical Center,9 East, 3900 Woodland Avenue, Philadelphia, PA 19104-4155, USA,2 Center for Clinical Epidemiology and Biostatistics, 113 Blockley Hall, 423 Guardian Drive, University of Pennsylvania, Philadelphia, PA 19104-6021,3 Division of Geriatric Medicine, University of Pennsylvania, 3615 Chestnut Street, Suite 312, Philadelphia, PA 19104
Abstract
Objective To determine how soap operas portray, and possibly misrepresent, the likelihood of recovery for patients in coma.
, http://www.100md.com
Design Retrospective cohort study.
Setting Nine soap operas in the United States reviewed between 1 January 1995 and 15 May 2005.
Subjects 64 characters who experienced a period of unconsciousness lasting at least 24 hours. Their final status at the end of the follow-up period was compared with pooled data from a meta-analysis.
Results Comas lasted a median of 13 days (interquartile range 7-25 days). Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state. Mortality for non-traumatic and traumatic coma was significantly lower than would be predicted from the meta-analysis data (non-traumatic 4% v 53%; traumatic 6% v 67%; Fisher's exact test both P < 0.001). On the day that patients regained consciousness, most (49/57; 86%) had no evidence of limited function, cognitive deficit, or residual disability needing rehabilitation. Compared with meta-analysis data, patients in this sample had a much better than expected chance of returning to normal function (non-traumatic 91% v 1%; traumatic 89% v 7%; both P < 0.001).
, 百拇医药
Conclusions The portrayal of coma in soap operas is overly optimistic. Although these programmes are presented as fiction, they may contribute to unrealistic expectations of recovery.
Introduction
Coma is a challenging complication of a variety of injuries.1-6 Some comatose patients recover full function, some die, and others remain unconscious or exhibit preserved sleep-wake cycles, a condition known as persistent vegetative state.2 7 Decisions about artificial nutrition and other forms of life sustaining treatment are often necessary,8 9 but prognostic uncertainty can make these decisions particularly difficult for families and physicians.1 10-12 Unrealistic expectations for recovery often contribute to disagreements about treatment, in which families and providers turn to the courts for assistance, most visibly in the recent Schiavo case in the United States.13-15
, 百拇医药
Mass media may influence these expectations, and television in particular can affect knowledge of health problems, promote attitudes and norms, and influence behaviour.16 17 One genre—daytime dramas or "soap operas"—is a persuasive source of health information for viewers. These programmes reach more than 40 million viewers in the United States and are broadcast in at least 90 other countries.18 19 In fact, soap operas are often used in industrialised and underdeveloped countries as a public health intervention to promote certain behaviours,20-23 and they may even have unintended effects on viewers' health related behaviour.24 However, the features that promote behaviour change—a compelling story, complex character development, and loyal audience—mean that misinformation can also have a far reaching and pernicious effect. For instance, television dramatically exaggerates survival after cardiopulmonary resuscitation.25 It is not known whether soap operas offer a similarly optimistic picture of outcomes of coma, so the goal of this study was to determine how soap operas portray the probability of recovery in coma and persistent vegetative state.
, 百拇医药
Methods
Three authors (DC, HJMacM, AP) searched the internet for episodes of soap operas shown in the United States in which a character was unconscious for at least 24 hours after an injury or medical event. The initial search strategy used Google, with the search terms "soap opera" and "unconscious" or "coma." Supplemental searches used television network websites, sanctioned digest websites (such as www.soapcentral.com), and websites that reproduce daytime drama storylines. We identified nine programmes televised in the United States between 1 January 1995 and 15 May 2005: Guiding Light, General Hospital, One Life to Live, Days of Our Lives, All My Children, Passions, As the World Turns, The Young and the Restless, and The Bold and the Beautiful.
