Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross‐sectional study

Abstract

Aims and objectives To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design A national cross‐sectional survey, according to the Checklist for Reporting Results of Internet E‐Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case‐by‐case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88–2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence‐based nursing interventions. Relevance to clinical practice The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

The Knowledge of Contextual Factors as Triggers of Placebo and Nocebo Effects in Patients With Musculoskeletal Pain: Findings From a National Survey

“…A survey instrument which included questions and clinical vignettes was developed adapting a previous survey on CFs performed among Italian physical therapists and nursing by our research group (50, 51). Questions and clinical vignettes were linguistically adapted to facilitate patient’s understanding and answers by the research group.…”

Matching actual treatment with patient administration-route-preference improves analgesic response among acute low back pain patients—a randomized prospective trial

“…It is currently accepted that the placebo response refers to the physiological processes experienced following the recognition of being treated, and not as a result of the inert procedure in itself [3]. Therefore, many medical treatments or medical rituals themselves may include a component of placebo response [7].…”

“…Prior experience, knowledge, and beliefs that shape positive expectations and conditioning are known to be key components in the placebo response [7] and are also involved in the formation of treatment preference [8], wherein preference can relate to both the type of medication and the mode of its delivery. While medication preference has been studied in this context in the past, the individualized ARP and analgesic ARP have been investigated far less [2,9,10].…”

Matching actual treatment with patient administration-route-preference improves analgesic response among acute-low-back-pain patients

“…Therefore, many medical treatments or medical rituals themselves may include a component of placebo response 7 .…”

“…Prior experience, knowledge and beliefs that shape positive expectations and conditioning, are known to be key components in the placebo response 7 and are also involved in the formation of treatment preference 8 which can relate to both the type of medication and the mode of its delivery. While medication preference has been studied in this context in the past, the individualized administration route preference (ARP) , and analgesic ARP have been investigated far less 2,9,10 .…”