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Ko SJ, Kim K, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Ha NY, Lee J, Kelley JM, Park JW, Kim J. Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea. PATIENT EDUCATION AND COUNSELING 2024; 121:108133. [PMID: 38199174 DOI: 10.1016/j.pec.2023.108133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Research suggests that a warm and empathic "patient-centered" patient-clinician relationship produces better clinical outcomes when compared with a more neutral "disease-centered" relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea. METHODS The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale. RESULTS Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes. CONCLUSION Patients demonstrated greater improvement following acupuncture conducted with a more neutral, "disease-centered" style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy. PRACTICE IMPLICATIONS Clinicians should consider cultural differences when applying acupuncture therapy.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Keumji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Braden Kuo
- Gastroenterology Unit, Center for Neurointestinal Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gerber
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Na-Yeon Ha
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Junhee Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychology Department, Endicott College, Beverly, MA, USA
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
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Kebir Y, Saint-Dizier de Almeida V. Identifying the Structural and Functional Dimensions of Chronic Disease Follow-Up Interviews. HEALTH COMMUNICATION 2023; 38:3163-3177. [PMID: 36369904 DOI: 10.1080/10410236.2022.2141040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The structure of medical interviews is a topic that has been extensively investigated in the scientific literature. However, some medical contexts remain unexplored, such as follow-up interviews for chronic diseases, despite being particularly rich in interactional, relational and emotional information. In this study, we set out to extract a hierarchical and functional structure from these medical consultations. The analysis method used was inspired by the methods of discourse analysis developed by the Geneva school of Roulet and colleagues. We recorded, transcribed and analyzed 13 authentic chronic disease follow-up interviews with hospital specialists. Following these analyses, we extracted a functional structure of these interviews with the phases and sequences that compose them. Findings distinguish similarities and disparities between chronic disease follow-up visits and other types of medical visits. Our discussion articulates how these types of patient-physician exchanges are similar to, but also different from, other types of medical interactions in different settings.
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Fatehi A, Brown LE, Versluijs Y, Van Maren K, Ring D, Gonzalez A, Ramtin S. The relationship of perceived empathy with levels of pain intensity and incapability among patients visiting a musculoskeletal specialist. PATIENT EDUCATION AND COUNSELING 2023; 115:107900. [PMID: 37467592 DOI: 10.1016/j.pec.2023.107900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND People that have more intense symptoms and greater incapability might have less rapport with the clinicians that care for them. OBJECTIVE This study tested the hypothesis that perceived clinician empathy is related to pain intensity and magnitude of incapability among people seeing a musculoskeletal specialist. PATIENT INVOLVEMENT After a consult with a musculoskeletal specialist, 211 adult patients completed a survey recording demographics, and measures of pain intensity, incapability, and perceived clinician empathy. RESULTS Higher perceived empathy was associated with being in a committed relationship and, to a modest degree (r = -0.16) lower pain intensity in bivariate and multivariable analyses. DISCUSSION People experiencing greater pain may be slightly less likely to perceive the clinician as empathetic. PRACTICAL VALUE Study of the relationship between the patient's experience of care and patient and clinician personal factors can inform efforts to improve patient experience. Advances may depend on experience measures with more normal distributions and less ceiling effect.
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Affiliation(s)
- Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Laura E Brown
- Center for Health Communication, Moody College of Communication, University of Texas at Austin, 300 W. Dean Keaton, Austin, TX 78712-1069, USA.
| | - Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Koen Van Maren
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Amanda Gonzalez
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
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Perceptions and experiences of a manual therapy trial: a qualitative study of people with moderate to severe COPD. Chiropr Man Therap 2021; 29:27. [PMID: 34315527 PMCID: PMC8314605 DOI: 10.1186/s12998-021-00387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) presents with physical, emotional and social difficulties that affect quality of life. Multimodal management includes both pharmacological and non-pharmacological strategies, and pulmonary rehabilitation (PR) plays an important role. Recent research has suggested that manual therapies may improve perceptions of dyspnea for people with COPD. Methods Focus group interviews were conducted as part of a mixed methods study to assess the feasibility of implementing a manual therapy technique—muscle energy technique (MET)—as an adjunct to PR for people with moderate to severe COPD. Focus group interviews were conducted to examine trial participants views of the intervention and the trial design. A thematic analysis was undertaken to explore the data. Results Twelve participants with moderate to severe COPD participated in three focus groups. Participants were motivated to participate in the trial to be proactive about their health. They perceived MET to be a gentle, comfortable form of stretching that allowed them to ‘breathe easier’ and prepared them for PR. A small number of participants reported mild muscular discomfort during MET, but this was short-lasting and was not bothersome. Participants enjoyed the one-on-one contact with researchers and learned more about their breathing while performing spirometric testing. Most participants wanted longer and more frequent MET sessions, and some requested ‘homework’ stretching exercises. Conclusions The findings of this study show that a manual therapy intervention was received well by participants in a clinical trial setting. A small number of participants reported mild musculoskeletal discomfort in relation to the MET treatment. Participant preferences for additional and longer treatment sessions should be carefully considered against available resources in future clinical trials. Trial registration ANZCTR, ACTRN12618000801213. Registered 11 May 2018 - Retrospectively registered. http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374643&isReview=true Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00387-0.
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Evans K, Colloca L, Pecina M, Katz N. What can be done to control the placebo response in clinical trials? A narrative review. Contemp Clin Trials 2021; 107:106503. [PMID: 34237458 PMCID: PMC8719632 DOI: 10.1016/j.cct.2021.106503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
The desire to reduce high placebo response rates in clinical trials is a popular concept. However, few studies have rigorously examined the effectiveness of methods to control for placebo responses that are relevant to randomized controlled trials. The primary objective of this review was to evaluate the effect of experimental placebo manipulations in randomized controlled trials (RCTs). We critically reviewed studies designed to manipulate placebo responses including positive expectations regarding the effectiveness of the placebo treatment, manipulating the time spent with subjects, and training study staff and subjects to accurately report symptom severity. These efforts have generally resulted in reduced placebo response and improved discrimination between drug and placebo. Interventions that neutralize staff and subject expectations and improve the ability of subjects to accurately report symptom severity have shown the most promise. Reduction of the placebo response has the potential to accelerate the development of new therapeutics.
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Affiliation(s)
- Kathryn Evans
- WCG Analgesic Solutions, Wayland, MA, United States of America.
| | - Luana Colloca
- University of Maryland, School of Nursing & School of Medicine, Baltimore, MD, United States of America
| | - Marta Pecina
- University of Pittsburg School of Medicine, Pittsburg, PA, United States of America
| | - Nathaniel Katz
- WCG Analgesic Solutions, Wayland, MA, United States of America; Tufts University School of Medicine, Boston, MA, United States of America
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Dossett ML, Hall JA, Kaptchuk TJ, Yeh GY. Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits. PATIENT EDUCATION AND COUNSELING 2021; 104:315-321. [PMID: 32811749 PMCID: PMC7855201 DOI: 10.1016/j.pec.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/03/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify differences in patient-physician interactions associated with improvements in GERD symptoms in a randomized controlled trial comparing integrative medicine and primary care/standard visits. METHODS We analyzed video recordings of 2-minute excerpts (thin slices) from the beginning, middle, and end of 21 study visits (11 standard, 10 integrative medicine). RESULTS According to blind coders' analysis of the excerpts, prospective improvement in GERD symptoms was most highly correlated with patients appearing pleased (r = 0.71, p < 0.01) and friendly (r = 0.67, p < 0.01) at the end of the visit, controlling for visit type. The combination of patient and physician smiling at the end of the visit was associated with improvement in GERD symptoms (r2 = 0.45, p = 0.004). The physician in the integrative visits was more engaged (p = 0.009), friendly (p = 0.005), relaxed (p = 0.002), smiled longer (p = 0.006), gazed longer (p = 0.02), and gestured more (p = 0.007), compared to standard visits. Patients in integrative visits also smiled longer (p = 0.004). CONCLUSION The expanded history-taking questions asked by integrative clinicians may enhance relationship building, modifying patients' responses and improving patient-centered behaviors from clinicians,ultimately facilitating symptom improvement. PRACTICE IMPLICATIONS Analysis of nonverbal behaviors may facilitate a better understanding of patient-clinician interactions in integrative medicine visits and yield insights to improve clinical interactions in conventional medicine.