, http://www.100md.com
We included only the first episode of coma for each patient. We determined the patient's characteristics and the cause of coma by reviewing the storyline at an official or sanctioned website and resolved disagreement by consensus (DC, HJMacM, AP). When a patient had an identity change (a facial transplant in one case), we used the characteristics of the original patient for analysis. Tests that have been found to predict prognosis (for example, evoked potentials, imaging)3 26 27 were not routinely described and so were not included in the search strategy.
, http://www.100md.com
We followed patients until recovery, death, or their last appearance, whichever came first. We determined follow-up time by real time, as the viewer would have experienced it. We used all available website summaries to define functional status on the Glasgow outcome scale28 by consensus (DC, HJMacM, AP). Categories included good recovery, moderate disability (limited occupational or social function), severe disability (partial or total dependence in activities of daily living), persistent vegetative state, and death.
, 百拇医药
We used Fisher's exact test to compare survival rates of soap opera patients with pooled data reported in an authoritative meta-analysis.1 When soap opera patients had a non-traumatic injury, we compared their outcomes with those of all patients from the meta-analysis. However, available case series of traumatic injury generally include only those patients who remained unconscious after one month. We therefore compared soap opera patients with traumatic comas within this subgroup. We used Stata statistical software (version 8.0) for all statistical analysis.
, http://www.100md.com
Results
Of 73 comas identified, six patients were ineligible (one seemed to wake for meals, two had fraudulent comas, and three comas were pharmacologically induced), and we excluded three because their final condition could not be determined. The table describes the remaining 64 patients in the study sample.
Characteristics of patient (n=64)
These patients spent a median of 13 days (interquartile range 7-25 days) in a coma. Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state at the end of follow-up. Two patients who died were later revealed to be alive (in one case, a body had been replaced with a mannequin), but we counted them as deaths because we reasoned that viewers would perceive them as having died.
, http://www.100md.com
The mortality for non-traumatic coma (1/23) was significantly lower at one year in soap opera patients than would be predicted from pooled meta-analysis data (90/169; P < 0.001).1 Of the 16 soap opera patients who were in a traumatic coma one month after injury, only one died, which is much lower than the mortality predicted by meta-analysis data (291/434; P < 0.001).1
Overall, half the patients recovered within the first month (n = 32; 50%), and almost all recovered within three months (55; 86%). Of the 41 patients with a traumatic injury, 20 (49%) recovered within one month, 34 (83%) recovered within three months, and two patients recovered six months or more after injury (total 36/41; 88%). Of the 23 patients with a non-traumatic injury, 13 (56%) recovered within one month, and all of the 21 (91%) patients who recovered had done so by three months.
, 百拇医药
On the day that patients regained consciousness, most (49/57; 86%) had no residual disability, although some seemed to have retrograde or anterograde amnesia. The eight patients with a residual disability had one or more of difficulty speaking (4; 7%), inability to ambulate (3; 5%), disorientation (2; 4%), and respiratory failure or ventilator dependence (1; 2%). All eventually returned to their previous state of health. Compared with meta-analysis data, patients had a much better than expected chance of returning to normal function after a non-traumatic injury (21/23 v 1/169; P < 0.001).1 Among those in a coma one month after traumatic injury, the probability of regaining normal function was also better than predicted (14/16 v 30/434; P < 0.001).1
, 百拇医药
Discussion
Patients in soap operas who experience coma after traumatic or non-traumatic injury have a better than expected chance of survival. Moreover, they are very likely to regain full function. These outcomes are unprecedented and offer television viewers a picture of coma and persistent vegetative state that is overly optimistic in two key respects.
