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Anatomy of positive messages in healthcare consultations: component analysis of messages within 22 randomised trials

Jeremy Howick, Emily Lyness, Charlotte Albury, Kirsten A Smith, Hajira Dambha-Miller, Mohana Ratnapalan, Jane Vennik, Stephanie Hughes, Jennifer Bostock, Leanne Morrison, Christian Mallen, Hazel Everitt, Sue Dean, Tracy Levett-Jones, Serra Ivynian, Paul Little, Felicity L Bishop

Abstract


Background: Patients desire both honesty and hope from their healthcare practitioners. A recent systematic review found that healthcare practitioners who deliver positive messages improve patient outcomes, most notably by reducing pain. However, the verbal and non-verbal components of positive messages within these trials varied greatly, which presents a barrier to the implementation of this evidence and person-centered care.

Objective: To investigate common components of positive messages within the reviewed trials.

Methods: We extracted the verbal and non-verbal language used to deliver positive messages in 22 trials from a recent systematic review. Three independent researchers coded the components of the messages using content analysis.

Results: Positive messages in our sample had between 2 and 18 different components. These were clustered into 5 areas: specifying the positive outcomes, making the message personal, drawing on associations and meanings, providing a supportive psychological context and providing a rationale. Messages were reinforced through repetition in half the studies. Within the clusters, the most common components of positive messages were suggestions of specific effects (18 studies) and personalised formulations (15 studies). Most studies did not describe the components of positive messages adequately.

Conclusions: Positive messages within randomized trials are complex interventions, with most including strong suggestions about specific effects, presented confidently and made personally relevant to the individual patient. Future trials of positive messages should report all components of these interventions.

Keywords


Communication, communication skills, complex interventions, empathy, ethics, mechanisms of action, pain, pain reduction, person-centered healthcare, positive communication, randomised controlled trials

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Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., Hallaert, G., Van Daele, S., Buylaert, W. & Vogelaers, D. (2015). Communication in healthcare: a narrative review of the literature and practical recommendations. International Journal of Clinical Practice 69 (11) 1257-1267.

Little, P., White, P., Kelly, J., Everitt, H. & Mercer, S. (2015). Randomised controlled trial of a brief intervention targeting predominantly non-verbal communication in general practice consultations. British Journal of General Practice 65 (635) e351-356.

Wise, R.A., Bartlett, S.J., Brown, E.D., Castro, M., Cohen, R., Holbrook, J.T., Irvin, C.G., Rand, C.S., Sockrider, M.M., Sugar, E.A. & American Lung Association Asthma Clinical Research Centers. (2009). Randomized trial of the effect of drug presentation on asthma outcomes: the American Lung Association Asthma Clinical Research Centers. Journal of Allergy and Clinical Immunology 124 (3) 436-444, 44e1-8.

Moore, P.J., Adler, N.E. & Robertson, P.A. (2000). Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. Western Journal of Medicine 173 (4) 244-250.

Doyle, C., Lennox, L. & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 3 (1) pii: e001570.

Zolnierek, K.B. & Dimatteo, M.R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 47 (8) 826-834.

Rotenstein, L.S., Torre, M., Ramos, M.A., Rosales, R.C., Guille, C., Sen, S. & Mata, D.A. (2018). Prevalence of Burnout Among Physicians: A Systematic Review. Journal of the American Medical Association 320 (11) 1131-1150.

Sturzu, L., Lala, A., Bisch, M., Guitter, M., Dobre, D. & Schwan, R. (2019). Empathy and Burnout - A Cross-Sectional Study Among Mental Healthcare Providers in France. Journal of Medicine and Life 12 (1) 21-29.

Howick, J., Lewith, G., Mebius, A., Fanshawe, T., Bishop, F.L., van Osch, M., van Dulmen, S., Christelis, N., Kaptchuk, T. & Mistiaen, P. (2017). Positive messages may reduce patient pain: A meta-analysis. European Journal of Integrative Medicine 11, 31-38.

