Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey

Robin Ortiz, Sara Chandros Hull, Luana Colloca, Robin Ortiz, Sara Chandros Hull, Luana Colloca

Abstract

Objectives: To examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown.

Setting: Members of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months.

Participants: 853 women (61%) and men, white (58%) and non-white participants aged 18-75 years.

Primary and secondary outcomes: Qualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables.

Results: Prior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; p<0.024). Of the minority of respondents who judged it never acceptable for doctors to recommend placebo treatments, the most often referenced rationale was obligation of the doctor to do more (n=102, 48.3%). Additional themes emerged around the issue of whether a doctor was transparent about placebo use, including honesty, patient's right to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; p<0.002).

Conclusions: Participants seem to appreciate and understand the lack of harm and potential benefit associated with placebo treatments, while valuing the role of the physician and the patient in its implementation.

Keywords: Deception; Doctor-patient relationship; Patients' view; Placebo; Placebo effects; Trust.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Design diagram. Respondents were asked about their beliefs regarding the acceptability of doctors recommending placebo treatments, using both general questions (level 1) and scenarios (levels 2). Respondents were also asked about their willingness to take placebos in the different scenarios (level 3).
Figure 2
Figure 2
Response rate and themes. The graph summarises the theme category frequency in scenarios 1 and 2. Responses related to characteristics of the placebo treatment were 52% of the total responses provided for scenario 1 (Deception), and 47% in scenario 2 (Transparency), respectively. However, when participants assigned to scenario 1 were asked if a patient who had been given a placebo deceptively should be informed about the use of a placebo, the majority of responses focused on themes related to the doctor and patients thought that doctors should not lie when actively asked by the patients.

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