Firstly, the vast majority of these patients survived. Moreover, because two deaths were staged, the true survival rate is actually even higher than that reported here. This finding is at odds with previous studies that have found coma to be associated with survival rates of 50% or less.1 4 29 Indeed, patients with non-traumatic coma have a one month survival rate of 15%.1 27 30 Survival rates for coma after traumatic injury are often higher but are still substantially lower than the rates seen in this study.1 5 31
, 百拇医药
Secondly, all surviving patients in this sample eventually regained full function, which is very unusual.1 29 32 For instance, typical rates of full recovery from coma after a non-traumatic injury are usually less than 10%.1 Patients typically experience subtle cognitive and functional deficits,33 which were not evident in these patients, who rapidly resumed their previous occupational, social, and romantic activities. In contrast, for real patients the recovery process usually involves months of rehabilitation with intensive physical and occupational therapy.34 35
, http://www.100md.com
This study has two main limitations. Firstly, elderly patients and those who have had cardiopulmonary resuscitation are underrepresented in this sample, which could partly explain the better survival results described here. Nevertheless, viewers receive an impression of good prognosis and a virtually certain return to full function. Secondly, some functional deficits may have been portrayed too subtly to be detected. However, many patients successfully returned to highly demanding professions (for example, physician, shipping tycoon), giving viewers a picture of full recovery.
, 百拇医药
These findings show that soap operas portray an unrealistically optimistic version of the outcomes of patients in comas. Whether these programmes influence viewers' beliefs about prognosis is not known, but television storylines are well known to carry substantial power to convince viewers.21 22 24 36 37 Therefore, it is reasonable to infer that regular viewers of soap operas may be more likely to hold implausibly favourable views of the prognosis of coma.
Of course, soap opera storylines are not always written to reflect real life. Characters have much more favourable outcomes from coma, but they also seem to face an extraordinarily high all cause mortality.38 Soap operas are not designed with the goal of educating the public about the realities of health and illness or even about the realities of interpersonal relationships, but they may contribute to public misperceptions in these areas. In the interests of public health, soap operas and other forms of mass media should seek to balance stories of improbable survival and recovery with compelling and compassionate stories of characters who die with comfort and dignity.
, 百拇医药
Contributors: DC, JMF, HJMacM, AP, and DAA all contributed to the design of this research, the analysis and interpretation of the data, and the drafting and revising of the article. All have provided final approval. James Tulsky contributed comments on a previous version of this manuscript. DC is the guarantor.
Funding: DC is the recipient of an advanced research career development award from the Department of Veterans Affairs, and a Paul Beeson Physician Faculty scholars award.
, 百拇医药
Competing interests: None declared.
Ethical approval: Not needed.
References
Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (2). N Engl J Med 1995;330: 1572-9.
Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med 1994;330: 1499-508.
Oder W, Goldenberg G, Podreka I, Deecke L. HM-PAO-SPECT in persistent vegetative state after head injury: prognostic indicator of the likelihood of recovery Intensive Care Med 1991;17: 149-53.
, 百拇医药
Sazbon L, Zagreba F, Ronen J, Solzi P, Costeff H. Course and outcome of patients in vegetative state of nontraumatic aetiology. J Neurol Neurosurg Psychiatry Res 1993;56: 407-9.
Levin HS, Saydjari C, Eisenberg HM. Vegetative state after closed-head injury: a traumatic coma data bank report. Arch Neurol 1991;48: 580-5.
Masson F, Thicoipe M, Mokni T, Aye P, Erny P, Dabadie P, et al. Epidemiology of traumatic comas: a prospective population-based study. Brain Inj 2003;17: 279-93.
, 百拇医药
Jennett B, Plum F. Persistent vegetative state after brain damage: a syndrome in search of a name. Lancet 1972: 734-7.
Cranford RE. Neurologic syndromes and prolonged survival: when can artificial nutrition and hydration be forgone Law Med Health Care 1991;19: 13-22.
Council on Scientific Affairs and Council on Ethical and Judicial Affairs. Persistent vegetative state and the decision to withdraw or withhold life support. JAMA 1990: 426-30.
, 百拇医药
Banja JD. Ethical aspects of treatment for coma and the persistent vegetative state. Phys Med Rehabil 1990;4: 579-92.
Grubb A, Walsh P, Lambe N, Murrells T, Robinson S. Survey of British clinicians' views on management of patients in persistent vegetative state. Lancet 1996;348: 35-40.
Hodges MO, Tolle SW, Stocking C, Cassel CK. Tube feeding: internists' attitudes regarding ethical obligations. Arch Intern Med 1994;154: 1013-20.