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Affiliation(s)
- Michelle L Dossett
- Division of General Internal Medicine, Geriatrics, and Bioethics, University of California, Davis, Sacramento, USA; Division of General Internal Medicine and Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, USA; Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, USA.
| | - Judith A Hall
- Department of Psychology, Northeastern University, Boston, USA
| | - Ted J Kaptchuk
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Gloria Y Yeh
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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Foley H, Steel A, Adams J. Perceptions of person-centred care amongst individuals with chronic conditions who consult complementary medicine practitioners. Complement Ther Med 2020; 52:102518. [PMID: 32951761 DOI: 10.1016/j.ctim.2020.102518] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Chronic conditions require continuous, multi-factorial care - such as person-centred care - to address patients' individual health needs and quality of life. Many patients with chronic conditions seek additional care outside mainstream medicine, often consulting complementary medicine (CM) practitioners. This study examines person-centred care experienced by patients with chronic conditions consulting CM practitioners. DESIGN Cross-sectional survey. SETTING CM clinics around Australia, conducted November 2018 to March 2019. PARTICIPANTS Patients with chronic conditions (n = 153) consulting osteopaths (n = 39), naturopaths (n = 33), massage therapists (n = 29), chiropractors (n = 28) and acupuncturists (n = 24). MAIN OUTCOME MEASURES Patient-Centred Care Scale, Perceived Provider Support Scale, Empowerment Scale, and Patient Assessment of Chronic Illness Care measure. RESULTS Patient perceptions of person-centred care were consistently high during consultation with CM practitioners (Patient-centred Care scale mean range 4.22-4.70; Perceived Provider Support scale mean range 4.39-4.69; Empowerment scale mean range 2.20-2.50; Patient Assessment of Chronic Illness Care mean summary 3.33). Ratings of person-centred care were higher for consultations with CM practitioners than for medical doctors. Patients of naturopaths reported the highest means for perceived person-centred care. Variation in participant ratings for different items between professions indicate nuance in consultation experiences across different CM professions. CONCLUSIONS Person-centred care appears characteristic of CM consultation, which may reflect holistic philosophies. Variations in patient experiences suggest diverse practices across CM professions. CM practitioners may present a resource of person-centred care for addressing unmet needs of individuals with chronic conditions, and reducing the health burden associated with rising rates of chronic conditions.
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Affiliation(s)
- Hope Foley
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia; Office of Research, Endeavour College of Natural Health, Brisbane, Australia.
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Cotton PB. Why did the sham-treated EPISOD study subjects do so well? Important lessons for research and practice. Gastrointest Endosc 2019; 89:1054-1055. [PMID: 30447217 PMCID: PMC6475602 DOI: 10.1016/j.gie.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/04/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Peter B Cotton
- Digestive Disease Center, MUSC, 114 Doughty St, Suite 258, MSC 702, Charleston, SC 29425, Admin Louise Jones 8438764265,
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Browne PD, den Hollander B, Speksnijder EM, van Wering HM, Tjon A Ten W, George EK, Groeneweg M, Bevers N, Wessels MMS, van den Berg MM, Goede J, Teklenburg-Roord STA, Frankenhuis C, Benninga MA, Vlieger AM. Gut-directed hypnotherapy versus standard medical treatment for nausea in children with functional nausea or functional dyspepsia: protocol of a multicentre randomised trial. BMJ Open 2019; 9:e024903. [PMID: 30975672 PMCID: PMC6500305 DOI: 10.1136/bmjopen-2018-024903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The treatment of chronic functional nausea or nausea due to functional dyspepsia in children is generally symptomatic. Moreover, these disorders pose a risk for worse psychosocial and health outcomes in children. Hypnotherapy (HT), by its ability to positively influence gastrointestinal and psychosocial functioning, may be an effective treatment for chronic nausea. METHODS AND ANALYSIS To test efficacy, this multicentre, parallel, randomised controlled, open label trial evaluates whether gut-directed HT is superior to standard medical treatment (SMT) for reducing nausea. The study will be conducted at eleven academic and non-academic hospitals across the Netherlands. A total of 100 children (8-18 years), fulfilling the Rome IV criteria for chronic idiopathic nausea or functional dyspepsia with prominent nausea, will be randomly allocated (1:1) to receive HT or SMT. Children allocated to the HT group will receive six sessions of HT during 3 months, while children allocated to the SMT group will receive six sessions of SMT+supportive therapy during the same period. The primary outcome will be the difference in the proportion of children with at least 50% reduction of nausea, compared with baseline at 12 months' follow-up. Secondary outcomes include the changes in abdominal pain, dyspeptic symptoms, quality of life, anxiety, depression, school absences, parental absence of work, healthcare costs and adequate relief of symptoms, measured directly after treatment, 6 and 12 months' follow-up. If HT proves effective for reducing nausea, it may become a new treatment strategy to treat children with chronic functional nausea or functional dyspepsia with prominent nausea. ETHICS AND DISSEMINATION Results of the study will be publicly disclosed to the public, without any restrictions, in peer-reviewed journal and international conferences. The study is approved by the Medical Research Ethics Committees United (MEC-U) in the Netherlands. TRIAL REGISTRATION NUMBER NTR5814.
