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When and why placebo-prescribing is acceptable and unacceptable: a focus group study of patients' views

When and why placebo-prescribing is acceptable and unacceptable: a focus group study of patients' views
When and why placebo-prescribing is acceptable and unacceptable: a focus group study of patients' views
Background
Surveys of doctors suggest that they use placebos and placebo effects clinically to help patients. However, patients' views are not well-understood. We aimed to identify when and why placebo-prescribing in primary care might be acceptable and unacceptable to patients.

Methods
A purposive diverse sample of 58 English-speaking adults (18 men; aged 19–80 years) participated in 11 focus groups. Vignettes describing doctors prescribing placebos in primary care were used to initiate discussions. Data were analyzed inductively.

Results
Participants discussed diverse harms and benefits of placebo-prescribing for individual patients, carers, healthcare providers, and society. Two perspectives on placebo-prescribing were identified. First, the “consequentialist” perspective focused on the potential for beneficial outcomes of placebo-prescribing. Here, some participants thought placebos are beneficial and should be used clinically; they often invoked the power of the mind or mind-body interactions. Others saw placebos as ineffective and therefore a waste of time and money. Second, the “respecting autonomy” perspective emphasized the harms caused by the deceptive processes thought necessary for placebo-prescribing. Here, participants judged placebo-prescribing unacceptable because placebo-prescribers deceive patients, thus a doctor who prescribes placebos cannot be trusted and patients' autonomy is compromised. They also saw placebo-responders as gullible, which deterred them from trying placebos themselves. Overall, the word “placebo” was often thought to imply “ineffective”; some participants suggested alternative carefully chosen language that could enable doctors to prescribe placebos without directly lying to patients.

Conclusions
Negative views of placebos derive from beliefs that placebos do not work and/or that they require deception by the doctor. Positive views are pragmatic in that if placebos work then any associated processes (e.g. mechanisms, deception) are deemed unimportant. Public education about placebos and their effects is warranted and research to identify optimal ways of harnessing placebo effects in clinical practice is needed.
1932-6203
e101822
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Aizlewood, Lizzi
17c2527d-6159-40f3-9915-e5f7cc8d2ed1
Adams, Alison E. M.
6bbf53a1-cad3-45c0-97d0-bc1ff334bdca
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Aizlewood, Lizzi
17c2527d-6159-40f3-9915-e5f7cc8d2ed1
Adams, Alison E. M.
6bbf53a1-cad3-45c0-97d0-bc1ff334bdca

Bishop, Felicity L., Aizlewood, Lizzi and Adams, Alison E. M. (2014) When and why placebo-prescribing is acceptable and unacceptable: a focus group study of patients' views. PLoS ONE, 9 (7), e101822. (doi:10.1371/journal.pone.0101822).

Record type: Article

Abstract

Background
Surveys of doctors suggest that they use placebos and placebo effects clinically to help patients. However, patients' views are not well-understood. We aimed to identify when and why placebo-prescribing in primary care might be acceptable and unacceptable to patients.

Methods
A purposive diverse sample of 58 English-speaking adults (18 men; aged 19–80 years) participated in 11 focus groups. Vignettes describing doctors prescribing placebos in primary care were used to initiate discussions. Data were analyzed inductively.

Results
Participants discussed diverse harms and benefits of placebo-prescribing for individual patients, carers, healthcare providers, and society. Two perspectives on placebo-prescribing were identified. First, the “consequentialist” perspective focused on the potential for beneficial outcomes of placebo-prescribing. Here, some participants thought placebos are beneficial and should be used clinically; they often invoked the power of the mind or mind-body interactions. Others saw placebos as ineffective and therefore a waste of time and money. Second, the “respecting autonomy” perspective emphasized the harms caused by the deceptive processes thought necessary for placebo-prescribing. Here, participants judged placebo-prescribing unacceptable because placebo-prescribers deceive patients, thus a doctor who prescribes placebos cannot be trusted and patients' autonomy is compromised. They also saw placebo-responders as gullible, which deterred them from trying placebos themselves. Overall, the word “placebo” was often thought to imply “ineffective”; some participants suggested alternative carefully chosen language that could enable doctors to prescribe placebos without directly lying to patients.

Conclusions
Negative views of placebos derive from beliefs that placebos do not work and/or that they require deception by the doctor. Positive views are pragmatic in that if placebos work then any associated processes (e.g. mechanisms, deception) are deemed unimportant. Public education about placebos and their effects is warranted and research to identify optimal ways of harnessing placebo effects in clinical practice is needed.

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Published date: 9 July 2014
Organisations: Psychology

Identifiers

Local EPrints ID: 375240
URI: https://eprints.soton.ac.uk/id/eprint/375240
ISSN: 1932-6203
PURE UUID: e9cd49cd-2a93-4067-bd7d-6b1e744ca5c8
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662

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Date deposited: 17 Mar 2015 14:53
Last modified: 06 Jun 2018 12:47

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Contributors

Author: Lizzi Aizlewood
Author: Alison E. M. Adams

University divisions

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