Peerdeman, K.J., van Laarhoven, A.I., Keij, S.M., Vase, L., Rovers, M.M., Peters, M.L. & Evers, A.W. (2016). Relieving patients' pain with expectation interventions: a meta-analysis. Pain 157 (6) 1179-1191.

Kelley, J.M., Lembo, A.J., Ablon, J.S., Villanueva, J.J., Conboy, L.A., Levy, R., Marci, C.D., Kerr, C.E., Kirsch, I., Jacobson, E.E., Riess, H. & Kaptchuk, T.J. (2009). Patient and practitioner influences on the placebo effect in irritable bowel syndrome. Psychosomatic Medicine 71 (7) 789-797.

Kaptchuk, T.J., Kelley, J.M., Conboy, L.A., Davis, R.B., Kerr, C.E., Jacobson, E.E., Kirsch, I., Schyner, R.N., Nam, B.H., Nguyen, L.T., Park, M., Rivers, A.L., McManus, C., Kokkotou, E., Drossman, D.A., Goldman, P. & Lembo, A.J. (2008). Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. British Medical Journal 336 (7651) 999-1003.

Hojat, M., Louis, D.Z., Markham, F.W., Wender, R., Rabinowitz, C. & Gonnella, J.S. (2011). Physicians' empathy and clinical outcomes for diabetic patients. Academic Medicine 86 (3) 359-364.

Mack, J.W. & Smith, T.J. (2012). Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. Journal of Clinical Oncology 30 (22) 2715-2717.

Mercer, S.W., Maxwell, M., Heaney, D. & Watt, G.C. (2004). The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Family Practice 21 (6) 699-705.

Hardman, D. & Howick, J. (2019). The friendly relationship between therapeutic empathy and person-centered care. European Journal for Person Centered Healthcare 7 (2) 351-357.

Kirsch, I. (1997). Response expectancy theory and application: A decennial review. Applied and Preventive Psychology 6 (2) 69-79.

Kirsch, I. (2004). Conditioning, expectancy, and the placebo effect: Comment on Stewart-Williams and Podd (2004). Psychological Bulletin 130 (2) 341-343.

Kirsch, I., Kong, J., Sadler, P., Spaeth, R., Cook, A., Kaptchuk, T. & Gollub, R.. Expectancy and Conditioning in Placebo Analgesia: Separate or Connected Processes? Psychology of Consciousness 1 (1) 51-59.

Benedetti, F., Mayberg, H.S., Wager, T.D., Stohler, C.S. & Zubieta, J.K. (2005). Neurobiological mechanisms of the placebo effect. Journal of Neuroscience 25 (45) 10390-10402.

Benedetti, F. (2009). Placebo effects: understanding the mechanisms in health and disease. Oxford: Oxford University Press.

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T.R., Lewith, G., Bishop, F.L., Mistiaen, P., Roberts, N.W., Dieninytė, E., Hu, X.Y., Aveyard, P. & Onakpoya, I.J. (2018). Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine 111 (7) 240-252.

Rief, W., Shedden-Mora, M.C., Laferton, J.A., Auer, C., Petrie, K.J., Salzmann, S., Schedlowski, M. & Moosdorf, R. (2017). Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Medicine 15 (1) 4.

Thomas, K.B. (1987). General practice consultations: is there any point in being positive? British Medical Journal (Clinicl Research Edition) 294 (6581) 1200-1202.

Hsieh, H.F. & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research 15 (9) 1277-1288.

Joffe, H. & Yardley, L. (2004). Content and thematic analysis. In: Research methods for clinical and health psychology. Marks, D.F., (Ed.), pp. 56-68. London: Sage.

Benedetti, F., Maggi, G., Lopiano, L., Lanotte, M., Rainero, I., Vighetti, S. & Pollo, A. (2003). Open versus hidden medical treatments: The patient's knowledge about a therapy affects the therapy outcome. Prevention & Treatment 2003; 6 (1) 1a.

de Craen, A.J.M., Lampe-Schoenmaeckers, A.J.E.M., Kraal, J.W., Tijssen, J.G.P. & Kleijnen, J. (2001). Impact of Experimentally-Induced Expectancy on the Analgesic Efficacy of Tramadol in Chronic Pain Patients: A 2 + 2 Factorial, Randomized, Placebo-Controlled, Double-Blind Trial. Journal of Pain and Symptom Management 21 (3) 210-217.