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Affiliation(s)
- Pamela D Browne
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bibiche den Hollander
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Esther M Speksnijder
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Walther Tjon A Ten
- Department of Pediatrics, Maxima Medical Center, Veldhoven, The Netherlands
| | - Elvira K George
- Department of Pediatrics, Northwest Clinics, Alkmaar, The Netherlands
| | - Michael Groeneweg
- Department of Pediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Nanja Bevers
- Department of Pediatrics, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | - Joery Goede
- Department of Pediatrics, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Carla Frankenhuis
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
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Sagy I, Abres J, Winnick A, Jotkowitz A. Placebos in the era of open-label trials: An update for clinicians. Eur J Clin Invest 2019; 49:e13038. [PMID: 30316203 DOI: 10.1111/eci.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022]
Abstract
Placebos have been used extensively by vast numbers of physicians, in a majority of clinical trials. Placebo effects involve behavioural, psychological and genetic factors and have been subject to ethical controversies stemming from the use of deception in treating patients. The patient-physician encounter, endogenous pharmacological pathways, personality traits and genetic diversity have all been reported to be key players in placebo responses. In the last decade, a new methodological paradigm of placebo research has emerged, using open-label placebos to investigate their effects which showed promising results for various common medical conditions. In this review, we will summarize the current body of evidence on placebos in clinical practice, with a view to open-label placebo trials in particular. It is our view that future larger-scale randomized blinded open placebo trials will benefit physicians and improve patient outcomes.
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Affiliation(s)
- Iftach Sagy
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jonathan Abres
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ariel Winnick
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Hamberger J, Meissner K, Hinterberger T, Loew T, Weimer K. Placebo Economics: A Systematic Review About the Economic Potential of Utilizing the Placebo Effect. Front Psychiatry 2019; 10:653. [PMID: 31572237 PMCID: PMC6751772 DOI: 10.3389/fpsyt.2019.00653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Recent research shows that placebo mechanisms can be utilized in ethical and legal ways such as in open-label conditions, when patients know that they receive placebos, and through psychological interventions aiming to optimize patients' expectations. Showing that placebo interventions are also cost-efficient could improve their acceptability. Objective: To review studies that performed health economic evaluations (HEEs) of intentional placebo interventions and to review studies that intentionally applied placebo interventions and reported outcomes eligible for HEEs. Methods: Two systematic reviews of the literature were performed. For the first review, we searched MEDLINE using "placebo" and Medical Subject Headings (MeSH) terms associated with HEEs such as "costs," "cost-benefit analyses," and "economics." Studies were eligible if they employed patients, applied placebo interventions, included an appropriate control group, and reported results of cost analyses. For the second review, we searched the Journal of Interdisciplinary Placebo Studies (JIPS) database and MEDLINE using search terms for outcomes eligible for cost-utility analyses, such as "quality of life" or "quality-adjusted life years" ("QALYs"). Risk of bias of all studies found was assessed according to the Cochrane Handbook, and a narrative synthesis of the results is provided. Results: The first search resulted in 1,853 articles, which were screened for eligibility. Two studies were found only in which costs or cost-effectiveness analysis were reported, but with medium to high risks of biases. The second search yielded 164 articles particularly from the JIPS database of which 11 studies met our search criteria: in six studies, patients received placebo pills in open-label conditions; three studies investigated effects of patient-physician relationships; and two studies used psychological interventions to optimize treatment expectations, in patients with various diseases and disorders. These studies report outcomes potentially eligible for HEEs when costs of interventions were known. Risks of biases were low to medium, but patients were not blinded to the conditions in most studies. Conclusions: The state of knowledge about HEEs of placebo interventions is scarce. To gain more visibility and acceptability for placebo interventions, future studies should measure outcomes usable for HEEs and costs of interventions, and HEEs should be performed for existing studies if data are available.
