儿科安慰剂：一项调查医生观点的横断面调查。
Placebos in pediatrics: A cross-sectional survey investigating physicians' perspectives.
机构信息
Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany; Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Psychosom Res. 2023 Sep;172:111421. doi: 10.1016/j.jpsychores.2023.111421. Epub 2023 Jun 19.
OBJECTIVE
Placebo responses are significantly higher in children than in adults, suggesting a potential underused treatment option in pediatric care. To facilitate the clinical translation of these beneficial effects, we explored physicians' current practice, opinions, knowledge, and likelihood of recommending placebos in the future.
METHODS
A cross-sectional web-based survey administered by REDCap was conducted at Boston Children's Hospital between October 2021 and March 2022. Physicians (n = 1157) were invited to participate through an email containing a link to a 23-item survey designed to assess physicians' attitudes and perceptions towards the clinical use of placebo in pediatrics.
RESULTS
From 207 (18%) returned surveys, 109 (9%) were fully completed. Most respondents (79%) believed that enhancing the therapeutic components that contribute to the placebo response may be a way of improving pediatric care. However, whereas most (62%) found placebo treatments permissible, only one-third reported recommending them. In pediatrics, placebos are typically introduced as a medicine that "might help" (43%). The most common treatments recommended to enhance placebo effects are physical therapy, vitamins, and over-the-counter analgesics. Physicians most frequently recommend placebos for occasional pain, headaches, and anxiety disorders. Finally, the great majority of physicians (87%) stated they would be more likely to recommend placebo treatments if there were safety and ethical guidelines for open-label placebos.
CONCLUSIONS
Placebo treatments seem permissible to physicians in pediatric care, but the development of safety and ethical guidelines may be necessary before physicians systematically incorporate the benefits of the placebo effect in pediatrics.
目的
安慰剂反应在儿童中明显高于成人，这表明在儿科护理中有潜在未充分利用的治疗选择。为了促进这些有益效果的临床转化，我们探讨了医生目前的实践、意见、知识以及未来推荐安慰剂的可能性。
方法
2021 年 10 月至 2022 年 3 月期间，我们在波士顿儿童医院通过 REDCap 进行了一项横断面网络调查。通过包含链接的电子邮件向医生（n=1157）发出邀请，该链接指向一项 23 项的调查，旨在评估医生对儿科中安慰剂临床应用的态度和看法。
结果
在 207 份（18%）返回的调查中，有 109 份（9%）完整填写。大多数受访者（79%）认为增强有助于安慰剂反应的治疗成分可能是改善儿科护理的一种方法。然而，尽管大多数（62%）人认为安慰剂治疗是可以接受的，但只有三分之一的人报告了推荐使用。在儿科中，安慰剂通常被引入为一种“可能有帮助”的药物（43%）。推荐用于增强安慰剂效果的最常见治疗方法是物理疗法、维生素和非处方止痛药。医生最常推荐用于偶尔疼痛、头痛和焦虑症的安慰剂。最后，绝大多数医生（87%）表示，如果有开放标签安慰剂的安全和伦理指南，他们更有可能推荐安慰剂治疗。
结论
在儿科护理中，安慰剂治疗似乎对医生来说是可以接受的，但在医生系统地将安慰剂效应的益处纳入儿科治疗之前，可能需要制定安全和伦理指南。
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