scholarly journals What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care

2021 ◽  
Vol 12 ◽  
Author(s):  
Hailey E. Yetman ◽  
Nevada Cox ◽  
Shelley R. Adler ◽  
Kathryn T. Hall ◽  
Valerie E. Stone

A placebo effect is a positive clinical response to non-specific elements of treatment with a sham or inert replica of a drug, device, or surgical intervention. There is considerable evidence that placebo effects are driven by expectation of benefit from the intervention. Expectation is shaped by a patient’s past experience, observations of the experience of others, and written, verbal, or non-verbal information communicated during treatment. Not surprisingly, expectation in the clinical setting is strongly influenced by the attitude, affect, and communication style of the healthcare provider. While positive expectations can produce beneficial effects, negative information and experiences can lead to negative expectations, and consequently negative or nocebo effects. Key components identified and studied in the placebo and nocebo literature intersect with factors identified as barriers to quality care in the clinical setting for Black patients and other patients of color, including poor patient-clinician communication, medical mistrust, and perceived discrimination. Thus, in the context of discrimination and bias, the absence of placebo and presence of nocebo-generating influences in clinical settings could potentially reinforce racial and ethnic inequities in clinical outcomes and care. Healthcare inequities have consequences that ripple through the medical system, strengthening adverse short- and long-term outcomes. Here, we examine the potential for the presence of nocebo effects and absence of placebo effects to play a role in contributing to negative outcomes related to unequal treatment in the clinical encounter.

2011 ◽  
Vol 366 (1572) ◽  
pp. 1922-1930 ◽  
Author(s):  
Luana Colloca ◽  
Franklin G. Miller

Laboratory research recently has greatly enhanced the understanding of placebo and nocebo effects by identifying specific neuromodulators and brain areas associated with them. However, little progress has been made in translating this knowledge into improved patient care. Here, we discuss the limitations in our knowledge about placebo (and nocebo) effects and the need for translational research with the aim of guiding physicians in maximizing placebo effects and minimizing nocebo effects in their routine clinical practice. We suggest some strategies for how, when and why interventions to promote beneficial placebo responses might be administered in the clinical setting.


2016 ◽  
Vol 9 (1) ◽  
pp. 56-63
Author(s):  
Elena I Ustinova ◽  
Olga P Ilkova

The phthisioophthalmology section work over the last 15 years is analyzed. Due to the antituberculous care system reform the number of section members decreased from 27 to 17. Scientific meetings are regular, their frequency decreased up to 5-6/year. Ever and again presentations are made at plenary sessions of the St.Petersburg Scientific Medical Society of Ophthalmology (6 presentations in 15 years) and at the congresses of associations of ophthalmologists and phthisiologists. In 15 years, session members performed and published 102 studies on ocular tuberculosis, including 38 articles in scientific magazines, 5 teaching editions for doctors, 4 monographs. Based on work reports and inspection results of several institutions, it follows that the section makes positive impact on the formation in clinicians of a scientific approach to clinical care process. Some shortcomings are revealed in the application of recommended methods. We believe that for their elimination, besides social activity of the section, it is necessary to publish teaching editions at federal level on ocular tuberculosis diagnosis and treatment, as well as enhancement of diagnosis and treatment quality control by local administration.


ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Natasha D. Buchanan ◽  
Jessica B. King ◽  
Juan L. Rodriguez ◽  
Arica White ◽  
Katrina F. Trivers ◽  
...  

Background. Differences in healthcare and cancer treatment for cancer survivors in the United States (US) have not been routinely examined in nationally representative samples or studied before and after important Institute of Medicine (IOM) recommendations calling for higher quality care provision and attention to comprehensive cancer care for cancer survivors. Methods. To assess differences between survivor characteristics in 1992 and 2010, we conducted descriptive analyses of 1992 and 2010 National Health Interview Survey (NHIS) data. Our study sample consisted of 1018 self-reported cancer survivors from the 1992 NHIS and 1718 self-reported cancer survivors from the 2010 NHIS who completed the Cancer Control (CCS) and Cancer Epidemiology (CES) Supplements. Results. The prevalence of reported survivors increased from 1992 to 2010 (4.2% versus 6.3%). From 1992 to 2010, there was an increase in long-term cancer survivors and a drop in multiple malignancies, and surgery remained the most widely used treatment. Significantly fewer survivors (<10 years after diagnosis) were denied insurance coverage. Survivors continue to report low participation in counseling or support groups. Conclusions. As the prevalence of cancer survivors continues to grow, monitoring differences in survivor characteristics can be useful in evaluating the effects of policy recommendations and the quality of clinical care.


Author(s):  
Martin Summers

This chapter continues an examination of the superintendency of William Alanson White but offers a more granular discussion of how ideas about racial difference shaped the clinical encounter in the era of dynamic psychiatry. Specifically, it looks at how Saint Elizabeths’ staff applied particular somatic “therapies”—including seclusion, restraint, and hydrotherapy—to black female, white female, black male, and white male patients. It also argues that the clinical staff’s limited psychotherapeutic engagement with African American patients was further undermined by two things. One was the psychiatrists’ assumptions about the inaccessibility of the black psyche—either because of the absolute cultural foreignness or natural duplicity of African Americans. The other was their tendency to prioritize black patients’ rehabilitation as laborers. Finally, the chapter looks at the quotidian ways that patients exerted their agency in the clinical encounter by resisting medical surveillance and institutional management.


