Informing Patients About Placebo Effects: Using Evidence, Theory, and Qualitative Methods to Develop a New Website

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

According to established ethical principles and guidelines, patients in clinical trials should be fully informed about the interventions they might receive. However, information about placebo-controlled clinical trials typically focuses on the new intervention being tested and provides limited and at times misleading information about placebos.

Objective

We aimed to create an informative, scientifically accurate, and engaging website that could be used to improve understanding of placebo effects among patients who might be considering taking part in a placebo-controlled clinical trial.

Methods

Our approach drew on evidence-, theory-, and person-based intervention development. We used existing evidence and theory about placebo effects to develop content that was scientifically accurate. We used existing evidence and theory of health behavior to ensure our content would be communicated persuasively, to an audience who might currently be ignorant or misinformed about placebo effects. A qualitative ‘think aloud’ study was conducted in which 10 participants viewed prototypes of the website and spoke their thoughts out loud in the presence of a researcher.

Results

The website provides information about 10 key topics and uses text, evidence summaries, quizzes, audio clips of patients’ stories, and a short film to convey key messages. Comments from participants in the think aloud study highlighted occasional misunderstandings and off-putting/confusing features. These were addressed by modifying elements of content, style, and navigation to improve participants’ experiences of using the website.

Conclusions

We have developed an evidence-based website that incorporates theory-based techniques to inform members of the public about placebos and placebo effects. Qualitative research ensured our website was engaging and convincing for our target audience who might not perceive a need to learn about placebo effects. Before using the website in clinical trials, it is necessary to test its effects on key outcomes including patients’ knowledge and capacity for making informed choices about placebos.

Related collections

Most cited references 50

Record: found
Abstract: found
Article: not found

The magical number 4 in short-term memory: a reconsideration of mental storage capacity.

M N Cowan (2001)

Miller (1956) summarized evidence that people can remember about seven chunks in short-term memory (STM) tasks. However, that number was meant more as a rough estimate and a rhetorical device than as a real capacity limit. Others have since suggested that there is a more precise capacity limit, but that it is only three to five chunks. The present target article brings together a wide variety of data on capacity limits suggesting that the smaller capacity limit is real. Capacity limits will be useful in analyses of information processing only if the boundary conditions for observing them can be carefully described. Four basic conditions in which chunks can be identified and capacity limits can accordingly be observed are: (1) when information overload limits chunks to individual stimulus items, (2) when other steps are taken specifically to block the recording of stimulus items into larger chunks, (3) in performance discontinuities caused by the capacity limit, and (4) in various indirect effects of the capacity limit. Under these conditions, rehearsal and long-term memory cannot be used to combine stimulus items into chunks of an unknown size; nor can storage mechanisms that are not capacity-limited, such as sensory memory, allow the capacity-limited storage mechanism to be refilled during recall. A single, central capacity limit averaging about four chunks is implicated along with other, noncapacity-limited sources. The pure STM capacity limit expressed in chunks is distinguished from compound STM limits obtained when the number of separately held chunks is unclear. Reasons why pure capacity estimates fall within a narrow range are discussed and a capacity limit for the focus of attention is proposed.

0 comments Cited 604 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Test-enhanced learning: taking memory tests improves long-term retention.

Henry L. Roediger, Jeffrey D Karpicke (2006)

Taking a memory test not only assesses what one knows, but also enhances later retention, a phenomenon known as the testing effect. We studied this effect with educationally relevant materials and investigated whether testing facilitates learning only because tests offer an opportunity to restudy material. In two experiments, students studied prose passages and took one or three immediate free-recall tests, without feedback, or restudied the material the same number of times as the students who received tests. Students then took a final retention test 5 min, 2 days, or 1 week later. When the final test was given after 5 min, repeated studying improved recall relative to repeated testing. However, on the delayed tests, prior testing produced substantially greater retention than studying, even though repeated studying increased students' confidence in their ability to remember the material. Testing is a powerful means of improving learning, not just assessing it.

0 comments Cited 498 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A comprehensive review of the placebo effect: recent advances and current thought.