, 百拇医药
Lo B, Dornbrand L, Wolf LE, Groman M. The Wendland case—withdrawing life support from incompetent patients who are not terminally ill. N Engl J Med 2002;346: 1489-93.
Dresser R. Schiavo: a hard case makes questionable law. Hastings Center Report 2004;34(3): 8-9.
Gostin LO. Ethics, the constitution, and the dying process: the case of Theresa Marie Schiavo. JAMA 2005;293: 2403-7.
Brodie M, Foehr U, Rideout V, Baer N, Miller C, Flournoy R, et al. Communicating health information through the entertainment media. Health Aff (Millwood) 2001;20: 192-9.
, http://www.100md.com
Kalichman SC. Magic Johnson and public attitudes towards AIDS: a review of empirical findings. AIDS Educ Prev 1994;6: 542-57.
Report on television. New York: Nielsen Media Research, 2000.
Ang I. Desperately seeking the audience. New York: Routledge, 1991.
Campbell MK, Carbone E, Honess-Morreale L, Heisler-Mackinnon J, Demissie S, Farrell D. Randomized trial of a tailored nutrition education CD-ROM program for women receiving food assistance. J Nutr Educ Behav 2004;36: 58-66.
, 百拇医药
Howe A, Owen-Smith V, Richardson J. The impact of a television soap opera on the NHS cervical screening programme in the north west of England. J Pub Health Med 2002;24: 299-304.
Shapiro D, Meekers D, Tambashe B. Exposure to the `SIDA dans la Cite' AIDS prevention television series in Cote' d'Ivoire, sexual risk behaviour and condom use. AIDS Care 2003;15: 303-14.
Rogers EM, Vaughan PW, Swalehe RM, Rao N, Svenkerud P, Sood S. Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania. Stud Fam Plan 1999;30: 193-211.
, 百拇医药
Kennedy MG, O'Leary A, Beck V, Pollard K, Simpson P. Increases in calls to the CDC national STD and AIDS hotline following AIDS-related episodes in a soap opera. J Commun 2004;44: 287-301.
Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television: miracles and misinformation. N Engl J Med 1996;334: 1578-82.
Judson JA, Cant BR, Shaw NA. Early prediction of outcome from cerebral trauma by somatosensory evoked potentials. Crit Care Med 1990;18: 363-8.
, 百拇医药
Bates D. Defining prognosis in medical coma. J Neurol Neurosurg Psychiatry 1991;54: 569-71.
Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975;i: 480-4.
Hamel MB, Goldman L, Teno J, Lynn J, Davis RB, Harrell FE Jr, et al. Identification of comatose patients at high risk for death or severe disability. JAMA 1995;273: 1842-8.
Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253: 1420-6.
, http://www.100md.com
Braakman R, Jennett WB, Minderhoud JM. Prognosis of the posttraumatic vegetative state. Acta Neurochir 1988;95: 49-52.
Higashi K, Hatano M, Abiko S, Ihara K, Katayama S, Wakuta Y, et al. Five-year follow-up study of patients with persistent vegetative state. J Neurol Neurosurg Psychiatry 1981;44: 552-4.
Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury: prospective cohort study. BMJ 2000;320: 1631-5.
, 百拇医药
Mazaux JM, Richer E. Rehabilitation after traumatic brain injury in adults. Disabil Rehabil 1998;20: 435-47.
Walker WC, Kreutzer JS, Witol AD. Level of care options for the low-functioning brain injury survivor. Brain Inj 1996;10: 65-75.
Borrayo EA. Where's Maria A video to increase awareness about breast cancer and mammography screening among low-literacy Latinas. Prevent Med 2004;39: 99-110.
, 百拇医药 Jibaja ML, Kingery P, Neff NE, Smith Q, Bowman J, Holcomb JD. Tailored, interactive soap operas for breast cancer education of high-risk Hispanic women. J Cancer Educ 2000;15: 237-42.