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Affiliation(s)
- Jens Hamberger
- Department of Psychosomatic Medicine, University Clinic Regensburg, Regensburg, Germany.,Division of Health Promotion, University of Applied Sciences Coburg, Coburg, Germany
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences Coburg, Coburg, Germany.,Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thilo Hinterberger
- Department of Psychosomatic Medicine, University Clinic Regensburg, Regensburg, Germany
| | - Thomas Loew
- Department of Psychosomatic Medicine, University Clinic Regensburg, Regensburg, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
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Hauenstein EJ, Clark RS, Merwin EI. Modeling Health Disparities and Outcomes in Disenfranchised Populations. Community Ment Health J 2019; 55:9-23. [PMID: 30136013 PMCID: PMC8751484 DOI: 10.1007/s10597-018-0326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.
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Affiliation(s)
| | - Rachael S Clark
- University of Delaware, 25 N. College Avenue, Newark, DE, 19716, USA
| | - Elizabeth I Merwin
- School of Nursing, Duke University, 3027A Pearson Building, Durham, NC, 27710, USA
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13
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Polich G, Iaccarino MA, Kaptchuk TJ, Morales-Quezada L, Zafonte R. Placebo Effects in Traumatic Brain Injury. J Neurotrauma 2018; 35:1205-1212. [PMID: 29343158 PMCID: PMC6016098 DOI: 10.1089/neu.2017.5506] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In recent years, several randomized controlled trials evaluating pharmaceutical treatments for traumatic brain injury (TBI) have failed to demonstrate efficacy over placebo, with both active and placebo arms improving at comparable rates. These findings could be viewed in opposing ways, suggesting on the one hand failure of the tested outcome, but on the other, representing evidence of robust placebo effects in TBI. In this article, we examine several of the primary psychological processes driving placebo effects (verbal suggestion, cognitive re-framing, interpersonal interactions, conditioning, therapeutic alliance, anxiety reduction) as well as placebo neurobiology (top-down cortical regulation, reward system activation, dopaminergic and serotonergic neurotransmission). We then extrapolate from the literature to explore whether something inherent in TBI makes it particularly responsive to placebos. Viewed as such here, placebos may indeed represent a powerful and effective treatment for a variety of post-TBI complaints.
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Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
- Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
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Necka EA, Atlas LY. The Role of Social and Interpersonal Factors in Placebo Analgesia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 138:161-179. [PMID: 29681323 DOI: 10.1016/bs.irn.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Placebo effects are beneficial clinical outcomes that emerge as a result of nonspecific contextual factors, transmitted primarily by the treating physician and the social, physical, and behavioral cues he or she displays. The patient-provider therapeutic alliance is critical for determining placebo effects and health outcomes. In this chapter, we review the recent literature, suggesting that provider social characteristics modulate placebo and clinical outcomes. We highlight the importance of studying not only the provider but also the patient's perception of the provider, which is subject to the influence of the patient's psychosocial orientation, such as their psychosocial motivations and perceptions of their interpersonal relationships broadly. We argue that psychosocial orientation can exaggerate the influence of the patient-provider relationship on placebo effects and can directly affect the likelihood of placebo effects emerging by modulating the underlying biological systems that support them. Here, we examine patient loneliness, or perceived social isolation, as a case example for understanding how patients' psychosocial orientation may affect placebo effects across diseases. We propose psychosocial mechanisms by which loneliness might modulate placebo effects across medical outcomes, and focus in particular on how loneliness might specifically alter behaviorally conditioned immune responses and placebo analgesia. Future studies should directly measure social factors to formally test the effects of social isolation on placebo effects and better elucidate the role of psychosocial and interpersonal factors in placebo effects and clinical outcomes.
