The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects: a discussion paper

Abstract

Introduction:Placebo and nocebo effects represent one of the most fascinating topics in the health care field.Objectives:the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research.Methods:a narrative review was conducted based on the available evidence.Results:Placebo responses (from Latin “I shall please”) are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin “I shall harm”), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context.Conclusion:Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date.

What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus

“…Training could, moreover, emphasize that different patients might require different information, and that placebo and nocebo effects can operate differently for different conditions. Finally, an emphasis should be placed on what clinicians can do to maximize placebo effects and minimize nocebo effects (i.e., deploying strategies such as optimizing verbal and nonverbal communication [15,[30][31][32][33][43][44][45][46][47][48][49][50][51][52]).…”

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

“…The therapeutic encounter is strongly characterized by CFs such as a) the clinicians’ beliefs and behaviors; b) the patients’ expectations and his/her previous experiences; c) the colour and the shape of the intervention; d) the verbal and non-verbal element of communication; and e) the ornaments and the colour of the healthcare setting (2). A robust body of evidence informs clinicians about the positive impact of CFs on therapeutic outcomes such as pain, disability, satisfaction, and perceived quality in different healthcare field as medicine, nursing, physiotherapy, musculoskeletal, and neurological rehabilitation (2, 20–23). As a consequence, a recent experts consensus suggested the adoption of CFs to stimulate placebo effects and to avoid nocebo effects, thus increasing the overall effectiveness of established evidence-based interventions (24).…”

How do placebo effects and patient-clinician relationships influence behaviors and clinical outcomes?

“…Placebo and nocebo effects were tested using a medium-intensity pain stimulus, and in this phase, the differences in movement choices across contexts disappeared, despite pain expectations remaining stable. Placebo effects occurred within the low cost of avoidance context, 15 suggesting that operant learning can shape pain-related avoidance behaviour with acquired pain beliefs that can be resistant to disconfirmation, despite self-initiated movements and contingencies.…”

“…Other factors discussed include the role of expectations, desire for pain relief, and anxiety in pain-relieving intervention such as medial branch radiofrequency neurotomy low back pain patients, 8 an online method of placebo manipulation, 17 and operant conditioning with avoidance movements. 10 The reviews describe the need for encouraging education about contextual and placebo effects in nursing, 15 strategies to minimize nocebo effects, 12 and relevance of placebo effects for central nervous system (CNS) disorders. 13 Together, this collection of innovative studies provides a diverse snapshot of the clinical relevance of placebo and nocebo effects and, most importantly, how health practitioners might harness them to improve health outcomes.…”

“…Knowledge on placebo and nocebo effects can positively influence nursing education, administration, clinical practice, and research as outlined by Palese who elucidated and debated the contextual factors that can trigger placebo and nocebo effects and their impact on nursing arena. 15…”