Patients' beliefs about treatment: The hidden determinant of treatment outcome?

Abstract

A new view of health care is emerging in which patients are expected and encouraged to take a more active role in their health care [1] and in decisions about treatment [2]. However, at present, we know little about how patients make decisions or about the origin of preferences for one treatment over another. This information is essential if we are to help patients make informed, rational decisions about the management of their illness. Previous attempts to understand the way in which patients make decisions about their treatment have examined patients’ beliefs about their illness but have ignored the interplay that exists between patients’ illness and treatment perceptions. It is likely that a twofold structure in which the patients’ perception of the problem (beliefs about the illness) and possible solutions (beliefs about treatment) are considered in parallel would lead to a more useful model. Given that the prescription of medicine is one of the most common forms of medical intervention, researchers and clinicians need to consider adopting this dual approach. Although the research in this area focuses predominantly on one class of treatment—namely medicines—the findings offer an insight into the factors influencing patients’ responses to treatment in general. It is important to distinguish between people’s views about a class of treatment (e.g., views about medicines in general or views about counseling) and their views about specific treatments within the class (e.g., beliefs about Prozac or perceptions of counseling as a treatment for depression). Recent research suggests that many people have a fairly negative view of medicines, perceiving them to be generally harmful substances that are overused by doctors [3]. Negative perceptions of medication are often associated with the notion that the dangerous aspects of medication are linked to their chemical/unnatural origins and that complementary treatments are perceived to be more “natural” and therefore safer. Such general perceptions of a class of treatment are likely to inform