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Affiliation(s)
- Elizabeth A Necka
- Section on Affective Neuroscience and Pain, National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States.
| | - Lauren Y Atlas
- Section on Affective Neuroscience and Pain, National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States; National Institute on Drug Abuse, NIH, Bethesda, MD, United States
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15
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The Placebo Effect in Cardiology: Understanding and Using It. Can J Cardiol 2017; 33:1535-1542. [DOI: 10.1016/j.cjca.2017.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/18/2022] Open
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16
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Ko SJ, Park JW, Leem J, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Dimisko L, Yeo I, Lee J, Kim J. Influence of the patient-practitioner interaction context on acupuncture outcomes in functional dyspepsia: study protocol for a multicenter randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:363. [PMID: 28709452 PMCID: PMC5513038 DOI: 10.1186/s12906-017-1869-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the treatment of functional dyspepsia, the placebo effect has been reported to be high, and the influence of the patient-practitioner relationship may be a major component of this effect. The specific and non-specific effects of acupuncture cannot be easily distinguished, and the patient-practitioner relationship may influence the total therapeutic effect in clinical practice. There have been no studies that investigate the influence of patient-practitioner relationship on acupuncture treatment for patients with functional dyspepsia. METHODS Patients with postprandial distress syndrome, a functional dyspepsia subtype, will be recruited at three hospitals (two in Korea and one in USA) for an international, multi-center, randomized, patient/assessor-blinded, clinical trial. The total anticipated sample size is 88. The participants will be randomly allocated into two groups: an augmented interaction group and a limited interaction group. Acupuncture, with total 12 acupoints, will be performed twice weekly for 4 weeks in both groups. Trained practitioners will provide an "augmented" or "limited" interaction context, as determined by random allocation. The primary outcome measure is the proportion of responders, the proportion of participants who answer "yes" to more than half of the adequate relief questions during the study. Secondary outcome measures include questionnaires for quality of life and symptoms of dyspepsia, and maximum tolerable volume of nutrient drink test. Data will be collected at baseline and following 4 weeks of acupuncture. DISCUSSION This study will evaluate the influence of the patient-practitioner interaction on clinical effects of acupuncture in patients with functional dyspepsia. TRIAL REGISTRATION CRIS Identifier: ( KCT0002229 ).
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Foley H, Steel A. Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Mathie RT, Ramparsad N, Legg LA, Clausen J, Moss S, Davidson JRT, Messow CM, McConnachie A. Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2017; 6:63. [PMID: 28340607 PMCID: PMC5366148 DOI: 10.1186/s13643-017-0445-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/24/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A rigorous systematic review and meta-analysis focused on randomised controlled trials (RCTs) of non-individualised homeopathic treatment has not previously been reported. We tested the null hypothesis that the main outcome of treatment using a non-individualised (standardised) homeopathic medicine is indistinguishable from that of placebo. An additional aim was to quantify any condition-specific effects of non-individualised homeopathic treatment. METHODS Literature search strategy, data extraction and statistical analysis all followed the methods described in a pre-published protocol. A trial comprised 'reliable evidence' if its risk of bias was low or it was unclear in one specified domain of assessment. 'Effect size' was reported as standardised mean difference (SMD), with arithmetic transformation for dichotomous data carried out as required; a negative SMD indicated an effect favouring homeopathy. RESULTS Forty-eight different clinical conditions were represented in 75 eligible RCTs. Forty-nine trials were classed as 'high risk of bias' and 23 as 'uncertain risk of bias'; the remaining three, clinically heterogeneous, trials displayed sufficiently low risk of bias to be designated reliable evidence. Fifty-four trials had extractable data: pooled SMD was -0.33 (95% confidence interval (CI) -0.44, -0.21), which was attenuated to -0.16 (95% CI -0.31, -0.02) after adjustment for publication bias. The three trials with reliable evidence yielded a non-significant pooled SMD: -0.18 (95% CI -0.46, 0.09). There was no single clinical condition for which meta-analysis included reliable evidence. CONCLUSIONS The quality of the body of evidence is low. A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions. Better designed and more rigorous RCTs are needed in order to develop an evidence base that can decisively provide reliable effect estimates of non-individualised homeopathic treatment.
