Department of Psychology, Stanford University, Stanford, California, USA
Department of Business Administration, University of Zurich, Zurich, Switzerland
BMJ Open. 2021 Feb 1;11(2):e040134. doi: 10.1136/bmjopen-2020-040134.
Given research showing that the very act of communicating side effects can increase their likelihood, how can providers inform patients about side effects while upholding their oath to do no unnecessary harm? An emerging approach provides a potential solution: truthfully describe certain minor side effects as a sign the treatment is active and working in the body. This approach focuses on instilling adaptive mindsets about the meaning of side effects while still keeping patients informed. This article describes existing research suggesting that this approach can be helpful in improving experience and outcomes in treatments for pain, hypertension and allergy. Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects and rated them as less threatening and intense. A longitudinal, randomised controlled trial of this approach in patients receiving oral immunotherapy for food allergies found that describing side effects as a sign treatment was working reduced the rate at which patients contacted providers with concerns about side effects and led to greater increases in a biomarker of allergic tolerance from pretreatment to post-treatment (peanut-specific blood IgG4). In unveiling this approach, this article also raises important issues regarding which treatments and symptoms this approach should be applied to. Finally, we outline questions future research should address to further understand and leverage this approach.
鉴于研究表明，交流副作用的行为本身就会增加其发生的可能性，那么医生在遵守不造成不必要伤害誓言的同时，如何既能向患者告知副作用，又该如何告知呢？一种新出现的方法提供了一个潜在的解决方案：诚实地将某些轻微的副作用描述为治疗在体内活跃且有效的迹象。这种方法侧重于在向患者提供副作用的信息的同时，树立关于副作用意义的适应性思维模式。本文介绍了现有研究，表明这种方法有助于改善疼痛、高血压和过敏治疗的体验和结果。与接受关于副作用的标准、富有同理心的信息的对照组相比，被告知副作用是治疗有效的迹象的患者对副作用的焦虑程度较低，他们认为副作用的威胁性和强度较低。一项针对接受口服免疫疗法治疗食物过敏的患者的这种方法的纵向、随机对照试验发现，将副作用描述为治疗有效的迹象可以降低患者因副作用问题联系提供者的频率，并导致从治疗前到治疗后的过敏耐受生物标志物（花生特异性血 IgG4）更大的增加。本文在揭示这种方法的同时，还提出了关于应该将这种方法应用于哪些治疗和症状的重要问题。最后，我们概述了未来研究应该解决的问题，以进一步理解和利用这种方法。