Crayford T, Hooper R, Evans S. Death rates of characters in soap operas on British television: is a government health warning required BMJ 1997;315: 1649-52., 百拇医药(David Casarett, Jessica M)
Abstract
Objective To determine how soap operas portray, and possibly misrepresent, the likelihood of recovery for patients in coma.
, http://www.100md.com
Design Retrospective cohort study.
Setting Nine soap operas in the United States reviewed between 1 January 1995 and 15 May 2005.
Subjects 64 characters who experienced a period of unconsciousness lasting at least 24 hours. Their final status at the end of the follow-up period was compared with pooled data from a meta-analysis.
Results Comas lasted a median of 13 days (interquartile range 7-25 days). Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state. Mortality for non-traumatic and traumatic coma was significantly lower than would be predicted from the meta-analysis data (non-traumatic 4% v 53%; traumatic 6% v 67%; Fisher's exact test both P < 0.001). On the day that patients regained consciousness, most (49/57; 86%) had no evidence of limited function, cognitive deficit, or residual disability needing rehabilitation. Compared with meta-analysis data, patients in this sample had a much better than expected chance of returning to normal function (non-traumatic 91% v 1%; traumatic 89% v 7%; both P < 0.001).
, 百拇医药
Conclusions The portrayal of coma in soap operas is overly optimistic. Although these programmes are presented as fiction, they may contribute to unrealistic expectations of recovery.
Introduction
Coma is a challenging complication of a variety of injuries.1-6 Some comatose patients recover full function, some die, and others remain unconscious or exhibit preserved sleep-wake cycles, a condition known as persistent vegetative state.2 7 Decisions about artificial nutrition and other forms of life sustaining treatment are often necessary,8 9 but prognostic uncertainty can make these decisions particularly difficult for families and physicians.1 10-12 Unrealistic expectations for recovery often contribute to disagreements about treatment, in which families and providers turn to the courts for assistance, most visibly in the recent Schiavo case in the United States.13-15
, 百拇医药
Mass media may influence these expectations, and television in particular can affect knowledge of health problems, promote attitudes and norms, and influence behaviour.16 17 One genre—daytime dramas or "soap operas"—is a persuasive source of health information for viewers. These programmes reach more than 40 million viewers in the United States and are broadcast in at least 90 other countries.18 19 In fact, soap operas are often used in industrialised and underdeveloped countries as a public health intervention to promote certain behaviours,20-23 and they may even have unintended effects on viewers' health related behaviour.24 However, the features that promote behaviour change—a compelling story, complex character development, and loyal audience—mean that misinformation can also have a far reaching and pernicious effect. For instance, television dramatically exaggerates survival after cardiopulmonary resuscitation.25 It is not known whether soap operas offer a similarly optimistic picture of outcomes of coma, so the goal of this study was to determine how soap operas portray the probability of recovery in coma and persistent vegetative state.
, 百拇医药
Methods
Three authors (DC, HJMacM, AP) searched the internet for episodes of soap operas shown in the United States in which a character was unconscious for at least 24 hours after an injury or medical event. The initial search strategy used Google, with the search terms "soap opera" and "unconscious" or "coma." Supplemental searches used television network websites, sanctioned digest websites (such as www.soapcentral.com), and websites that reproduce daytime drama storylines. We identified nine programmes televised in the United States between 1 January 1995 and 15 May 2005: Guiding Light, General Hospital, One Life to Live, Days of Our Lives, All My Children, Passions, As the World Turns, The Young and the Restless, and The Bold and the Beautiful.
, http://www.100md.com
We included only the first episode of coma for each patient. We determined the patient's characteristics and the cause of coma by reviewing the storyline at an official or sanctioned website and resolved disagreement by consensus (DC, HJMacM, AP). When a patient had an identity change (a facial transplant in one case), we used the characteristics of the original patient for analysis. Tests that have been found to predict prognosis (for example, evoked potentials, imaging)3 26 27 were not routinely described and so were not included in the search strategy.