2019 ◽  
Vol 14 (3) ◽  
pp. 321-331 ◽  
Author(s):  
Robin S. Goldstein

AbstractInformation conveyed on the price tag or label of a consumable packaged good is widely thought to change the consumer's sensory experience of consuming the good. Can the positive “placebo” effects of high prices and negative “nocebo” effects of low prices on consumer experience be isolated and observed in a controlled experiment without using deception? In a pilot wine experiment using a method I call “half-blind tasting,” I observe that the nocebo response to a $5 price tag is stronger than the placebo response to a $50 price tag. To interpret these preliminary results, I borrow some insights from prospect theory. (JEL Classifications: C91, D81, L66, M31, Q11)


2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 10S-16S
Author(s):  
Sarah Hopkins ◽  
Polly Brune ◽  
Jens R. Chapman ◽  
Marc Horton ◽  
Rod Oskouian ◽  
...  

Our health care system is an evidenced-based quality-centric environment. Pursuit of quality is a process that encompasses knowledge development and care advancements through collaboration and expertise. Depicted here is the foundational knowledge, process, and contributions that hallmark successful clinical quality programs. Beginning with methodology, followed by process and form, we create the foundational knowledge and exemplars demonstrating framework and continuum of process in pursuit and attainment of successful clinical quality and care development for patients. Although our protocol has been devised for complex spine care, this could be implemented across all health care specialties to provide individualized and high-quality care for all current and future patients, all while creating a culture of accountability for physicians.


2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e11-e11
Author(s):  
Avery Longmore ◽  
Kathleen Hollamby ◽  
Jeanne Zielonka ◽  
Douglas M Campbell

Abstract Background Newborn infants are at increased risk of requiring respiratory support with a mechanical ventilator. Nasal continuous positive airway pressure (nCPAP) is the most commonly used non-invasive respiratory support. Current nCPAP support is not synchronized to an infant’s breathing efforts, and can contribute to patient discomfort, skin breakdown, and interference with mother-infant bonding. An alternative to nCPAP is negative pressure ventilation. Our NeoVest was developed as a wearable vest that utilizes Neurally Adjusted Ventilator Assist (NAVA) technology to synchronize with the infant’s own respiratory drive and control. NeoVest and NAVA have demonstrated efficacy/feasibility in preliminary experiments emulating neonatal respiratory distress in animal models. Before implementation of this new technology in NICUs, it is important to assess the perspectives of NICU multi-disciplinary staff and parents to optimize design and understand its impact. Objectives The objective was to assess both clinicians’ and NICU parents’ perceptions of the NeoVest as compared with traditional nCPAP devices. Design/Methods Nurses, respiratory therapists and NICU parents at St. Michael’s Hospital in Toronto, Canada were invited to participate in the study. Research Ethics Board approval was obtained for this study. Parents were approached if their baby has previously been on CPAP. After consent, participants attended simulations that demonstrated the utility of the NeoVest. After the simulation, participants completed a survey that assessed their satisfaction and stress level regarding use of the NeoVest in a clinical setting. Numeric Likert scale responses and free text comments were collected from participants and analyzed. Free text comments were assessed using the principles of thematic analysis. Results Thirty clinicians (16 nurses, and 14 RTs), and 4 parents answered the survey. Almost all respondents were excited by the new technology and believed the use of simulation in the NICU was beneficial. Respondents reported that the NeoVest would not add stress to their roles in the NICU, and the majority of clinicians also believed that the NeoVest will improve care of the infant patient. Parents and clinicians both suggested that nCPAP can cause stress, and that the NeoVest would be preferred. One of the major themes regarding how the NeoVest may improve care from the perspective of both parents and clinicians was improved parent-child bonding through improved eye contact. Clinicians also believed it would reduce irritation, maintain skin integrity and have less complications as compared to nCPAP. The major themes with respect to clinician concerns about the NeoVest included: examining the neonate, umbilical line access, and the learning curve for new technology. The major themes with respect to parental concerns included: interference with skin to skin and holding their child. Conclusion Survey responses were overall favourable for introduction of new NICU technology, in this case a novel breathing device: the NeoVest. Although small, this cohort provided invaluable insight regarding the NeoVest’s impact on future patient populations. This highlights the importance of patient feedback in innovation. Next steps include a pilot study assessing the feasibility and efficacy of the NeoVest in the clinical setting, with re-administration of the questionnaires to compare reality and simulation.


2020 ◽  
Vol 77 (7) ◽  
pp. 552-559
Author(s):  
Allison Steen ◽  
Jessica Bovio Franck

Abstract Purpose To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. Methods In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). Results After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. Conclusion The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators’ collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.


2016 ◽  
Vol 6 (1) ◽  
pp. 1 ◽  
Author(s):  
Jane Peterson ◽  
Margaret Brommelsiek ◽  
Sarah Knopf Amelung

Background/Objective: The number of veterans and their families seeking healthcare and support within civilian communities is increasing worldwide. There is a need for healthcare providers to provide sensitive, comprehensive care for veterans with both physical and behavioral health conditions. Many civilian providers are unfamiliar with veterans’ issues and need training on military culture and combat experiences in order to provide compassionate, high quality care. An interprofessional (IPE) course to increase health professional students’ understanding of military culture and the associated health problems of veterans was implemented and evaluated. Methods: An 8-week IPE immersion course was offered for students with clinical experience at a Veterans’ Health primary care clinic and a didactic component. The class content included military culture, behavioral and physical health disorders common among veterans, and the related behavioral and pharmacological treatments. Faculty-led discussions with students in IPE teams used veteran-focused case studies and standardized patients to prepare students to work in IPE teams in the clinical care of veterans. Results: This educational project was evaluated using quantitative surveys and qualitative reflection questions and focus groups. Students scored high for readiness for interprofessional learning pre-course. Post-course students reported valuing the team approach to veterans care and students engaged in high levels of communication and collaboration within the team. Students’ knowledge scores increased related to understanding of military culture and their patient advocate role. Conclusions: Students learned about military culture and the provision of humanistic, high quality care for military veterans in this clinical and didactic immersion IPE course.


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