Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey

Abstract

ObjectivesTo examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown.SettingMembers of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months.Participants853 women (61%) and men, white (58%) and non-white participants aged 18–75 years.Primary and secondary outcomesQualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables.ResultsPrior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; p<0.024). Of the minority of respondents who judged it never acceptable for doctors to recommend placebo treatments, the most often referenced rationale was obligation of the doctor to do more (n=102, 48.3%). Additional themes emerged around the issue of whether a doctor was transparent about placebo use, including honesty, patient's right to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; p<0.002).ConclusionsParticipants seem to appreciate and understand the lack of harm and potential benefit associated with placebo treatments, while valuing the role of the physician and the patient in its implementation.

Tell Me the Truth and I Will Not Be Harmed: Informed Consents and Nocebo Effects

“…There is a critical need for educating clinicians and patients about the nature of detrimental effects of nocebo processes, including how, when, and why they happen. It has been shown that patients welcome the possibility of being informed about the placebo phenomenon (Ortiz, Hull, and Colloca 2016). Likewise, educating patients about nocebo effects, the experience of other patients will help understand and contextualize the potential for anxiety and other psychophysiological mechanisms that could lead to the occurrence of unwanted nocebo effects.…”

Placebos in the era of open‐label trials: An update for clinicians

“…OLP, on the other hand, is accompanied by informed consent and transparency, which seems to solve the ethical controversy of placebo use . Moreover, the acceptance of OLP regimens by patients appears to be high, as 85% of surveyed patients felt it was acceptable for a physician to use a placebo …”

“…86 Moreover, the acceptance of OLP regimens by patients appears to be high, as 85% of surveyed patients felt it was acceptable for a physician to use a placebo. 87 Regardless of the advantages of OLP, the aforementioned trials pose some limitations. These include small sample size, heterogeneity of medical conditions studied, and lack of long-term follow-up to examine long-term effects of OLP.…”

Ethical examination of sham surgeries for relief of chronic pain in clinical practice

“…This can be difficult to navigate, as studies evaluating patient attitudes regarding physician recommendation of placebo have demonstrated that some patients deem it untrustworthy practice, while others feel it is acceptable. [21][22][23] It is generally established, however, that the physician should disclose any information that a reasonable person would want to know and that might influence decision-making; however, there is debate over what exactly this constitutes. In the case of sham surgeries, the physician must communicate the potential risks, but is he or she obligated to explain exactly how the procedure works?…”