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.
Highlights
Placebo effects can be substantial and clinically meaningful; efforts to harness them in clinical practice to benefit patients are warranted [1]
Our three literature reviews and qualitative interview study effectively identified potentially effective intervention components, barriers and facilitators to practitioners engaging with the intervention, and features of OA consultations that required consideration
By involving target users at all stages of development, and using a systematic approach to refining it, we have maximized the potential of the intervention to be effective. This focus on user engagement is valuable when trying to implement evidence from the placebo literature into clinical practice, an endeavor that is often met with valid ethical concerns as well as objections founded on misunderstandings and myths about placebo effects [49, 50]
Summary
Placebo effects can be substantial and clinically meaningful; efforts to harness them in clinical practice to benefit patients are warranted [1]. A different approach is suggested by processoriented definitions of placebo effects, in which placebo effects are elicited by the psychosocial context within which treatment occurs and, especially, the doctor-patient interaction [2] From this perspective, harnessing placebo effects in clinical practice can be achieved by leveraging the psychosocial context that triggers the neuropsychological processes underpinning placebo effects. This approach aligns with data suggesting that clinicians and patients may be more favorably inclined toward harnessing placebo effects through leveraging psychosocial context than through prescribing placebos [2, 3] It is this process-oriented perspective that guided our intention to develop an intervention to enable primary care practitioners to harness placebo effects by enhancing their communication of clinical empathy and realistic optimism in clinical consultations. 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
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