安慰剂处方何时以及为何是可接受和不可接受的：一项关于患者观点的焦点小组研究
When and why placebo-prescribing is acceptable and unacceptable: a focus group study of patients' views.
作者信息
Bishop Felicity L, Aizlewood Lizzi, Adams Alison E M
机构信息
Centre for Applications of Health Psychology, University of Southampton, Southampton, Hampshire, United Kingdom.
Department of Biology, Northern Arizona University, Flagstaff, Arizona, United States of America.
出版信息
PLoS One. 2014 Jul 9;9(7):e101822. doi: 10.1371/journal.pone.0101822. eCollection 2014.
BACKGROUND
Surveys of doctors suggest that they use placebos and placebo effects clinically to help patients. However, patients' views are not well-understood. We aimed to identify when and why placebo-prescribing in primary care might be acceptable and unacceptable to patients.
METHODS
A purposive diverse sample of 58 English-speaking adults (18 men; aged 19-80 years) participated in 11 focus groups. Vignettes describing doctors prescribing placebos in primary care were used to initiate discussions. Data were analyzed inductively.
RESULTS
Participants discussed diverse harms and benefits of placebo-prescribing for individual patients, carers, healthcare providers, and society. Two perspectives on placebo-prescribing were identified. First, the "consequentialist" perspective focused on the potential for beneficial outcomes of placebo-prescribing. Here, some participants thought placebos are beneficial and should be used clinically; they often invoked the power of the mind or mind-body interactions. Others saw placebos as ineffective and therefore a waste of time and money. Second, the "respecting autonomy" perspective emphasized the harms caused by the deceptive processes thought necessary for placebo-prescribing. Here, participants judged placebo-prescribing unacceptable because placebo-prescribers deceive patients, thus a doctor who prescribes placebos cannot be trusted and patients' autonomy is compromised. They also saw placebo-responders as gullible, which deterred them from trying placebos themselves. Overall, the word "placebo" was often thought to imply "ineffective"; some participants suggested alternative carefully chosen language that could enable doctors to prescribe placebos without directly lying to patients.
CONCLUSIONS
Negative views of placebos derive from beliefs that placebos do not work and/or that they require deception by the doctor. Positive views are pragmatic in that if placebos work then any associated processes (e.g. mechanisms, deception) are deemed unimportant. Public education about placebos and their effects is warranted and research to identify optimal ways of harnessing placebo effects in clinical practice is needed.
背景
对医生的调查表明，他们在临床中使用安慰剂及安慰剂效应来帮助患者。然而，患者的看法却未得到充分理解。我们旨在确定在基层医疗中开具安慰剂处方何时以及为何会被患者接受或不被接受。
方法
一项针对58名讲英语的成年人（18名男性；年龄在19至80岁之间）的有目的的多样化样本参与了11个焦点小组。使用描述医生在基层医疗中开具安慰剂处方的 vignettes 来引发讨论。对数据进行归纳分析。
结果
参与者讨论了开具安慰剂处方对个体患者、护理人员、医疗保健提供者和社会的各种危害和益处。确定了关于开具安慰剂处方的两种观点。首先，“结果主义”观点关注开具安慰剂处方产生有益结果的可能性。在此，一些参与者认为安慰剂是有益的，应该在临床上使用；他们经常援引心理的力量或身心相互作用。另一些人则认为安慰剂无效，因此是浪费时间和金钱。其次，“尊重自主性”观点强调开具安慰剂处方被认为所必需的欺骗过程所造成的危害。在此，参与者认为开具安慰剂处方是不可接受的，因为开具安慰剂的医生欺骗患者，因此开安慰剂的医生不可信，患者的自主性受到损害。他们还认为对安慰剂有反应的人容易上当受骗，这使他们自己不敢尝试安慰剂。总体而言，“安慰剂”这个词常被认为意味着“无效”；一些参与者建议精心选择替代语言，使医生能够开具安慰剂而无需直接对患者说谎。
结论
对安慰剂的负面看法源于认为安慰剂不起作用和/或需要医生欺骗的信念。正面看法则较为务实，即如果安慰剂有效，那么任何相关过程（如机制、欺骗）都被认为不重要。有必要对公众进行关于安慰剂及其效应的教育，并且需要开展研究以确定在临床实践中利用安慰剂效应的最佳方法。
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