, http://www.100md.com
We followed patients until recovery, death, or their last appearance, whichever came first. We determined follow-up time by real time, as the viewer would have experienced it. We used all available website summaries to define functional status on the Glasgow outcome scale28 by consensus (DC, HJMacM, AP). Categories included good recovery, moderate disability (limited occupational or social function), severe disability (partial or total dependence in activities of daily living), persistent vegetative state, and death.
, 百拇医药
We used Fisher's exact test to compare survival rates of soap opera patients with pooled data reported in an authoritative meta-analysis.1 When soap opera patients had a non-traumatic injury, we compared their outcomes with those of all patients from the meta-analysis. However, available case series of traumatic injury generally include only those patients who remained unconscious after one month. We therefore compared soap opera patients with traumatic comas within this subgroup. We used Stata statistical software (version 8.0) for all statistical analysis.
, http://www.100md.com
Results
Of 73 comas identified, six patients were ineligible (one seemed to wake for meals, two had fraudulent comas, and three comas were pharmacologically induced), and we excluded three because their final condition could not be determined. The table describes the remaining 64 patients in the study sample.
Characteristics of patient (n=64)
These patients spent a median of 13 days (interquartile range 7-25 days) in a coma. Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state at the end of follow-up. Two patients who died were later revealed to be alive (in one case, a body had been replaced with a mannequin), but we counted them as deaths because we reasoned that viewers would perceive them as having died.
, http://www.100md.com
The mortality for non-traumatic coma (1/23) was significantly lower at one year in soap opera patients than would be predicted from pooled meta-analysis data (90/169; P < 0.001).1 Of the 16 soap opera patients who were in a traumatic coma one month after injury, only one died, which is much lower than the mortality predicted by meta-analysis data (291/434; P < 0.001).1
Overall, half the patients recovered within the first month (n = 32; 50%), and almost all recovered within three months (55; 86%). Of the 41 patients with a traumatic injury, 20 (49%) recovered within one month, 34 (83%) recovered within three months, and two patients recovered six months or more after injury (total 36/41; 88%). Of the 23 patients with a non-traumatic injury, 13 (56%) recovered within one month, and all of the 21 (91%) patients who recovered had done so by three months.
, 百拇医药
On the day that patients regained consciousness, most (49/57; 86%) had no residual disability, although some seemed to have retrograde or anterograde amnesia. The eight patients with a residual disability had one or more of difficulty speaking (4; 7%), inability to ambulate (3; 5%), disorientation (2; 4%), and respiratory failure or ventilator dependence (1; 2%). All eventually returned to their previous state of health. Compared with meta-analysis data, patients had a much better than expected chance of returning to normal function after a non-traumatic injury (21/23 v 1/169; P < 0.001).1 Among those in a coma one month after traumatic injury, the probability of regaining normal function was also better than predicted (14/16 v 30/434; P < 0.001).1
, 百拇医药
Discussion
Patients in soap operas who experience coma after traumatic or non-traumatic injury have a better than expected chance of survival. Moreover, they are very likely to regain full function. These outcomes are unprecedented and offer television viewers a picture of coma and persistent vegetative state that is overly optimistic in two key respects.
Firstly, the vast majority of these patients survived. Moreover, because two deaths were staged, the true survival rate is actually even higher than that reported here. This finding is at odds with previous studies that have found coma to be associated with survival rates of 50% or less.1 4 29 Indeed, patients with non-traumatic coma have a one month survival rate of 15%.1 27 30 Survival rates for coma after traumatic injury are often higher but are still substantially lower than the rates seen in this study.1 5 31
, 百拇医药
Secondly, all surviving patients in this sample eventually regained full function, which is very unusual.1 29 32 For instance, typical rates of full recovery from coma after a non-traumatic injury are usually less than 10%.1 Patients typically experience subtle cognitive and functional deficits,33 which were not evident in these patients, who rapidly resumed their previous occupational, social, and romantic activities. In contrast, for real patients the recovery process usually involves months of rehabilitation with intensive physical and occupational therapy.34 35
, http://www.100md.com
This study has two main limitations. Firstly, elderly patients and those who have had cardiopulmonary resuscitation are underrepresented in this sample, which could partly explain the better survival results described here. Nevertheless, viewers receive an impression of good prognosis and a virtually certain return to full function. Secondly, some functional deficits may have been portrayed too subtly to be detected. However, many patients successfully returned to highly demanding professions (for example, physician, shipping tycoon), giving viewers a picture of full recovery.
