Flood A B, Lorence D P, Ding J, McPherson K, Black N A
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH 03755-3863.
Med Care. 1993 Nov;31(11):1043-56. doi: 10.1097/00005650-199311000-00006.
Outcomes research typically focuses on the technical capabilities associated with treatment that predicts patients' post-therapy outcomes adjusting for health-related factors. Research on the ability of placebo therapy to alter outcomes suggests that a patient's expectations about therapy can also influence outcomes. Few studies have examined the effects of expectations and their implications for assessing outcomes. This study followed 348 patients who had surgery for benign prostatic hyperplasia. Four hypotheses are tested: whether positive expectations about improvement influence: 1) patients' postoperative reports of symptoms; 2) their belief that they have improved; 3) their overall health after treatment; and 4) whether these effects persist during the year following treatment. Using step-wise regression to control for sociodemographic and clinical factors, we found positive expectations did not appear to strongly influence a patient's report of postoperative symptoms or their overall health. However, we found strong support for positive expectations increasing the likelihood of reporting they felt better after surgery, even after controlling for symptom changes. This effect persisted throughout the postoperative year. We conclude that positive expectations result in a more optimistic view of improvement after surgery rather than altering reports of outcomes or health.
结果研究通常关注与治疗相关的技术能力，这些能力可预测患者在调整健康相关因素后的治疗后结果。关于安慰剂治疗改变结果能力的研究表明，患者对治疗的期望也会影响结果。很少有研究考察期望的影响及其对评估结果的意义。本研究跟踪了348例接受良性前列腺增生手术的患者。检验了四个假设：对改善的积极期望是否会影响：1）患者术后的症状报告；2）他们认为自己已经改善的信念；3）治疗后的整体健康状况；4）这些影响在治疗后的一年内是否持续存在。使用逐步回归来控制社会人口统计学和临床因素，我们发现积极期望似乎并未强烈影响患者的术后症状报告或整体健康状况。然而，我们发现有力证据支持积极期望会增加患者报告术后感觉更好的可能性，即使在控制了症状变化之后。这种效果在术后一年中持续存在。我们得出结论，积极期望会导致对术后改善有更乐观的看法，而不是改变结果报告或健康状况。
