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Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

ABSTRACT: OBJECTIVE:Research on placebo/nocebo effects suggests that expectations can influence treatment outcomes, but placebo/nocebo effects are not always evident. This research demonstrates that a provider's social behavior moderates the effect of expectations on physiological outcomes. METHODS:After inducing an allergic reaction in participants through a histamine skin prick test, a health care provider administered a cream with no active ingredients and set either positive expectations (cream will reduce reaction) or negative expectations (cream will increase reaction). The provider demonstrated either high or low warmth, or either high or low competence. RESULTS:The impact of expectations on allergic response was enhanced when the provider acted both warmer and more competent and negated when the provider acted colder and less competent. CONCLUSION:This study suggests that placebo effects should be construed not as a nuisance variable with mysterious impact but instead as a psychological phenomenon that can be understood and harnessed to improve treatment outcomes. (PsycINFO Database Record

SUBMITTER: Howe LC

PROVIDER: S-EPMC7608626 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

Howe Lauren C LC Goyer J Parker JP Crum Alia J AJ

Health psychology : official journal of the Division of Health Psychology, American Psychological Association 20170309 11

<h4>Objective</h4>Research on placebo/nocebo effects suggests that expectations can influence treatment outcomes, but placebo/nocebo effects are not always evident. This research demonstrates that a provider's social behavior moderates the effect of expectations on physiological outcomes.<h4>Methods</h4>After inducing an allergic reaction in participants through a histamine skin prick test, a health care provider administered a cream with no active ingredients and set either positive expectation ...[more]

PMID: 28277699

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Project description:BackgroundPhysician characteristics and perceptions and their effect on choice of therapies for patients with thyroid cancer have been well studied. Some data also exist about physician characteristics and prescribing treatment for subclinical hypothyroidism. The effect of physician characteristics on prescribing thyroid preparations for treating overt hypothyroidism is less studied.MethodsMembers of the American Thyroid Association were surveyed in 2017. Physicians were presented with 13 different theoretical patients with hypothyroidism and asked to choose among six therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and liothyronine monotherapy. The 13 patient scenarios incorporated parameters that potentially provide reasons for considering combination therapy (presence of symptoms, low serum triiodothyronine concentration, and documentation of deiodinase polymorphisms). Repeated-measures logistic regression analysis was performed to examine the prescribing of the various therapies. Data regarding the responding physicians were also collected. These data included number of years in practice, country of practice, and specialty. Multivariate repeated-measures logistic regression analysis of prescribing patterns was also conducted controlling for all patient and physician characteristics.ResultsOf the 389 survey respondents, 93% prescribed therapy for hypothyroidism. Fifty-three percent of respondents had been in practice for >20 years, and 23% had been in practice for 11-20 years. Sixty-four percent practiced in North America, and 18% practiced in Europe. Eight-six percent were endocrinologists, and 5% were surgeons. In multivariate analysis, physicians from North America were both more likely to prescribe any triiodothyronine-containing therapies (odds ratio [OR]?=?1.8 [confidence interval (CI) 1.3-2.4]) and more likely to add liothyronine to levothyroxine therapy (OR?=?1.9 [CI 1.2-2.9]). In addition, they were more likely to prescribe desiccated thyroid extract or liothyronine monotherapy (OR?=?1.7 [CI 1.0-2.9]).ConclusionsA previous analysis of this survey showed that patient characteristics profoundly affect physician prescribing patterns. The current multivariate analysis shows that physician characteristics affect prescribing patterns. Whether this is due to impact upon physicians of patient-related experiences, media exposure, influence from pharmaceutical companies, educational activities, or other concerns cannot be determined. However, these results have potential importance for understanding physician-patient interactions at a time when the benefits and risks of triiodothyronine-containing therapies have not been fully documented.

Project description:BackgroundMost endocrinologists encounter patients who are dissatisfied with their current hypothyroidism therapy and request combination therapy with either liothyronine (LT3) or thyroid extract.MethodsA survey of American Thyroid Association members was conducted in 2017. Respondents were presented with 13 scenarios describing patients with hypothyroidism and were asked to choose among six therapeutic options. The index patient was satisfied taking levothyroxine (LT4) therapy. Twelve variations introduced parameters that potentially provide reasons for considering combination therapy (presence of symptoms, low serum triiodothyronine concentration, documentation of deiodinase polymorphisms). Therapeutic options included (i) continuing LT4, (ii) increasing LT4, (iii) adding LT3 to a reduced LT4 dose, (iv) adding LT3 to the current LT4 dose, (v) replacing LT4 with thyroid extract, and (vi) replacing LT4 with LT3. Repeated-measures logistic regression analysis was performed to examine both the prescribing of LT4 (options i and ii) versus all other therapies and the choice of continuing LT4 (option i) versus either increasing LT4 (option ii), adding LT3 (options iii and iv), or replacing LT4 with thyroid extract or LT3 (options v and vi).ResultsOf the 389 survey respondents, 363 physicians prescribed therapy for hypothyroidism. For the index patient, 98% of physicians continued current LT4 therapy. However, as the patient scenario incorporated other patient characteristics, physicians opted to increase LT4 dose or prescribe other therapies. The tendency to prescribe alternative therapies was powerfully increased by patient symptoms (odds ratio = 25.6 [confidence interval 9-73], p < 0.0001). Older age and the presence of a comorbidity reduced the likelihood that an alternative therapy was prescribed (p = 0.0002 and <0.0001, respectively). All other characteristics, except athyreotic status, patient sex, and body mass index, significantly increased the likelihood that alternative therapies would be prescribed in multivariate analyses (p < 0.0001).ConclusionsEven with the acknowledged limitations of survey methodology, this analysis appears to show a marked increase in the willingness of physicians to prescribe combination therapy in specific circumstances. If current prescribing patterns do incorporate the use of therapies other than LT4, there is a critical need for more research into the benefits and risks of these therapies.

Project description:BackgroundThe tension in doctor-patient relationships is becoming progressively greater due to the high expectations of patients and the physicians' work pressure. Recent studies have addressed factors which affect the tension of doctor-patient relationships, and our study continues this trend by looking at the influence of resiliency and physician trust in the patient (PTP), that is, how much the doctor trusts the patient.MethodsBased on a survey of 329 physicians, a descriptive analysis of measured data was done using SPSS 19.0. Pearson correlation coefficient analysis was used to examine the correlation between PTP and resilience and the demographic variables. KMO and Bartlett methods were used to examine the correlation between PTPS and resilience. The method of factor analysis was used for multicollinearity tests, and multiple stepwise regression analysis was used to explore the demographic factors correlated with PTP and resilience.ResultOur results indicate that the level of PTP is influenced by the age, education, and income of the doctors. Physician age and income are significantly and positively correlated with PTP, but education is significantly and negatively related. Age, education, and income also affect the level of psychological resilience of physicians. Resilience is positively correlated with age and education but is negatively related to income. Resilience positively influences PTP.ConclusionThe direct factors of PTP include resilience, age, education, and income, while gender, title, and hospital department were found to be indirect influencing factors. To meet goals expressed in Chinese government policy related to these issues, we suggest improving the level of education of the doctors, providing reasonable annual salary increases for doctors, easing the tensions involved in medical treatment, reducing the physicians' work pressure, improving the physicians' work environment, and enhancing the physicians' professional sympathy. Through such measures, the level of PTP will be enhanced.

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Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

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Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

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