NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Faculty of Health Science, University College of Southeast Norway, PO Box 7053, NO-3007 Drammen, Norway.
Patient Educ Couns. 2017 Aug;100(8):1482-1489. doi: 10.1016/j.pec.2017.03.009. Epub 2017 Mar 6.
To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.
Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.
Positive affect-oriented communication reduced anxiety (p<0.001), negative mood (p=0.001), and increased satisfaction (p<0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p<0.001) and outcome expectancies (p<0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001).
Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best.
Continued medical training is needed to harness placebo-effects of medical communication into practice.
实验测试医生的情感导向沟通和诱导期望对月经疼痛患者结果的影响。
使用 2×2 RCT 设计，使用四个录像模拟医疗咨询，描绘了一名医生和一名月经疼痛患者。在视频中，操纵了医生沟通的两个要素：（1）情感导向沟通（积极：热情、同理心；消极：冷淡、正式），和（2）结果预期诱导（积极与不确定）。参与者（293 名月经疼痛女性）作为模拟患者，观看了四个视频之一。参与者在观看视频前后评估了结果（焦虑、情绪、自我效能感、结果期望和满意度）。
与消极情感导向沟通相比，积极情感导向沟通降低了焦虑（p<0.001）、消极情绪（p=0.001），并增加了满意度（p<0.001）。积极的期望增加了自我效能感（p<0.001）和结果期望（p<0.001），与不确定的期望相比，但没有降低焦虑。积极情感导向沟通和积极期望的组合降低了焦虑（p=0.02），增加了结果期望（p=0.01）和满意度（p=0.001）。
富有同理心和诱导积极期望具有独特且联合的效果，表明两者都需要为了最佳效果影响患者的结果。
需要继续进行医学培训，将医学沟通的安慰剂效应应用于实践。
