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Harnessing placebo effects in primary care: using the person-based approach to develop an online intervention to enhance practitioners' communication of clinical empathy and realistic optimism during consultations

Harnessing placebo effects in primary care: using the person-based approach to develop an online intervention to enhance practitioners' communication of clinical empathy and realistic optimism during consultations
Harnessing placebo effects in primary care: using the person-based approach to develop an online intervention to enhance practitioners' communication of clinical empathy and realistic optimism during consultations
Background: Empathic communication and positive messages are important components of “placebo” effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention—“Empathico”–to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations.

Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization.

Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities.

Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.
Smith, Kirsten A.
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Vennik, Jane
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Morrison, Leanne
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Hughes, Stephanie
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Steele, Mary
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Tiwari, Riya
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Bostock, Jennifer
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Howick, Jeremy
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Mallen, Christian
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Little, Paul
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Ratnapalan, Mohana
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Lyness, Emily
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Misurya, Pranati
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Leydon, Geraldine M.
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Dambha-miller, Hajira
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Everitt, Hazel A.
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Bishop, Felicity L.
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Smith, Kirsten A.
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Vennik, Jane
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Morrison, Leanne
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Hughes, Stephanie
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Steele, Mary
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Tiwari, Riya
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Bostock, Jennifer
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Howick, Jeremy
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Mallen, Christian
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Little, Paul
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Ratnapalan, Mohana
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Lyness, Emily
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Misurya, Pranati
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Leydon, Geraldine M.
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Dambha-miller, Hajira
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Everitt, Hazel A.
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Bishop, Felicity L.
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Smith, Kirsten A., Vennik, Jane, Morrison, Leanne, Hughes, Stephanie, Steele, Mary, Tiwari, Riya, Bostock, Jennifer, Howick, Jeremy, Mallen, Christian, Little, Paul, Ratnapalan, Mohana, Lyness, Emily, Misurya, Pranati, Leydon, Geraldine M., Dambha-miller, Hajira, Everitt, Hazel A. and Bishop, Felicity L. (2021) Harnessing placebo effects in primary care: using the person-based approach to develop an online intervention to enhance practitioners' communication of clinical empathy and realistic optimism during consultations. Frontiers in Pain Research, 2. (doi:10.3389/fpain.2021.721222).

Record type: Article

Abstract

Background: Empathic communication and positive messages are important components of “placebo” effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention—“Empathico”–to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations.

Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization.

Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities.

Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.

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Accepted/In Press date: 26 July 2021
Published date: 24 August 2021

Identifiers

Local EPrints ID: 451096
URI: http://eprints.soton.ac.uk/id/eprint/451096
PURE UUID: 8b59f149-efb0-4f2b-bf99-29409ec987bd
ORCID for Mohana Ratnapalan: ORCID iD orcid.org/0000-0002-6505-6107
ORCID for Geraldine M. Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Hajira Dambha-miller: ORCID iD orcid.org/0000-0003-0175-443X
ORCID for Hazel A. Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662

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Date deposited: 07 Sep 2021 16:33
Last modified: 13 Dec 2021 03:32

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Contributors

Author: Jane Vennik
Author: Leanne Morrison
Author: Mary Steele
Author: Riya Tiwari
Author: Jennifer Bostock
Author: Jeremy Howick
Author: Christian Mallen
Author: Paul Little
Author: Emily Lyness
Author: Pranati Misurya

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