Table 2.
Procedure | Suggested clinical applications | |
Patient’s beliefs and characteristics | ||
1. | Select patients based on treatment history | Stop prescribing interventions of a type that a patient has previously not responded to (eg, tablets); instead, prescribe a different, new type of treatment (eg, psychological therapy). |
2. | Create positive expectancy | Tell the patient the intervention is likely to be effective. |
Elicit patients’ treatment and illness beliefs and expectations and dispel any misconceptions. | ||
Empower patients to self-care. | ||
3. | Reduce negative expectancy | Limit emphasis on major potential side effects and describe how uncommon they are. |
Hide cessation of analgesia administration (eg, as in Benedetti et al 73), after obtaining advanced consent and ensuring patients are aware they can request additional analgesia if needed. | ||
4. | Convey a positive therapeutic message through informed consent procedures | Provide written and/or verbal information that conveys a positive therapeutic message about treatment. |
Provide clear rationale for treatment. | ||
Provide patient testimonials and supporting literature/media. | ||
5. | Harness sociocultural context | Elicit patients’ culturally embedded treatment and illness beliefs, preferences and expectations, dispelling any potentially harmful misconceptions. |
Involve significant others in care. | ||
Practitioner’s beliefs and characteristics | ||
6. | Practitioner expectancy | Only prescribe a treatment to patients when the practitioner expects it will be effective; communicate that expectation to patients. |
7. | Practitioner’s personal characteristics | Honour patient preferences for particular practitioners. |
Use indicators of expertise/high status in offices, in correspondence and when referring to other practitioners. | ||
Ensure the patient is seen by a practitioner whose views/values are congruent with the patient’s views/values. | ||
Healthcare setting | ||
8. | Active recruitment | Actively seek out patients and invite them to attend clinic regarding a particular intervention (as opposed to waiting for patients to present). |
9. | Active retention | Personally contact patients if they miss an appointment. |
Use incentives to encourage patients to keep appointments. | ||
10. | Follow-up | Routinely invite patients to book a follow-up appointment after an intervention has finished and prior to repeat prescription. |
Encourage the patient to take responsibility for and self-manage their condition following an intervention. | ||
11. | Follow a standardised protocol | Use patient-friendly treatment protocols and share with patients where they fit in that protocol. |
12. | Ethical oversight | Ensure that patients understand that their treatment protocol is sanctioned by a higher authority, for example, National Institute for Health and Care Excellence. |
13. | Participating in research | Inform patients that all outcomes and practitioner performance is audited and can contribute to improved knowledge and treatment for future patients. |
14. | Symptom monitoring | Ask patients to monitor their symptoms regularly, for example using email, phone apps, web-based systems, paper forms. |
Assess treatment outcome. | ||
Give patients feedback on symptom improvements following monitoring. | ||
15. | Enhanced environment | Ensure that the environment is professional, pleasant and peaceful. |
Employ friendly and helpful support staff. | ||
Treatment characteristics | ||
16. | Sham intervention—medication | Openly prescribe sham medication. |
With advanced prior consent, prescribe sham medication. | ||
17. | Sham interventions—physical | Openly prescribe sham physical treatments. |
With advanced prior consent, prescribe sham physical treatments. | ||
18. | Sham interventions—attention only | Increase frequency and duration of consultations. |
19. | Ineffective substances | Prescribe substances that are likely not to cause harm but not clearly indicated or substances unlikely to be effective, for example, simple linctus. |
20. | Use side effects | Tell patients about side effects associated with positive clinical outcome. |
21. | Matched treatments | Design appearance of prescribed substance (eg, colour, packaging, taste) to match known effective treatments. |
22. | Maximised treatment procedures | Within safety limits prescribe higher dose/higher frequency/larger pill. |
Use different colour treatments. | ||
Instigate ritualistic procedures patients can perform when taking medicines. | ||
Maximise adherence to treatment through education, easy follow-up appointments, easy repeat prescription arrangements, and so on. | ||
23. | Conditioning | Prescribe highest tolerated dose first, then titrate downwards. |
With consent, begin with active intervention, pair with a seemingly identical placebo then substitute for placebo alone (eg, as in Sandler and Bodfish56). | ||
Patient–practitioner interaction | ||
24. | The process of informed consent | Actively seek patient consent. |
Provide treatment options and encourage the patient to choose from these options if they so desire. | ||
25. | Detailed history | Take a detailed medical and psychosocial history/update. |
Ensure the patient feels listened to, for example, through non-verbal communication and/or capturing information. | ||
Ask questions about the meaning of symptoms. | ||
26. | Diagnosis/tests | Provide a definitive/confident diagnosis. |
Examine the patient fully. | ||
27. | Care | Allow patient adequate time to tell their story and listen to them. |
Validate the patient’s concerns. | ||
Use non-verbal techniques to convey empathy, compassion, warmth. | ||
Use touch judiciously. | ||
28. | Patient-centred communication | Individualise consultation style according to a patient’s preference for example, collaborative versus authoritative. |
Engage in collaborative decision-making with the patient. | ||
Develop shared treatment goals that you and the patient agree on. | ||
29. | Extra attention | Give extra attention to or show more interest in a patient by seeing them more frequently, having longer consultations or visiting at home. |
Do not rush the patient. | ||
30. | Continuity of care | Ensure patient is cared for by the same practitioner. |
Read records before consultation. |
Suggestions for clinical applications pending research into effectiveness and ethical acceptability in clinical settings.