Patients' expectations of treatment influence the success of a therapy: positive expectations increase the chances of a therapy succeeding, while negative expectations can reduce its success and increase the risk of side effects. In the Journal of the American Medical Association (JAMA), Prof. Meike Shedden Mora, Prof. Winfried Rief, and Prof. Johannes Laferton present four evidence-based communication strategies that practitioners can use to specifically promote positive expectations.
The authors (from left to right): Johannes Laferton, Professor of Medical Psychology at HMU Health and Medical University Potsdam; Winfried Rief, Professor of Clinical Psychology and Psychotherapy at Philipps University Marburg; Meike Shedden Mora, Professor of Clinical Psychology and Psychotherapy at Medical School Hamburg
Their four strategies, which the three researchers explain in the “JAMA Insights” series, are aimed at everyone working in the healthcare sector. The goal is to improve communication by focusing on the treatment expectations of those affected, thereby increasing the chances of successful therapy and reducing the risk of unwanted side effects:
For their practical suggestions, psychologists Prof. Meike Shedden Mora (Medical School Hamburg), Prof. Winfried Rief (Clinical Psychology and Psychotherapy, University of Marburg), and Prof. Johannes Laferton (Health and Medical University, Potsdam) extracted the decisive factors from various studies on placebo effects. An essential basis for this is provided by work from the Collaborative Research Center 289 “Treatment Expectation,” in which Shedden Mora and Rief lead key subprojects as principal investigators.
1. Understanding the experiences and expectations of those affected
Positive and negative expectations, as well as fear of side effects, can independently influence the success of treatment, as shown by a comprehensive analysis of six studies with a total of 748 participants. Even if a person expects to benefit greatly from treatment, they may at the same time be concerned about experiencing unpleasant side effects. Therefore, healthcare professionals should ask their patients specific questions about
- Previous experiences: “Tell me, how have you felt about your previous treatments?”
- Expectations: “How much do you think the treatment will help you?”
- Fears: “Are you afraid of side effects?”
“We encourage everyone who is in contact with patients to ask these questions, because this is the only way to ensure that individualized therapy and supportive communication tailored to individual fears and needs can be used successfully,” advises psychologist and psychotherapist Prof. Shedden Mora.
2. Strengthen the doctor-patient relationship
When doctors demonstrate competence and empathy toward their patients, it influences the success of the treatment. Nonverbal signals such as eye contact or an affirmative nod, as well as well-structured and understandable communication, create trust:
“If you are concerned about side effects, let's think together about what we can do if side effects occur.”
A study involving 262 patients with irritable bowel syndrome showed that significantly more patients benefited from (placebo) acupuncture treatment when their doctor radiated warmth and empathy rather than when the contact was more factual and distant.
“Asking open questions, listening, and emphasizing your own experience as a doctor can be an important factor in the success of the treatment. Every doctor, psychologist, and physical therapist should be aware of the impact of their communication,” emphasizes psychologist and psychotherapist Prof. Winfried Rief.
3. Specifically promote positive expectations
Every patient has expectations about an upcoming treatment. Positive expectations can increase the chances of success of the therapy, while negative ones can decrease them. To support positive assumptions and a confident outlook among those affected, caregivers can realistically reinforce the individual's personal goals:
“After the operation, you want to go hiking with your family again. I am confident that you will be able to take short walks within the first six weeks and manage moderate hikes again after three months.”
Studies of people who have undergone heart surgery and abdominal surgery show that a personal recovery plan promotes recovery. After heart surgery, patients were able to be discharged from hospital up to 4.5 days earlier, and after abdominal surgery, they resumed their normal daily activities around five days earlier. “When developing such a recovery plan with the help of psychological intervention, it is important that the goals are realistic and have personal significance, for example, being able to walk the dog again after bypass surgery,” confirms psychologist and psychotherapist Prof. Johannes Laferton.
4. Effectively reducing fear of side effects
It is well documented that patients often overestimate the risk of adverse side effects, but underestimate the benefits of therapy. How medical staff explain possible side effects has a significant impact on the frequency of side effects. Balanced information provided in a positive context, where benefits are also emphasized and explained, reduces the burden of side effects.
In a clinical study, people who received methotrexate for inflammatory rheumatism reported significantly fewer side effects when these were explained to them as a positive sign that the drug was working in their bodies. Patients who received such a positive explanation for side effects were significantly less likely to discontinue treatment.
Conclusion
“We are very pleased that JAMA is publishing these findings and recommendations, as our research network has been contributing substantially to the evidence for these effects for many years,” says Prof. Ulrike Bingel, spokesperson for the Collaborative Research Center “Treatment Expectation.” "The positive significance of communication in the therapeutic field of all disciplines cannot be overestimated. At the same time, we still have a lot to learn that will allow us to use expectation effects in a personalized, context-specific, and comprehensive way in daily practice, for the benefit of patients," says Bingel. She is a neurologist, the head of the Center for Pain Medicine at Essen University Hospital and has been conducting intensive research into placebo and nocebo effects in medicine for decades.
Original work:
Laferton JAC, Rief W, Shedden-Mora M. Improving Patients’ Treatment Expectations. JAMA. Published online June 04, 2025. doi:10.1001/jama.2025.6261
https://jamanetwork.com/journals/jama/article-abstract/2834861