Evers Andrea W M, Colloca Luana, Blease Charlotte, Gaab Jens, Jensen Karin B, Atlas Lauren Y, Beedie Chris J, Benedetti Fabrizio, Bingel Ulrike, Büchel Christian, Bussemaker Jet, Colagiuri Ben, Crum Alia J, Finniss Damien G, Geers Andrew L, Howick Jeremy, Klinger Regine, Meeuwis Stefanie H, Meissner Karin, Napadow Vitaly, Petrie Keith J, Rief Winfried, Smeets Ionica, Wager Tor D, Wanigasekera Vishvarani, Vase Lene, Kelley John M, Kirsch Irving
Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands,
Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
Psychother Psychosom. 2021;90(1):49-56. doi: 10.1159/000510738. Epub 2020 Oct 19.
Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments.
There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information.
Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients.
There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities.
The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
临床和实验室研究表明，安慰剂和反安慰剂效应会影响给予惰性治疗和活性治疗后的各种症状及病情。
对于如何在临床实践中告知患者安慰剂和反安慰剂效应以及如何培训临床医生披露此类信息，目前越来越需要最新的建议。
基于先前有关安慰剂和反安慰剂效应的临床建议，在一组国际知名的跨学科专家中开展了一项仅邀请参与的三步德尔菲研究。该研究包括开放式和封闭式调查问题，随后召开了一次最终专家会议。调查分为三个部分：（1）告知患者安慰剂效应；（2）告知患者反安慰剂效应；（3）培训临床医生如何向患者传达此类信息。
专家们达成共识，向患者传达有关安慰剂和反安慰剂效应的一般信息（例如，解释它们在治疗中的作用）可能有益，但此类信息需要根据具体临床情况（例如病情和治疗方法）进行调整。专家们还一致认为，培训临床医生就安慰剂和反安慰剂效应进行沟通应成为医学教育中常规且综合的一部分，采用多种形式，包括面对面和在线方式。
当前的三步德尔菲研究为临床实践中关于安慰剂和反安慰剂效应的披露提供了基于共识的建议和实际考虑因素。未来需要开展研究，以确定如何根据具体临床情况和患者需求优化信息，以及为临床医生开发标准化的披露培训模块。