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Affiliation(s)
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynn A Legg
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | | | - Sian Moss
- Homeopathy Research Institute, London, UK
| | - Jonathan R T Davidson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Claudia-Martina Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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19
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Foley H, Steel A. Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience. PATIENT EDUCATION AND COUNSELING 2017; 100:212-223. [PMID: 27693375 DOI: 10.1016/j.pec.2016.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This review aims to describe the prevalence of empathy, empowerment and patient-centred clinical care experienced by patients in complementary medicine (CM) consultations. METHODS A systematic review was undertaken of original research exploring patient perceptions of CM clinical care. Ten databases were searched: Alt HealthWatch, AMED, CINAHL Plus, MEDLINE Complete, Cochrane Library, PubMed, Proquest Medical Collection, PsycInfo, Social Sciences Citation Index and Psychology Collection. Studies were included which reported patient perceptions of consultation with CM practitioners and were excluded where experimental methods controlled the nature of consultation processes. RESULTS Findings of included studies (n=34) were categorised under the a priori themes of empathy, empowerment and patient-centred care. This produced a substantial pool of qualitative data detailing patient-reported experiences which consistently confirmed occurrence of these themes in CM consultation. Quantitative data was correlative, yet was insufficient to definitively describe prevalence of such experiences. CONCLUSION While it is evident that CM consultations provide a patient experience of empathy, empowerment and patient-centredness, further research is warranted to quantify this experience before it can be defined as characteristic of CM clinical care. PRACTICE IMPLICATIONS This review draws attention to the potential role of CM as a resource for patients' psychosocial health needs.
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Affiliation(s)
- Hope Foley
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia.
| | - Amie Steel
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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20
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Davidson J, Jonas W. Individualized Homeopathy: A Consideration of Its Relationship to Psychotherapy. J Altern Complement Med 2016; 22:594-8. [PMID: 27285053 DOI: 10.1089/acm.2015.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The benefit and potential mechanisms of action of homeopathy have long been debated. Almost entirely neglected has been the study of individualized homeopathy (IH) as a form of psychotherapy, which incorporates factors that are common to most therapies while using processes that are specific to IH. METHODS Recent research into the therapeutic components of IH is reviewed; similarities and differences between IH and other forms of psychotherapy are also described. RESULTS IH includes elements found in humanistic therapy and narrative medicine and additionally incorporates idiographic material in treatment selection. It is structured in a manner that takes maximum advantage of the components of the placebo effect, which could further expand its effectiveness beyond those conditions thought usually amenable to psychotherapy. CONCLUSIONS It is possible that IH entails specific psychotherapeutic processes in addition to possible therapeutic action of the homeopathic remedy, but the relative contributions of each remain to be determined. Suggestions are given for future research.
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Affiliation(s)
- Jonathan Davidson
- 1 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, NC
| | - Wayne Jonas
- 2 Samueli Institute, Georgetown School of Medicine and Uniformed Services University , Alexandria, VA
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21
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Dossett ML, Davis RB, Kaptchuk TJ, Yeh GY. Homeopathy Use by US Adults: Results of a National Survey. Am J Public Health 2016; 106:743-5. [PMID: 26890179 PMCID: PMC4816083 DOI: 10.2105/ajph.2015.303025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 01/09/2023]
Abstract
We used the 2012 National Health Interview Survey to compare homeopathy users with supplement users and those using other forms of complementary and integrative medicine. Among US adults, 2.1% used homeopathy within the past 12 months. Respiratory and otorhinolaryngology complaints were most commonly treated (18.5%). Homeopathy users were more likely to use multiple complementary and integrative medicine therapies and to perceive the therapy as helpful than were supplement users. US homeopathy use remains uncommon; however, users perceive it as helpful.
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Affiliation(s)
- Michelle L Dossett
- All of the authors were with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, when this work was performed. Roger B. Davis is also with the Harvard T. H. Chan School of Public Health, Boston, MA. Ted J. Kaptchuk is also with the Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
| | - Roger B Davis
- All of the authors were with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, when this work was performed. Roger B. Davis is also with the Harvard T. H. Chan School of Public Health, Boston, MA. Ted J. Kaptchuk is also with the Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
| | - Ted J Kaptchuk
- All of the authors were with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, when this work was performed. Roger B. Davis is also with the Harvard T. H. Chan School of Public Health, Boston, MA. Ted J. Kaptchuk is also with the Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
| | - Gloria Y Yeh
- All of the authors were with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, when this work was performed. Roger B. Davis is also with the Harvard T. H. Chan School of Public Health, Boston, MA. Ted J. Kaptchuk is also with the Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
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