What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus,Psychotherapy and Psychosomatics

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What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus
Psychotherapy and Psychosomatics ( IF 16.3 ) Pub Date : 2020-10-19 , DOI: 10.1159/000510738
Andrea W M Evers _{1,

2} , Luana Colloca ₃ , Charlotte Blease ₄ , Jens Gaab ₅ , Karin B Jensen ₆ , Lauren Y Atlas ₇ , Chris J Beedie ₈ , Fabrizio Benedetti ₉ , Ulrike Bingel ₁₀ , Christian Büchel ₁₁ , Jet Bussemaker ₁₂ , Ben Colagiuri ₁₃ , Alia J Crum ₁₄ , Damien G Finniss ₁₅ , Andrew L Geers ₁₆ , Jeremy Howick ₁₇ , Regine Klinger ₁₈ , Stefanie H Meeuwis ₁₉ , Karin Meissner ₂₀ , Vitaly Napadow ₂₁ , Keith J Petrie ₂₂ , Winfried Rief ₂₃ , Ionica Smeets ₂₄ , Tor D Wager ₂₅ , Vishvarani Wanigasekera ₂₆ , Lene Vase ₂₇ , John M Kelley ₂₈ , Irving Kirsch ₂₈ ,

Affiliation

Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands,
Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA.
General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Faculty of Psychology, University of Basel, Basel, Switzerland.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
School of Psychology, University of Kent, Canterbury, United Kingdom.
Physiology and Neuroscience, University of Turin Medical School, Turin, Italy.
Department of Neurology, University Hospital Essen, Essen, Germany.
Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
Department of Psychology, Stanford University, Stanford, California, USA.
Royal North Shore Hospital, Sydney, New South Wales, Australia.
Department of Psychology, University of Toledo, Toledo, Ohio, USA.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.
Division of Health Promotion, University of Applied Sciences, Coburg, Germany.
Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands.
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA.

Introduction: Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. Objective: There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. Methods: Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. Results: There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. Conclusions: The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients’ needs, and on developing standardized disclosure training modules for clinicians.
Psychother Psychosom

中文翻译：

关于安慰剂和反安慰剂效应，临床医生应该告诉患者什么？基于专家共识的实际考虑

简介：临床和实验室研究表明，安慰剂和反安慰剂效应会影响惰性和活性治疗后的各种症状和状况。目的：越来越需要关于如何在临床实践中告知患者安慰剂和反安慰剂效应以及培训临床医生如何披露这些信息的最新建议。方法：根据先前有关安慰剂和反安慰剂效应的临床建议，在一个由国际知名专家组成的跨学科小组中进行了一项三步、仅限邀请的德尔福研究。该研究包括开放式和封闭式调查问题，然后是最终专家会议。调查分为 3 个部分：(1) 告知患者安慰剂效应，(2) 告知患者反安慰剂效应，以及 (3) 培训临床医生如何将这些信息传达给患者。结果：共识是向患者传达有关安慰剂和反安慰剂效应的一般信息（例如，解释他们在治疗中的作用）可能是有益的，但需要调整这些信息以匹配特定的临床情况（例如，病情和治疗）。专家们还一致认为，培训临床医生以交流安慰剂和反安慰剂效应应该成为医学教育的常规和综合部分，该教育利用多种形式，包括面对面和在线方式。结论：目前的三步德尔福研究为临床实践中披露安慰剂和反安慰剂效应提供了基于共识的建议和实际考虑。未来需要研究如何根据特定临床情况和患者需求优化信息定制，以及为临床医生开发标准化的信息披露培训模块。
心理治疗师

更新日期：2020-10-19

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