Andrea W M Evers1,2, Luana Colloca3, Charlotte Blease4, Jens Gaab5, Karin B Jensen6, Lauren Y Atlas7, Chris J Beedie8, Fabrizio Benedetti9, Ulrike Bingel10, Christian Büchel11, Jet Bussemaker12, Ben Colagiuri13, Alia J Crum14, Damien G Finniss15, Andrew L Geers16, Jeremy Howick17, Regine Klinger18, Stefanie H Meeuwis19, Karin Meissner20, Vitaly Napadow21, Keith J Petrie22, Winfried Rief23, Ionica Smeets24, Tor D Wager25, Vishvarani Wanigasekera26, Lene Vase27, John M Kelley28, Irving Kirsch28. 1. Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, a.evers@fsw.leidenuniv.nl. 2. Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands, a.evers@fsw.leidenuniv.nl. 3. Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA. 4. General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 5. Faculty of Psychology, University of Basel, Basel, Switzerland. 6. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. 7. 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. 8. School of Psychology, University of Kent, Canterbury, United Kingdom. 9. Physiology and Neuroscience, University of Turin Medical School, Turin, Italy. 10. Department of Neurology, University Hospital Essen, Essen, Germany. 11. Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 12. Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. 13. School of Psychology, University of Sydney, Sydney, New South Wales, Australia. 14. Department of Psychology, Stanford University, Stanford, California, USA. 15. Royal North Shore Hospital, Sydney, New South Wales, Australia. 16. Department of Psychology, University of Toledo, Toledo, Ohio, USA. 17. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. 18. Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 19. Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands. 20. Division of Health Promotion, University of Applied Sciences, Coburg, Germany. 21. Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA. 22. Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. 23. Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany. 24. Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands. 25. Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA. 26. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. 27. Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark. 28. Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA.
Abstract
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.
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.