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Meta-Analysis
. 2001 Mar 10;357(9258):757-62.
doi: 10.1016/s0140-6736(00)04169-6.

Influence of context effects on health outcomes: a systematic review

Z Di Blasi  1 , E Harkness, E Ernst, A Georgiou, J Kleijnen
Affiliations
Meta-Analysis

Influence of context effects on health outcomes: a systematic review

Z Di Blasi et al. Lancet. .

Abstract

Background: Throughout history, doctor-patient relationships have been acknowledged as having an important therapeutic effect, irrespective of any prescribed drug or treatment. We did a systematic review to determine whether there was any empirical evidence to support this theory.

Methods: A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. The quality of eligible trials was objectively assessed by two reviewers, and the type of non-treatment care given in each trial was categorised as cognitive or emotional. Cognitive care aims to influence patients' expectations about the illness or the treatment, whereas emotional care refers to the style of the consultation (eg, warm, empathic), and aims to reduce negative feelings such as anxiety and fear.

Findings: We identified 25 eligible randomised controlled trials. 19 examined the effects of influencing patients' expectations about treatment, half of which found significant effects. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients' expectations through positive information about the treatment or the illness, while providing support or reassurance, significantly influenced health outcomes.

Interpretation: There is much inconsistency regarding emotional and cognitive care, although one relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.

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Comment in

  • ACP J Club. 2001 Nov-Dec;135(3):98
  • Examination of context of medicine.
    van Weel C. van Weel C. Lancet. 2001 Mar 10;357(9258):733-4. doi: 10.1016/S0140-6736(00)04176-3. Lancet. 2001. PMID: 11253959 No abstract available.
  • Context and health outcomes.
    Vermiere E, Avonts D, Van Royen P, Buntinx F, Denekens J. Vermiere E, et al. Lancet. 2001 Jun 23;357(9273):2059-60. doi: 10.1016/s0140-6736(00)05153-9. Lancet. 2001. PMID: 11441871 No abstract available.
  • Context and health outcomes.
    Kernick D. Kernick D. Lancet. 2001 Jun 23;357(9273):2060. doi: 10.1016/S0140-6736(00)05154-0. Lancet. 2001. PMID: 11447607 No abstract available.
  • Releasing the grip of big pharma.
    Conti Nibali S, Siracusano MF. Conti Nibali S, et al. Lancet. 2001 Aug 25;358(9282):664. doi: 10.1016/s0140-6736(01)05790-7. Lancet. 2001. PMID: 11545073 No abstract available.

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