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

Andrea W M Evers^{1

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; Consortium of Placebo Experts

Affiliations

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.

PMID: 33075796
DOI: 10.1159/000510738

Free article

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

Andrea W M Evers et al. Psychother Psychosom. 2021.

Free article

. 2021;90(1):49-56.

doi: 10.1159/000510738. Epub 2020 Oct 19.

Authors

Affiliations

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.

PMID: 33075796
DOI: 10.1159/000510738

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.

Keywords: Disclosure; Expert consensus; Nocebo effects; Patient-clinician communication; Placebo effects.

PubMed Disclaimer

Comment in

Questioning the Consensus on Placebo and Nocebo Effects.
Hardman D, Hutchinson P, Ongaro G. Hardman D, et al. Psychother Psychosom. 2021;90(3):211-212. doi: 10.1159/000513466. Epub 2020 Dec 30. Psychother Psychosom. 2021. PMID: 33378764 No abstract available.
"Consensus on Placebo and Nocebo Effects Connects Science with Practice:" Reply to "Questioning the Consensus on Placebo and Nocebo Effects".
Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I; on behalf of the Consortium of Placebo Experts. Evers AWM, et al. Psychother Psychosom. 2021;90(3):213-214. doi: 10.1159/000514435. Epub 2021 Feb 25. Psychother Psychosom. 2021. PMID: 33631769 No abstract available.
Comment on Evers et al. "What Should Clinicians Tell Patients about Placebo and Nocebo Effects?": Open-Label Placebos May Reduce Feelings of Hunger during Weight Loss.
Schaefer M, Kühnel A, Enge S. Schaefer M, et al. Psychother Psychosom. 2021;90(6):422-423. doi: 10.1159/000518803. Epub 2021 Aug 25. Psychother Psychosom. 2021. PMID: 34515208 No abstract available.
Talking about Side Effects in Psychotherapy Did Not Impair the Therapeutic Alliance in an Experimental Study.
Muschalla B, Müller J, Grocholewski A, Linden M. Muschalla B, et al. Psychother Psychosom. 2022;91(5):360-362. doi: 10.1159/000524278. Epub 2022 Apr 12. Psychother Psychosom. 2022. PMID: 35413707 No abstract available.

MeSH terms

Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- S. Karger AG, Basel, Switzerland
Other Literature Sources
- figshare - Access datasets and other research materials.

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Comment in

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources