The University of Southampton
University of Southampton Institutional Repository

From substance to process: a meta-ethnographic review of how healthcare professionals and patients understand placebos and their effects in primary care

From substance to process: a meta-ethnographic review of how healthcare professionals and patients understand placebos and their effects in primary care
From substance to process: a meta-ethnographic review of how healthcare professionals and patients understand placebos and their effects in primary care
Research suggests that a ‘placebo’ can improve conditions common in primary care including pain, depression, and irritable bowel syndrome. However, disagreement persists over the definition and clinical relevance of placebo treatments. We conducted a meta-ethnographic, mixed-research systematic review to explore how healthcare professionals and patients understand placebos and their effects in primary care. We conducted systematic literature searches of five databases – augmented by reference chaining, key author searches, and expert opinion – related to views on placebos, placebo effects, and placebo use in primary care. From a total of 34 eligible quantitative, qualitative and mixed-methods articles reporting findings from 28 studies, 21 were related to healthcare professionals’ views, 11 were related to patients’ views, and two were related to both groups. In the studies under review, healthcare professionals reported using placebos at markedly different frequencies. This was highly influenced by how placebos were defined in the studies. Both healthcare professionals and patients predominantly defined placebos as material substances such as ‘inert’ pills, despite this definition being inconsistent with current scientific thinking. However, healthcare professionals also, but less prevalently, defined placebos in a different way: as contextual processes. This better concurs with modern placebo definitions, which focus on context, ritual, meaning, and enactivism. However, given the enduring ubiquity of substance definitions, for both healthcare professionals and patients, we question the practical, clinical validity of stretching the term ‘placebo’ towards its modern iteration. To produce ‘placebo effects’, therefore, primary healthcare professionals may be better off abandoning placebo terminology altogether.
1363-4593
Hardman, Douglas, Iain
bf7ba905-0d04-4d1f-9686-f9a3a3d642db
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Viecelli, Clelia
6fdebb31-55ba-465b-9e27-adfe6600ca8e
Bishop, Felicity
1f5429c5-325f-4ac4-aae3-6ba85d079928
Hardman, Douglas, Iain
bf7ba905-0d04-4d1f-9686-f9a3a3d642db
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Viecelli, Clelia
6fdebb31-55ba-465b-9e27-adfe6600ca8e
Bishop, Felicity
1f5429c5-325f-4ac4-aae3-6ba85d079928

Hardman, Douglas, Iain, Geraghty, Adam, Lewith, George, Lown, Mark, Viecelli, Clelia and Bishop, Felicity (2018) From substance to process: a meta-ethnographic review of how healthcare professionals and patients understand placebos and their effects in primary care. Health. (doi:10.1177/1363459318800169).

Record type: Article

Abstract

Research suggests that a ‘placebo’ can improve conditions common in primary care including pain, depression, and irritable bowel syndrome. However, disagreement persists over the definition and clinical relevance of placebo treatments. We conducted a meta-ethnographic, mixed-research systematic review to explore how healthcare professionals and patients understand placebos and their effects in primary care. We conducted systematic literature searches of five databases – augmented by reference chaining, key author searches, and expert opinion – related to views on placebos, placebo effects, and placebo use in primary care. From a total of 34 eligible quantitative, qualitative and mixed-methods articles reporting findings from 28 studies, 21 were related to healthcare professionals’ views, 11 were related to patients’ views, and two were related to both groups. In the studies under review, healthcare professionals reported using placebos at markedly different frequencies. This was highly influenced by how placebos were defined in the studies. Both healthcare professionals and patients predominantly defined placebos as material substances such as ‘inert’ pills, despite this definition being inconsistent with current scientific thinking. However, healthcare professionals also, but less prevalently, defined placebos in a different way: as contextual processes. This better concurs with modern placebo definitions, which focus on context, ritual, meaning, and enactivism. However, given the enduring ubiquity of substance definitions, for both healthcare professionals and patients, we question the practical, clinical validity of stretching the term ‘placebo’ towards its modern iteration. To produce ‘placebo effects’, therefore, primary healthcare professionals may be better off abandoning placebo terminology altogether.

Text
Placebo effects in primary care_Meta-ethnography - Accepted Manuscript
Download (407kB)

More information

Accepted/In Press date: 6 July 2018
e-pub ahead of print date: 21 September 2018

Identifiers

Local EPrints ID: 422462
URI: http://eprints.soton.ac.uk/id/eprint/422462
ISSN: 1363-4593
PURE UUID: 7f264636-92e7-4890-8a5d-0b3f3e984573
ORCID for Douglas, Iain Hardman: ORCID iD orcid.org/0000-0001-6717-2323
ORCID for Clelia Viecelli: ORCID iD orcid.org/0000-0001-6646-3073
ORCID for Felicity Bishop: ORCID iD orcid.org/0000-0002-8737-6662

Catalogue record

Date deposited: 24 Jul 2018 16:30
Last modified: 17 Dec 2019 05:19

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×