Dutt-Gupta, J., Bown, T. & Cyna, A.M. (2007). Effect of communication on pain during intravenous cannulation: a randomized controlled trial. British Journal of Anaesthesia 99 (6) 871-875.

Goodenough, B., Kampel, L., Champion, G.D., Laubreaux, L., Nicholas, M.K., Ziegler, J.B. & McInerney, M. (1997). An investigation of the placebo effect and age-related factors in the report of needle pain from venipuncture in children. Pain 72 (3) 383-391.

Kemeny, M.E., Rosenwasser, L.J., Panettieri, R.A., Rose, R.M., Berg-Smith, S.M. & Kline, J.N. (2007). Placebo response in asthma: A robust and objective phenomenon. Journal of Allergy and Clinical Immunology 119 (6) 1375-1381.

Knipschild, P. & Arntz, A. (2005). Pain patients in a randomized trial did not show a significant effect of a positive consultation. Journal of Clinical Epidemiology 58 (7) 708-713.

Lauder, G.R., McQuillan, P.J. & Pickering, R.M. (1995). Psychological adjunct to perioperative antiemesis. British Journal of Anaesthesia 74 (3) 266-270.

Olsson, B., Olsson, B. & Tibblin, G. (1989). Effect of patients' expectations on recovery from acute tonsillitis. Family Practice 6 (3) 188-192.

Petersen, G.L., Finnerup, N.B., Grosen, K., Pilegaard, H.K., Tracey, I., Benedetti, F., Price, D.D., Jensen, T.S. & Vase, L. (2014). Expectations and positive emotional feelings accompany reductions in ongoing and evoked neuropathic pain following placebo interventions. Pain 155 (12) 2687-2698.

Petersen, G.L., Finnerup, N.B., Nørskov, K.N., Grosen, K., Pilegaard, H.K., Benedetti, F., Price, D.D., Jensen, T.S. & Vase, L. (2012). Placebo manipulations reduce hyperalgesia in neuropathic pain. Pain 153 (6) 1292-1300.

Phillips, R.J. (2006). An Examination of the Impact of Self-efficacy Interventions versus Outcome Expectancy Interventions on Efficacy Beliefs, Expectancy Beliefs, Participation, and Functional Performance in a Population of Medical Rehabilitation Patients: Fielding Graduate University. Available at: https://search.proquest.com/openview/7d7efb8d0f3b971708f30b77b22c1563/1?pq-origsite=gscholar&cbl=18750&diss=y

Resnick, B.M. (1996). Self-efficacy in Geriatric Rehabilitation. University of Maryland. Available at: https://archive.hshsl.umaryland.edu/handle/10713/1478

Ronel, J., Mehilli, J., Ladwig, K.H., Blättler, H., Oversohl, N., Byrne, R.A., Bauer, A., Schneider, S., Linde, K., Henningsen, P., Lahmann, C., Noll-Hussong, M. & Meissner, K. (2011). Effects of verbal suggestion on coronary arteries: results of a randomized controlled experimental investigation during coronary angiography. American Heart Journal 162 (3) 507-511.

Suarez-Almazor, M.E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D.M. & Street, R.L. Jr. (2010). A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication. Arthritis Care & Research 62 (9) 1229-1236.

Varelmann, D., Pancaro, C., Cappiello, E.C. & Camann, W.R. (2010). Nocebo-induced hyperalgesia during local anesthetic injection. Anesthesia & Analgesia 110 (3) 868-870.

Wang, F., Shen, X., Xu, S., Liu, Y., Ma, L., Zhao, Q., Fu, D., Pan, Q., Feng, S. & Li, X. (2008). Negative words on surgical wards result in therapeutic failure of patient-controlled analgesia and further release of cortisol after abdominal surgeries. Minerva Anestesiologica 74 (7-8) 353-365.

Szilagyi, A.K., Dioszeghy, C., Benczur, L. & Varga, K. (2007). Effectiveness of psychological support based on positive suggestion with the ventilated patient. European Journal of Mental Health 2, 149-170.

