The Nocebo Effect by Michael Bernstein

Author:Michael Bernstein
Language: eng
Format: epub
Publisher: Mayo Clinic Press
Published: 2024-01-15T00:00:00+00:00

Information Strategies

How can clinicians minimize nocebo effects by considering the information they give to patients? Perhaps the simplest and most straightforward strategy, at least in theory, is to eliminate the harmful thing altogether, as Chapter 7 discussed—that is, to simply omit side effect information. If we do not provide information about side effects, then that information cannot cause nocebo effects and harm the patient.

In fact, this strategy seems to be highly effective at minimizing nocebo effects. A systematic review investigating different strategies for minimizing nocebo effects found that omitting side effect information was the most effective.2 An example of how effective it can be to omit such information is evident in a classic nocebo study, described in Chapter 1, in which 120 patients who had been prescribed finasteride—a medicine that treats benign prostate enlargement—were split into two groups.3 Patients in the no-information group reported a smaller proportion of sexual side effects compared to patients who had been informed of these potential side effects during the informed consent process (15 percent vs. 44 percent).

Although omission seems highly effective, its use in real-world patient-clinician situations is obviously problematic. It violates the ethical principle of respect for patient autonomy, which states that patients have a right to be fully informed about a treatment so that they can make an informed decision about whether to agree to the treatment. Nevertheless, regardless of the ethical perspective, as Marco Annoni noted, we need to ask what patients themselves want to know in such a situation. If in fact it turned out that most patients did not really want any information about side effects, then perhaps we could disregard the ethical principle. However, several surveys asking just that show that the majority of patients want to be fully informed about potential side effects.4 Although some patients say they prefer limited or no side effect information, these belong to the minority. Thus, omitting side effect information, while effective at minimizing nocebo effects, would go against the wishes of the majority of patients.

However, let us for a moment dwell on the minority of patients who prefer to have limited or even no knowledge of potential side effects. Could the clinician then consider omitting such information when interacting with this particular group of patients? Perhaps, if they used the method of authorized concealment,5 discussed in Chapter 7. To recap: with this strategy, the clinician is open about the fact that the treatment could come with some side effects, but does not mention which ones. Additionally, the list of potential side effects could be written down and put inside a sealed envelope for the patient to keep (and eventually open in case they changed their mind and wanted to know about the specific side effects after all). Yet omission of side effect information, even through authorized concealment, presents another problem: patients should know which symptoms are to be expected but pose no great risk and which symptoms warrant contacting the clinician. One work-around would be for the patient to designate someone (say, their spouse or roommate) with whom they share all their symptoms.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.