Howe Lauren C, Leibowitz Kari A, Crum Alia J
Department of Business Administration, University of Zurich, Zurich, Switzerland.
Department of Psychology, Stanford University, Stanford, CA, United States.
Front Psychiatry. 2019 Jul 4;10:475. doi: 10.3389/fpsyt.2019.00475. eCollection 2019.
Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of , or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of , or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.
研究表明，安慰剂效应会影响医学治疗的效果，并且在许多病症的治愈过程中占相当大的比例。然而，医疗服务提供者在临床实践中有意或无意利用产生安慰剂效应的力量的程度可能存在差异。一些研究表明，医疗服务提供者与患者互动的方式会影响安慰剂效应的大小，但这项研究尚未提炼出最有可能影响安慰剂反应的医患互动维度，以及医患互动的各个方面影响安慰剂反应的机制。我们提供了一个简化且统一的框架，在这个框架中，能增强安慰剂反应的互动可以被分解为两个关键维度：患者对医生“懂行”程度的认知，即医生展现出的效率、知识和技能；以及患者对医生“懂我”程度的认知，即医生展现出的个人投入、与患者的联系以及对患者的关怀。首先，我们将讨论这个框架是如何建立在心理学中关于能力和温暖的社会认知的过往研究，以及医学文献中关于有效医疗、患者满意度和医患互动模型的研究基础之上的。然后，我们将探讨能力和温暖可能影响医疗保健中安慰剂反应的潜在机制。最后，我们分享来自患者和医疗服务提供者的原始数据，突出这个框架在医疗保健中的应用方式。患者和医疗服务提供者的数据都说明了医疗服务提供者可以向患者展示能力和温暖的可行方法。我们最后给出建议，即研究人员和从业者如何能够更系统地考虑医疗服务提供者的能力和温暖在医患互动中的作用，以加深我们对安慰剂效应的理解，并最终使医疗服务提供者能够在临床护理中与活性药物（即含有已知医学成分的药物）和治疗一起增强安慰剂效应。