Varga, K., Dioszeghy, C. & Frituz, G. (2007). Suggestive communication with the ventilated patient. European Journal of Mental Health 2, 137-147.

Benedetti, F., Pollo, A., Lopiano, L., Lanotte, M., Vighetti, S. & Rainero, I. (2003). Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. [Study 1: Postoperative pain.]. Journal of Neuroscience 23 (10) 4315-4323.

Moerman, D.E. (2002). Meaning, medicine, and the "placebo effect". Cambridge: Cambridge University Press.

de Craen, A.J., Roos, P.J., Leonard de Vries, A. & Kleijnen, J. (1996). Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness. British Medical Journal 313 (7072) 1624-1626.

Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A. & Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review. Lancet 357 (9258) 757-762.

Benedetti, F., Carlino, E. & Pollo, A. (2011). How placebos change the patient's brain. Neuropsychopharmacology 36 (1) 339-354.

Benedetti, F. (2007). Placebo and endogenous mechanisms of analgesia. Handbook of Experimental Pharmacology (177) 393-413.

Haanstra, T.M., van den Berg, T., Ostelo, R.W., Poolman, R.W., Jansma, I.P., Cuijpers, P. & de Vet, H.C. (2012). Systematic review: Do patient expectations influence treatment outcomes in total knee and total hip arthroplasty? Health and Quality of Life Outcomes 10, 152.

Neuprez, A., Delcour, J.P., Fatemi, F., Gillet, P., Crielaard, J.M., Bruyère, O. & Reginster, J.Y. (2016). Patients' Expectations Impact Their Satisfaction following Total Hip or Knee Arthroplasty. PLoS One 11 (12) e0167911.

Rozanski, A., Bavishi, C., Kubzansky, L.D. & Cohen, R. (2019). Association of Optimism With Cardiovascular Events and All-Cause Mortality: A Systematic Review and Meta-analysis. JAMA Network Open 2 (9) e1912200.

Peerdeman, K.J., van Laarhoven, A.M., Peters, M.L. & Evers, A.W.M. (2016). An Integrative Review of the Influence of Expectancies on Pain. Frontiers in Psychology 7, 1270.

Petty, R.E. & Wegener, D.T. (1998). Attitude change: Multiple roles for persuasion variables. In: The Handbook of Social Psychology. Gilbert, D.T., Fiske, S.T. & Lindzey, G. (Eds.), pp 323-390. London: McGraw-Hill.

Petty, R.E. & Cacioppo, J. (1986). Communication and persuasion: Central and peripheral routes to attitude change. New York: Springer-Verlag.

Leventhal, H., Meyer, D. & Nerenz, D. (1980). The common sense representation of illness danger. In: Medical Psychology Vol II. Rachman, S., (Ed.), pp.7-30. Oxford: Pergamon Press.

Leventhal, H. & Diefenbach, M. (1991). The active side of illness cognition. In: Mental representation in health and illness. Skelton, J.A. & Croyle, R.T. (Eds.), pp. 247-272. New York: Springer Verlag.

Howe, L.C., Leibowitz, K.A. & Crum, A.J. (2019). When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Frontiers in Psychiatry 10, 475.

Ryan, R.M. & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist 55 (1) 68-78.

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review 84 (2) 191-215.

Horne, R., Chapman, S.C.E., Parham, R., Freemantle, N., Forbes, A. & Cooper, V. (2013). Understanding Patients' Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework. PLoS One 8 (12) e80633.

Benedetti, F., Pollo, A., Lopiano, L., Lanotte, M., Vighetti, S. & Rainero, I. (2003). Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. [Study 2: State Anxiety]. Journal of Neuroscience 23 (10) 4315-4323.

Benedetti, F., Pollo, A., Lopiano, L., Lanotte, M., Vighetti, S. & Rainero, I. (2003). Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. [Study 3: Parkinson's Disease]. Journal of Neuroscience 23 (10) 4315-4323.




DOI: http://dx.doi.org/10.5750/ejpch.v7i4.1788

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