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Letter: The Hawthorne effect—behavioral changes from research observation—as confounder and mediator in the ERASE trial

Prostate Cancer and Prostatic Diseases (2026)Cite this article

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Dear Editor,

We read with interest the ERASE trial by Kang et al. [1], which demonstrates excellent methodological rigor including 94% retention, 96% adherence, and clinically meaningful cholesterol reductions exceeding established minimal important differences. These strengths make it an ideal case for examining a methodological consideration that warrants discussion: the Hawthorne effect and its dual role as both confounder and mediator. The Hawthorne effect refers to behavioral modification that occurs when individuals are aware of being observed, first described in workplace studies and now recognized as a significant factor in clinical trials [2].

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Fig. 1: Hawthorne Effect Dual Role in Exercise Intervention Trials: The ERASE Study Example.

References

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Authors and Affiliations

  1. Urology of Shenzhen Longgang Central Hospital, Shenzhen, China

    Zuomin Wang, Qinwei Liu & Wangdong Deng

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  1. Zuomin Wang
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  2. Qinwei Liu
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  3. Wangdong Deng
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Contributions

QL and WD contributed equally to the conception and design of the study. ZW conducted the literature search, data collection, and analysis. QL assisted in the interpretation of findings and critically revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Wangdong Deng.

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Wang, Z., Liu, Q. & Deng, W. Letter: The Hawthorne effect—behavioral changes from research observation—as confounder and mediator in the ERASE trial. Prostate Cancer Prostatic Dis (2026). https://doi.org/10.1038/s41391-026-01087-7

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