Nocebo effect in health communication: how to minimize it?

Rodrigues, Bruna Alves; Silva, Luciana Micaelly Costa Pessoa; Lucena, Hiênio Ítalo da Silva; Morais, Edna Pereira Gomes de; Rocha, Ana Carolina; Alves, Giorvan Anderson dos Santos; Benevides, Silvia Damasceno

doi:10.1590/1982-0216/20222443022

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REVIEW ARTICLES • Rev. CEFAC 24 (4) • 2022 • https://doi.org/10.1590/1982-0216/20222443022 copy

Nocebo effect in health communication: how to minimize it?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to describe the strategies used to minimize the nocebo effect in health communication.

Methods:

an integrative review of the literature. The keywords “nocebo effect” and “health communication” and their combinations were used in English, Portuguese, and Spanish to search publications from 2011 to 2021 in MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, EMBASE, and Web of Science/ISI. The following research question was used: “Which strategies have been used to minimize the nocebo effect in health communication?”.

Literature Review:

altogether, 77 articles were found, although only six met the inclusion criteria and comprised the review sample. Their year of publication ranged from 2015 to 2021. Positive framing, assertive communication, and contextual factors were the strategies used to minimize the nocebo effect.

Conclusion:

the strategies used to minimize the nocebo effect were contextual factors, motivational talk, positive framing, assertive communication, and empathetic communication. These communication techniques are seemingly effective, though still little known by health professionals. This knowledge is important as it helps develop communicative skills aiming at humanized patient care.

Keywords:
Nocebo Effect; Health Communication; Health Strategies

Authors/Year/Country	Objective	Methodology	Strategies to minimize the nocebo effect/Results	Contributions
Bisconti and col. (2021) Italy⁹	To understand the management of contextual factors and identify the most relevant ones and the underestimated ones by physical therapists.	Cross-sectional study with the development of a questionnaire, which was divided into two parts. The first part is the sociodemographic questionnaire, while the second part has specific questions on contextual factors.	The following strategies were used: taking into consideration the contextual factors (verbal and nonverbal interaction, health professional’s appearance and behaviors, patient’s expectations) and stimulating positive expectations in patients toward successful therapies.	The study observed the need for using contextual factors in practice, as well as its effectiveness to minimize the nocebo effect.
Rossettini and col. (2019) Italy¹⁰	To investigate the attitudes and beliefs of Italian patients with musculoskeletal pain about the use of contextual factors in clinical practice.	Web-based quantitative cross-sectional study. The sample comprised Italian patients with musculoskeletal pain, who answered a questionnaire on sociodemographic data, characteristics of the musculoskeletal pain, expectations for the treatment based on previous experiences and laser use.	Contextual factors associated with evidence-based therapy.	The use of contextual factors along with evidence-based intervention provides better therapeutic results.
Petit and col. (2021) France¹²	To assess an intervention aimed at reducing the patient’s nocebo effect by switching the drug of infliximab originator to biosimilar infliximab SB2.	Study divided into four stages. The first one was a systematic review. The second one had interviews with the patients who received the drug. The third stage had a multiprofessional intervention. In the fourth stage, the intervention was put into effect, switching the drug.	Motivational talk was the strategy used for patients to accept drug switch.	The adapted communication strategy focused on a trust relationship between patients and the multiprofessional team proved to be well-accepted in drug switch and minimized the nocebo effect.
Devlin and col. (2019) Australia¹⁵	To observe whether the expectancies of side effects before the treatment influence subsequent experiences.	The sample comprised university students. Interviewers informed them they were participating in a study, indicating its objective. The instruments used were sociodemographic questionnaires, behavioral style scale, depression, anxiety, and stress scale, response expectancy scale, and experience scale. Subjects were also informed of the cold pressor test (CPT). Then, standardized CPT data were presented to them.	Positive framing	Positive framing reduced short-term adverse effects. However, such a reduction did not occur in follow-up.
Vijayan and col. (2015) United Kingdom¹⁶	To describe whether the communication process induces patients’ negative expectations and whether they can generate a nocebo response, represented by greater pain intensity.	Mixed study combining two cross-sectional and one randomized study. The observational study included interviews with professionals addressing verbal communication in venipuncture. It used the degree of agreement regarding four statements about the justification of a verbal warning. The second study was conducted on patients of a clinic, who answered a questionnaire on the use of verbal warnings.	Assertive communication before venipuncture	Health professionals managed to use phrases before invasive procedures without causing the nocebo effect.
Van and col. (2019) The Netherlands¹⁸	To provide further information on how and how often oncologists use expectancy and empathy expressions in their visits.	Multicentric observational study regarding visits with advanced breast cancer patients. The sample comprised 33 recorded visits, which were later analyzed and decoded to determine the expressions of expectancy and empathy and positive, negative, and uncertain expectancies.	Empathetic communication.	Empathetic communication between physicians and patients influences the therapeutic process, ensuring better treatment results.

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E-mail: revistacefac@cefac.br

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[1] Corresponding address: Bruna Alves Rodrigues, Rua Manoel Herculano da Cruz n°51, CEP: 58865-000 - São Bento - Paraíba, Brasil, E-mail: bruna_alves.sb.pb@hotmail.com