Investigating the Effects of Nocebo Information and Clinician-Expressed Empathy on Breast Cancer Patients’ Psychological Outcomes

Background: An innovative approach to improving poor psychological outcomes in breast cancer patients undergoing chemotherapy is via clinician-patient communication strategies such as educating patients about the nocebo effect (i.e., nocebo information) and using reassurance of non-abandonment (i.e., clinician-expressed empathy). Research suggests that nocebo information may improve some outcomes in non-cancer settings, but its effectiveness on psychological outcomes in cancer settings remains uncertain. Clinician-expressed empathy has repeatedly been shown to improve short-term psychological outcomes in cancer patients, although the long-term effects require further investigation. Moreover, potential interaction effects between nocebo information and clinician-expressed empathy observed in non-cancer settings warrant exploration in cancer care. Objective: To investigate the distinct and combined effects of nocebo information and clinician-expressed empathy on breast cancer patients...Show moreBackground: An innovative approach to improving poor psychological outcomes in breast cancer patients undergoing chemotherapy is via clinician-patient communication strategies such as educating patients about the nocebo effect (i.e., nocebo information) and using reassurance of non-abandonment (i.e., clinician-expressed empathy). Research suggests that nocebo information may improve some outcomes in non-cancer settings, but its effectiveness on psychological outcomes in cancer settings remains uncertain. Clinician-expressed empathy has repeatedly been shown to improve short-term psychological outcomes in cancer patients, although the long-term effects require further investigation. Moreover, potential interaction effects between nocebo information and clinician-expressed empathy observed in non-cancer settings warrant exploration in cancer care. Objective: To investigate the distinct and combined effects of nocebo information and clinician-expressed empathy on breast cancer patients’ psychological outcomes (main outcome: state anxiety) over time and at short term when undergoing chemotherapy. Methods: In this 2x2 clinical proof-of-principle randomized controlled trial, female breast cancer patients undergoing chemotherapy for the first time viewed 1 out of 4 role-played information videos, wherein the levels of nocebo information (present vs. absent) and empathy (present vs. absent) were varied. Using stepwise multilevel analyses and two-way analyses of variance, we investigated the videos’ effects on participants’ psychological outcomes over time and at short term. Results: Among the 19 participants, over time, nocebo information showed trends (p > .05) to improve state anxiety but worsen self-efficacy and distress, and empathy showed trends to worsen state anxiety, self-efficacy, as well as distress. When combined, nocebo information and empathy significantly and largely worsened self-efficacy (β = -3.21; p = .009). At short term, both nocebo information and empathy showed trends (p > .05) to worsen feelings of satisfaction and trust. Conclusion: Although these unexpected and mixed findings are preliminary, they highlight the need to fully understand the potential benefits and risks associated with clinician-patient communication strategies in cancer care.Show less

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Investigating the Effects of Nocebo Information and Clinician-Expressed Empathy on Breast Cancer Patients’ Psychological Outcomes