A test of positive suggestions about side effects as a way of enhancing the analgesic response to NSAIDs

Fernandez, Aurore; Kirsch, Irving; Noël, Louis; Rodondi, Pierre-Yves; Kaptchuk, Ted J.; Suter, Marc R; Décosterd, Isabelle; Berna, Chantal

doi:10.1371/journal.pone.0209851

Cited by 20 publications

(21 citation statements)

References 56 publications

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“…Two studies employed positive message framing, involving information that side effects were indicative of the drug working ( Wilhelm et al, 2018 ; Fernandez et al, 2019 ).…”

Section: Evidence To Datementioning

confidence: 99%

“… Fernandez et al (2019) administered the analgesic diclofenac with a side-effect-inducing agent (atropine) in healthy volunteers. Video instructions stated that experiencing side effects were an indication that the medication was active in the body and would help reduce pain (positive frame) or simply to inform staff if side effects were experienced (control frame).…”

Section: Evidence To Datementioning

confidence: 99%

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Can Positive Framing Reduce Nocebo Side Effects? Current Evidence and Recommendation for Future Research

et al. 2019

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Although critical for informed consent, side effect warnings can contribute directly to poorer patient outcomes because they often induce negative expectations that trigger nocebo side effects. Communication strategies that reduce the development of nocebo side effects whilst maintaining informed consent are therefore of considerable interest. We reviewed theoretical and empirical evidence for the use of framing strategies to achieve this. Framing refers to the way in which information about the likelihood or significance of side effects is presented (e.g., negative frame: 30% will experience headache vs. positive frame: 70% will not experience headache), with the rationale that positively framing such information could diminish nocebo side effects. Relatively few empirical studies (k = 6) have tested whether framing strategies can reduce nocebo side effects. Of these, four used attribute framing and two message framing. All but one of the studies found a significant framing effect on at least one aspect of side effects (e.g., experience, attribution, threat), suggesting that framing is a promising strategy for reducing nocebo effects. However, our review also revealed some important open questions regarding these types of framing effects, including, the best method of communicating side effects (written, oral, pictorial), optimal statistical presentation (e.g., frequencies vs. percentages), whether framing affects perceived absolute risk of side effects, and what psychological mechanisms underlie framing effects. Future research that addresses these open questions will be vital for understanding the circumstances in which framing are most likely to be effective.

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“…Two studies employed positive message framing, involving information that side effects were indicative of the drug working ( Wilhelm et al, 2018 ; Fernandez et al, 2019 ).…”

Section: Evidence To Datementioning

confidence: 99%

Section: Evidence To Datementioning

confidence: 99%

Can Positive Framing Reduce Nocebo Side Effects? Current Evidence and Recommendation for Future Research

et al. 2019

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“…The recent literature showed that theoretical and empirical evidence for the use of framing strategies could reduce the development of nocebo side effects with the rationale that positively framing such information could diminish this risk [25, 26]. Other authors suggest that the studies using multiple modes (including video, which comprises visual and verbal presentation methods) elicited numerically larger framing effect sizes, suggesting that multimodal presentation may more successfully elicit the framing effect [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Effect of written outcome information on attitude of perinatal healthcare professionals at the limit of viability: a randomized study

Papadimitriou¹,

Tosello

Pfister³

2019

BMC Med Ethics

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BackgroundDifferences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability (intensive care versus comfort care) are influenced by the way information on incurred risks is given or received.MethodsThis is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our sample included 102 healthcare professionals.ResultsForty-nine responders (48%) were students (response rate of 33.1%), 32 (31%) paediatricians (response rate of 91.4%) and 21 (20%) nurses in NICU (response rate of 50%). The received risk tended to be more severe in both groups compared to the graphically presented facts and current guidelines, although optimistic representation favoured the perception of “survival without disability” at 23 to 25 weeks. Therapeutic attitudes did not differ between groups, but healthcare professionals with children were more restrained and students more aggressive at very low gestational ages.ConclusionWritten information on mortality and morbidity given to healthcare professionals in graphic form encourages them to overestimate the risk. However, perception in healthcare staff may not be directly transferable to parental perception during counselling as the later are usually naïve to the data received. This parental information are always communicated in ways that subtly shape the decisions that follow.

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“…Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects 8 and rated side effects as less threatening 6 and less intense. 7 Reducing threat, worry and intensity of side effects are powerful ways to improve overall treatment experience.…”

Section: State Of the Sciencementioning

confidence: 99%

“…Overall, 65% of participants preferred the latter. 7 This suggests that, when given an informed choice, most people prefer to have side effects explained as an indication of treatment efficacy.…”

Section: State Of the Sciencementioning

confidence: 99%

Changing mindsets about side effects

2021

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Given research showing that the very act of communicating side effects can increase their likelihood, how can providers inform patients about side effects while upholding their oath to do no unnecessary harm? An emerging approach provides a potential solution: truthfully describe certain minor side effects as a sign the treatment is active and working in the body. This approach focuses on instilling adaptive mindsets about the meaning of side effects while still keeping patients informed. This article describes existing research suggesting that this approach can be helpful in improving experience and outcomes in treatments for pain, hypertension and allergy. Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects and rated them as less threatening and intense. A longitudinal, randomised controlled trial of this approach in patients receiving oral immunotherapy for food allergies found that describing side effects as a sign treatment was working reduced the rate at which patients contacted providers with concerns about side effects and led to greater increases in a biomarker of allergic tolerance from pretreatment to post-treatment (peanut-specific blood IgG4). In unveiling this approach, this article also raises important issues regarding which treatments and symptoms this approach should be applied to. Finally, we outline questions future research should address to further understand and leverage this approach.

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A test of positive suggestions about side effects as a way of enhancing the analgesic response to NSAIDs

Cited by 20 publications

References 56 publications

Can Positive Framing Reduce Nocebo Side Effects? Current Evidence and Recommendation for Future Research

Can Positive Framing Reduce Nocebo Side Effects? Current Evidence and Recommendation for Future Research

Effect of written outcome information on attitude of perinatal healthcare professionals at the limit of viability: a randomized study

Changing mindsets about side effects

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