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. 2021 Aug 24:2:721222.
doi: 10.3389/fpain.2021.721222. eCollection 2021.

Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations

Kirsten A Smith  1 , Jane Vennik  1 , Leanne Morrison  1   2 , Stephanie Hughes  1 , Mary Steele  1 , Riya Tiwari  1   2 , Jennifer Bostock  3 , Jeremy Howick  4 , Christian Mallen  5 , Paul Little  1 , Mohana Ratnapalan  1 , Emily Lyness  1 , Pranati Misurya  2 , Geraldine M Leydon  1 , Hajira Dambha-Miller  1 , Hazel A Everitt  1 , Felicity L Bishop  2
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Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations

Kirsten A Smith et al. Front Pain Res (Lausanne). .

Abstract

Background: Empathic communication and positive messages are important components of "placebo" effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention-"Empathico"-to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations. Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization. Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities. Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.

Keywords: clinical empathy; doctor patient communication; optimism; osteoarthritis; pain; placebo effects; primary medical care; qualitative research.

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Conflict of interest statement

CDM has supported BMS to recruit to a non-pharmacological atrial fibrillation trial. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of studies and activities conducted within the intervention planning and optimization phases of Empathico's development.
Figure 2
Figure 2
The evidence-base for the planned contents of Empathico training on clinical empathy and realistic optimism.
Figure 3
Figure 3
Overview of the Empathico structure and contents.
Figure 4
Figure 4
Logic model for Empathico.
See this image and copyright information in PMC

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