, 百拇医药
These findings show that soap operas portray an unrealistically optimistic version of the outcomes of patients in comas. Whether these programmes influence viewers' beliefs about prognosis is not known, but television storylines are well known to carry substantial power to convince viewers.21 22 24 36 37 Therefore, it is reasonable to infer that regular viewers of soap operas may be more likely to hold implausibly favourable views of the prognosis of coma.
Of course, soap opera storylines are not always written to reflect real life. Characters have much more favourable outcomes from coma, but they also seem to face an extraordinarily high all cause mortality.38 Soap operas are not designed with the goal of educating the public about the realities of health and illness or even about the realities of interpersonal relationships, but they may contribute to public misperceptions in these areas. In the interests of public health, soap operas and other forms of mass media should seek to balance stories of improbable survival and recovery with compelling and compassionate stories of characters who die with comfort and dignity.
, 百拇医药
Contributors: DC, JMF, HJMacM, AP, and DAA all contributed to the design of this research, the analysis and interpretation of the data, and the drafting and revising of the article. All have provided final approval. James Tulsky contributed comments on a previous version of this manuscript. DC is the guarantor.
Funding: DC is the recipient of an advanced research career development award from the Department of Veterans Affairs, and a Paul Beeson Physician Faculty scholars award.
, 百拇医药
Competing interests: None declared.
Ethical approval: Not needed.
References
Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (2). N Engl J Med 1995;330: 1572-9.
Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med 1994;330: 1499-508.
Oder W, Goldenberg G, Podreka I, Deecke L. HM-PAO-SPECT in persistent vegetative state after head injury: prognostic indicator of the likelihood of recovery Intensive Care Med 1991;17: 149-53.
, 百拇医药
Sazbon L, Zagreba F, Ronen J, Solzi P, Costeff H. Course and outcome of patients in vegetative state of nontraumatic aetiology. J Neurol Neurosurg Psychiatry Res 1993;56: 407-9.
Levin HS, Saydjari C, Eisenberg HM. Vegetative state after closed-head injury: a traumatic coma data bank report. Arch Neurol 1991;48: 580-5.
Masson F, Thicoipe M, Mokni T, Aye P, Erny P, Dabadie P, et al. Epidemiology of traumatic comas: a prospective population-based study. Brain Inj 2003;17: 279-93.
, 百拇医药
Jennett B, Plum F. Persistent vegetative state after brain damage: a syndrome in search of a name. Lancet 1972: 734-7.
Cranford RE. Neurologic syndromes and prolonged survival: when can artificial nutrition and hydration be forgone Law Med Health Care 1991;19: 13-22.
Council on Scientific Affairs and Council on Ethical and Judicial Affairs. Persistent vegetative state and the decision to withdraw or withhold life support. JAMA 1990: 426-30.
, 百拇医药
Banja JD. Ethical aspects of treatment for coma and the persistent vegetative state. Phys Med Rehabil 1990;4: 579-92.
Grubb A, Walsh P, Lambe N, Murrells T, Robinson S. Survey of British clinicians' views on management of patients in persistent vegetative state. Lancet 1996;348: 35-40.
Hodges MO, Tolle SW, Stocking C, Cassel CK. Tube feeding: internists' attitudes regarding ethical obligations. Arch Intern Med 1994;154: 1013-20.
, 百拇医药
Lo B, Dornbrand L, Wolf LE, Groman M. The Wendland case—withdrawing life support from incompetent patients who are not terminally ill. N Engl J Med 2002;346: 1489-93.
Dresser R. Schiavo: a hard case makes questionable law. Hastings Center Report 2004;34(3): 8-9.
Gostin LO. Ethics, the constitution, and the dying process: the case of Theresa Marie Schiavo. JAMA 2005;293: 2403-7.
Brodie M, Foehr U, Rideout V, Baer N, Miller C, Flournoy R, et al. Communicating health information through the entertainment media. Health Aff (Millwood) 2001;20: 192-9.
, http://www.100md.com
Kalichman SC. Magic Johnson and public attitudes towards AIDS: a review of empirical findings. AIDS Educ Prev 1994;6: 542-57.
Report on television. New York: Nielsen Media Research, 2000.
Ang I. Desperately seeking the audience. New York: Routledge, 1991.
Campbell MK, Carbone E, Honess-Morreale L, Heisler-Mackinnon J, Demissie S, Farrell D. Randomized trial of a tailored nutrition education CD-ROM program for women receiving food assistance. J Nutr Educ Behav 2004;36: 58-66.
, 百拇医药
Howe A, Owen-Smith V, Richardson J. The impact of a television soap opera on the NHS cervical screening programme in the north west of England. J Pub Health Med 2002;24: 299-304.
Shapiro D, Meekers D, Tambashe B. Exposure to the `SIDA dans la Cite' AIDS prevention television series in Cote' d'Ivoire, sexual risk behaviour and condom use. AIDS Care 2003;15: 303-14.
Rogers EM, Vaughan PW, Swalehe RM, Rao N, Svenkerud P, Sood S. Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania. Stud Fam Plan 1999;30: 193-211.
, 百拇医药
Kennedy MG, O'Leary A, Beck V, Pollard K, Simpson P. Increases in calls to the CDC national STD and AIDS hotline following AIDS-related episodes in a soap opera. J Commun 2004;44: 287-301.
Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television: miracles and misinformation. N Engl J Med 1996;334: 1578-82.
Judson JA, Cant BR, Shaw NA. Early prediction of outcome from cerebral trauma by somatosensory evoked potentials. Crit Care Med 1990;18: 363-8.
, 百拇医药
Bates D. Defining prognosis in medical coma. J Neurol Neurosurg Psychiatry 1991;54: 569-71.
Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975;i: 480-4.
Hamel MB, Goldman L, Teno J, Lynn J, Davis RB, Harrell FE Jr, et al. Identification of comatose patients at high risk for death or severe disability. JAMA 1995;273: 1842-8.
Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253: 1420-6.
, http://www.100md.com
Braakman R, Jennett WB, Minderhoud JM. Prognosis of the posttraumatic vegetative state. Acta Neurochir 1988;95: 49-52.
Higashi K, Hatano M, Abiko S, Ihara K, Katayama S, Wakuta Y, et al. Five-year follow-up study of patients with persistent vegetative state. J Neurol Neurosurg Psychiatry 1981;44: 552-4.
Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury: prospective cohort study. BMJ 2000;320: 1631-5.
, 百拇医药
Mazaux JM, Richer E. Rehabilitation after traumatic brain injury in adults. Disabil Rehabil 1998;20: 435-47.
Walker WC, Kreutzer JS, Witol AD. Level of care options for the low-functioning brain injury survivor. Brain Inj 1996;10: 65-75.
Borrayo EA. Where's Maria A video to increase awareness about breast cancer and mammography screening among low-literacy Latinas. Prevent Med 2004;39: 99-110.
, 百拇医药 Jibaja ML, Kingery P, Neff NE, Smith Q, Bowman J, Holcomb JD. Tailored, interactive soap operas for breast cancer education of high-risk Hispanic women. J Cancer Educ 2000;15: 237-42.
Crayford T, Hooper R, Evans S. Death rates of characters in soap operas on British television: is a government health warning required BMJ 1997;315: 1649-52., 百拇医药(David Casarett, Jessica M)