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Placebos in primary care? A nominal group study explicating UK GP and patient views of six theoretically plausible models of placebo practice

Placebos in primary care? A nominal group study explicating UK GP and patient views of six theoretically plausible models of placebo practice
Placebos in primary care? A nominal group study explicating UK GP and patient views of six theoretically plausible models of placebo practice
Objectives: to better understand which theoretically plausible placebogenic techniques might be acceptable in UK primary care.

Design: a qualitative study using nominal group technique and thematic analysis. Participants took part in audio-recorded face-to-face nominal groups in which the researcher presented 6 scenarios describing the application in primary care of theoretically plausible placebogenic techniques: (1) Withholding side-effects; (2) Monitoring (3) GP endorsement (4) Idealised consultation (5) Deceptive placebo pills (6) Open-label placebo pills. Participants voted on whether they thought each scenario was acceptable in practice and discussed their reasoning. Votes were tallied and discussions transcribed verbatim.

Setting: primary care in England.
Participants: 21 GPs in 4 nominal groups and 20 “expert patients” in 5 nominal groups.

Results: participants found it hard to decide which practices were acceptable and spoke about needing to weigh potential symptomatic benefits against the potential harms of lost trust eroding the therapeutic relationship. Primary care patients and doctors felt it was acceptable to harness placebo effects in practice by patient self-monitoring (scenario 2), by the GP expressing a strongly positive belief in a therapy (3), and by conducting patient-centered, empathic consultations (4). Deceptive placebogenic practices (scenarios 1 and 5) were unacceptable to most groups. Patient and GP groups expressed a diverse range of opinions about open label placebo pills.

Conclusions: attempts to harness placebo effects in UK primary care are more likely to be accepted and implemented if they focus on enhancing positive patient-centered communication and empathic relationships. Using placebos deceptively is likely to be unacceptable to both GPs and patients. Open-label placebos also do not have clear support; they might be acceptable to some doctors and patients in very limited circumstances - but further evidence, clear information and guidance would be needed.
general practice, placebo effects, placebos, primary care, qualitative research
2044-6055
Ratnapalan, Mohana
28361114-c167-4de3-a23c-b6cef4443377
Coghlan, Beverly
2ca0d06b-0ea4-42df-b4ae-96592ff824e9
Tan, Mengxin
25758700-b068-499b-888c-a746dd1b2471
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Bishop, Felicity
1f5429c5-325f-4ac4-aae3-6ba85d079928
Ratnapalan, Mohana
28361114-c167-4de3-a23c-b6cef4443377
Coghlan, Beverly
2ca0d06b-0ea4-42df-b4ae-96592ff824e9
Tan, Mengxin
25758700-b068-499b-888c-a746dd1b2471
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Bishop, Felicity
1f5429c5-325f-4ac4-aae3-6ba85d079928

Ratnapalan, Mohana, Coghlan, Beverly, Tan, Mengxin, Everitt, Hazel, Geraghty, Adam, Little, Paul, Lewith, George and Bishop, Felicity (2020) Placebos in primary care? A nominal group study explicating UK GP and patient views of six theoretically plausible models of placebo practice. BMJ Open, 2020 (10), [e032524]. (doi:10.1136/bmjopen-2019-032524).

Record type: Article

Abstract

Objectives: to better understand which theoretically plausible placebogenic techniques might be acceptable in UK primary care.

Design: a qualitative study using nominal group technique and thematic analysis. Participants took part in audio-recorded face-to-face nominal groups in which the researcher presented 6 scenarios describing the application in primary care of theoretically plausible placebogenic techniques: (1) Withholding side-effects; (2) Monitoring (3) GP endorsement (4) Idealised consultation (5) Deceptive placebo pills (6) Open-label placebo pills. Participants voted on whether they thought each scenario was acceptable in practice and discussed their reasoning. Votes were tallied and discussions transcribed verbatim.

Setting: primary care in England.
Participants: 21 GPs in 4 nominal groups and 20 “expert patients” in 5 nominal groups.

Results: participants found it hard to decide which practices were acceptable and spoke about needing to weigh potential symptomatic benefits against the potential harms of lost trust eroding the therapeutic relationship. Primary care patients and doctors felt it was acceptable to harness placebo effects in practice by patient self-monitoring (scenario 2), by the GP expressing a strongly positive belief in a therapy (3), and by conducting patient-centered, empathic consultations (4). Deceptive placebogenic practices (scenarios 1 and 5) were unacceptable to most groups. Patient and GP groups expressed a diverse range of opinions about open label placebo pills.

Conclusions: attempts to harness placebo effects in UK primary care are more likely to be accepted and implemented if they focus on enhancing positive patient-centered communication and empathic relationships. Using placebos deceptively is likely to be unacceptable to both GPs and patients. Open-label placebos also do not have clear support; they might be acceptable to some doctors and patients in very limited circumstances - but further evidence, clear information and guidance would be needed.

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More information

Accepted/In Press date: 15 January 2020
e-pub ahead of print date: 18 February 2020
Keywords: general practice, placebo effects, placebos, primary care, qualitative research

Identifiers

Local EPrints ID: 437684
URI: http://eprints.soton.ac.uk/id/eprint/437684
ISSN: 2044-6055
PURE UUID: 68f62288-a45b-4f64-a6f3-493790f8ff9e
ORCID for Mohana Ratnapalan: ORCID iD orcid.org/0000-0002-6505-6107
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Adam Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Felicity Bishop: ORCID iD orcid.org/0000-0002-8737-6662

Catalogue record

Date deposited: 11 Feb 2020 17:34
Last modified: 09 Jan 2022 04:07

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Contributors

Author: Beverly Coghlan
Author: Mengxin Tan
Author: Hazel Everitt ORCID iD
Author: Adam Geraghty ORCID iD
Author: Paul Little
Author: George Lewith
Author: Felicity Bishop ORCID iD

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