Can Optimising Patients’ Expectations Improve Treatment Outcomes?

Abstract

Patients' expectations play a significant role in the response to medical treatment. Through placebo mechanisms, patients' expectations can influence health outcomes by either minimising or maximising the response to treatment. Finding ways to effectively utilise the placebo effect in medical care will help achieve an additive benefit beyond that only caused by the active treatment. Research has demonstrated that optimising patients' expectations is a novel way of capitalising on this effect. The primary objective of this study was to investigate whether a brief intervention could optimise patients' expectations and produce an additive effect to intravenous iron infusion. Iron deficiency anaemia is a common and debilitating condition. Iron deficiency anaemia can lead to significant fatigue, both mentally and physically, which has a negative impact on a person's quality of life and day-to-day functioning. Intravenous iron infusions are an effective way of improving iron levels and subsequently reducing fatigue. The study design was a double-blind randomised controlled trial. 48 participants were recruited from an outpatient clinic at Auckland City Hospital. Participants completed a baseline assessment, which measured demographic information and the primary outcomes, fatigue and vitality. Participants were randomly allocated to either the intervention group, which received a psychoeducational expectationbased intervention, or the active control group, who received general health information. After the intervention participants completed a manipulation check to assess whether expectations had increased from baseline. Two follow-up assessments were completed over the phone, one-week after the iron infusion and four-weeks after the iron infusion, to assess changes in fatigue and vitality. The intervention significantly changed patients' expectations about the effectiveness of the iron infusion at increasing iron levels, energy levels, and day-to-day functioning. There were, however, no significant differences between groups, on any of the outcome measures, from baseline to one-week, baseline to four-weeks or one-week to four weeks, as hypothesised. There are limitations which should be considered when interpreting the results from the current study. The study is limited by a small sample and there were several issues with the clinical characteristics of the participants in the sample that may have limited the appropriateness and effectiveness of the intervention. The findings from this study demonstrated that a brief 5 minute expectation-based intervention may not be long enough to maximise the placebo effect in order to improve outcomes from iron infusion. However, the findings from this study present important theoretical and clinical implications that will help inform future research.