Pain Management Research Institute, The University of Sydney, Sydney, NSW, Australia.
Fuqua School of Business, Duke University, Durham, NC, United States.
Int Rev Neurobiol. 2018;139:159-190. doi: 10.1016/bs.irn.2018.07.020. Epub 2018 Aug 6.
Other people's words can have a powerful influence on how we interpret our environment, what we expect and experience, what we value, how we feel, what we choose, and how we behave. Placebo (and nocebo) effects are a dramatic example of this. The way in which healthcare professionals discuss, describe, and inform patients about the characteristic effects of a given disease and it prevention, diagnosis and treatment influence patients' feelings and expectations which in turn affects their psychobiological responses to, and subjective experiences and outcomes of the disease and its treatment effects. The effect of clinicians' words on patients' responses to treatments and procedures, both active and inert or sham is nothing less than incredible. The way in which information about treatment effects is delivered to patients can even reverse the clinically proven effects of an active treatment, or increase the adverse effects of it. In this chapter, we begin by presenting the data on the impact of message framing on affect and expectations of health care in experimental situations followed by the evidence that indicates how various patient, disease and clinician related factors modify framing effects in the clinic. Finally we discuss how framing effects affect clinical practice. They can be leveraged to enhance placebo effects and minimize nocebo effects. They can provide strategies to assist shared-decision making in the face of complex uncertainty. Going forward, automation of health care and artificial intelligence may change the delivery of health care but patients will continue to be humans seeking health gains while avoiding health losses and how the information is presented will always be susceptible to framing effects.
他人的话语会对我们如何解读环境、预期和体验、价值观、感受、选择以及行为方式产生强大的影响。安慰剂（和反安慰剂）效应就是一个显著的例子。医护人员讨论、描述和告知患者特定疾病的特征性影响及其预防、诊断和治疗的方式，会影响患者的感受和预期，进而影响他们对疾病及其治疗效果的心理生物学反应、主观体验和结果。临床医生的言语对患者对治疗和程序（包括活性和惰性或假治疗）的反应的影响令人难以置信。向患者传递治疗效果信息的方式甚至可以逆转活性治疗的临床疗效，或增加其不良反应。在本章中，我们首先介绍关于信息框架对实验情境中医疗保健的影响的相关数据，然后介绍表明各种患者、疾病和临床医生相关因素如何在临床环境中改变框架效应的证据。最后，我们讨论框架效应如何影响临床实践。可以利用这些效应来增强安慰剂效应，最大限度地减少反安慰剂效应。可以为面对复杂不确定性时的共同决策提供策略。展望未来，医疗保健的自动化和人工智能可能会改变医疗保健的提供方式，但患者将继续是寻求健康收益同时避免健康损失的人，而信息的呈现方式将始终容易受到框架效应的影响。