Donald D Price, Damien Finniss, Fabrizio Benedetti (2008)

Our understanding and conceptualization of the placebo effect has shifted in emphasis from a focus on the inert content of a physical placebo agent to the overall simulation of a therapeutic intervention. Research has identified many types of placebo responses driven by different mechanisms depending on the particular context wherein the placebo is given. Some placebo responses, such as analgesia, are initiated and maintained by expectations of symptom change and changes in motivation/emotions. Placebo factors have neurobiological underpinnings and actual effects on the brain and body. They are not just response biases. Other placebo responses result from less conscious processes, such as classical conditioning in the case of immune, hormonal, and respiratory functions. The demonstration of the involvement of placebo mechanisms in clinical trials and routine clinical practice has highlighted interesting considerations for clinical trial design and opened up opportunities for ethical enhancement of these mechanisms in clinical practice.

0 comments Cited 265 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Felicity L Bishop:

Psychology DepartmentFaculty of Social and Human SciencesUniversity of SouthamptonBuilding 44Highfield CampusSouthampton, SO17 1BJUnited Kingdom44 238059902044 2380594597f.l.bishop@southampton.ac.uk

ORCID: http://orcid.org/0000-0002-8737-6662

Journal

Journal ID (nlm-ta): JMIR Res Protoc

Journal ID (iso-abbrev): JMIR Res Protoc

Journal ID (publisher-id): ResProt

Title: JMIR Research Protocols

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 1929-0748

Publication date Collection: Apr-Jun 2016

Publication date (Electronic): 10 June 2016

Volume: 5

Issue: 2

Electronic Location Identifier: e106

Affiliations

[1] ¹Psychology Department Faculty of Social and Human Sciences University of Southampton SouthamptonUnited Kingdom

[2] ²Institute of Psychiatry, Psychology & Neuroscience King's College London LondonUnited Kingdom

[3] ³Centre for Innovation & Leadership in Health Sciences Faculty of Health Sciences University of Southampton SouthamptonUnited Kingdom

[4] ⁴Primary Care and Population Sciences Faculty of Medicine University of Southampton SouthamptonUnited Kingdom

[5] ⁵ZeMedia SouthamptonUnited Kingdom

Author notes

Corresponding Author: Felicity L. Bishop f.l.bishop@ 123456southampton.ac.uk

Author information

Maddy Greville-Harris https://orcid.org/http://orcid.org/0000-0001-8191-9614

Jennifer Bostock https://orcid.org/http://orcid.org/0000-0001-9261-9350

Amy Din https://orcid.org/http://orcid.org/0000-0002-1594-5280

Cynthia A Graham https://orcid.org/http://orcid.org/0000-0002-7884-599X

George Lewith https://orcid.org/http://orcid.org/0000-0002-2364-3960

Christina Liossi https://orcid.org/http://orcid.org/0000-0003-0627-6377

Tim O’Riordan https://orcid.org/http://orcid.org/0000-0003-4905-7430

Peter White https://orcid.org/http://orcid.org/0000-0003-3988-2250

Lucy Yardley https://orcid.org/http://orcid.org/0000-0002-3853-883X

Felicity L Bishop https://orcid.org/http://orcid.org/0000-0002-8737-6662

Article

Publisher ID: v5i2e106

DOI: 10.2196/resprot.5627

PMC ID: 4920960

PubMed ID: 27288271

SO-VID: ceb62540-7f64-434e-bf38-408f73104ca2

Copyright statement: ©Maddy Greville-Harris, Jennifer Bostock, Amy Din, Cynthia A. Graham, George Lewith, Christina Liossi, Tim O’Riordan, Peter White, Lucy Yardley, Felicity L. Bishop. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 10.06.2016.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

History

Date received : 9 February 2016

Date revision requested : 10 March 2016

Date revision received : 23 March 2016

Date accepted : 30 March 2016

Product

Self URI: http://www.researchprotocols.org/2016/2/e106/

Comments

Comment on this article

scite_

Cited by 2

See all cited by

Most referenced authors 1,048

See all reference authors

To submit your manuscript, please click here

Informing Patients About Placebo Effects: Using Evidence, Theory, and Qualitative Methods to Develop a New Website

Read this article at

Abstract

Background

Objective

Methods

Results

Conclusions

Related collections

JMIR: Research Protocols

Most cited references 50

The magical number 4 in short-term memory: a reconsideration of mental storage capacity.

Test-enhanced learning: taking memory tests improves long-term retention.

A comprehensive review of the placebo effect: recent advances and current thought.

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Product

Categories

Comments

Comment on this article

Similar content 98

Cited by 2

Most referenced authors 1,048