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

Abstract

<b><i>Introduction:</i></b> Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. <b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

“Consensus on Placebo and Nocebo Effects Connects Science with Practice:” Reply to “Questioning the Consensus on Placebo and Nocebo Effects”

“…Hardman, Hutchinson and Ongaro for their thoughtful comments [1]. We provide consensus and recommendations in our paper on how to inform patients about placebo and nocebo effects in clinical practice, and how to train clinicians in disclosing that information, based upon previous consensus papers [2][3][4]. Hardman et al claim that our recommendations are not in line with recent research that shows a disconnect between the modern scientific definition of placebo and nocebo effects and how patients and clinicians understand those effects [5].…”

“…Usage and distribution for commercial purposes requires written permission. DOI: 10.1159/000514435 treatment outcomes that cannot be attributed to active treatment components, but are elicited by positive expectations and/or the psychosocial context in which treatment takes place" [2][3][4]. Thus, our definition and recommendations encompass an integrated approach to healthcare that includes biomedical, psychological, ethical, and philosophical perspectives.…”

“…Two randomised trials suggest that this recommendation might harm patients, for example, those taking statins or those suffering from wind turbine syndrome [7, 8]. Additionally, our consensus statement emphasized the need for guidance on tailoring information to a patient’s specific needs and circumstances [3]. We also highlight the need to explain the mechanisms behind placebo effects, and to replace the term “placebo effect” with alternative terms (e.g., reflecting specific mechanisms) whenever it is deemed helpful.…”

Vermeidbares Leid: Noceboeffekte und die COVID-19-Pandemie

“…So setzten kurz nach Erscheinen von Medienberichten zur Unverträglichkeit von Statinen vor allem ältere Patienten diese Medikamente auch bei langjähriger Einnahme wieder ab [4]. Als eine Gruppe internationaler Experten haben wir vor kurzem Ansätze formuliert, wie Noceboeffekte im klinischen Alltag minimiert werden können [5]. So sollten Behandler und Patienten über die Existenz von Noceboeffekten aufgeklärt werden.…”

Questioning the Consensus on Placebo and Nocebo Effects

“…We read with interest a recent article in Psychotherapy and Psychosomatics reporting the consensus of 27 experts on what should be communicated to patients about placebo and nocebo effects and how clinicians should be trained to deliver this information [1]. The authors propose that communicating general information to patients about placebo and nocebo effects is beneficial but should be adjusted to the context.…”