What Should Clinicians Tell Patients about Placebo and Nocebo Effects?
This 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. 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.
Practical Considerations Based on Expert Consensus
Informing patients about placebo and nocebo effects
- Patients should be informed that placebo effects are beneficial effects, represent a genuine reaction of the body that promotes healing and treatment response, are inherent to any treatment and that anyone can experience them.
- Patients should be informed about the potential role of nocebo effects in increasing adverse effects.
- Patients should receive information about the underlying psychological and neurobiological mechanisms of placebo and nocebo effects, such as associative learning and expectations.
- Information provided to patients about placebo and nocebo effects should be evidence-based and not overstate the scale of placebo effects. When informing about nocebo effects, care should be taken to avoid inadvertently eliciting iatrogeny
- How patients are informed about placebo and nocebo effects should be tailored to specific circumstances, patients and health care contexts
- When informing patients, the terms placebo and nocebo effects as well as related terms to explain the mechanisms (e.g., expectations, trust and fear of side effects) should be used.
Training clinicians to communicate about placebo and nocebo effects
- Training of clinicians to communicate about placebo and nocebo effects should include an outline of the effects and clinical implications of both placebo and nocebo effects for different conditions as well as the underlying neurobiological and psychological mechanisms.
- Training should emphasize the need for tailoring information to the specific needs of individual patients, the type of treatment and the context in which it is offered, incorporating ethical considerations regarding informing patients about placebo and nocebo effects.
- Training should emphasize what clinicians can do to maximize placebo effects and minimize nocebo effects.
- Training should make use different formats to inform clinicians about placebo and nocebo effects (e.g., face-to-face, online assignments and written information).