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To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent.
Am J Bioeth 2012; 12(3):22-9AJ

Abstract

The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event-especially subjective self-appraised symptoms-can actually increase side effects. Describing one version of what might happen (clinical "facts") may actually create outcomes that are different from what would have happened without this information (another version of "facts"). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white "truth." This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through "contextualized informed consent," which takes into account possible side effects, the patient being treated, and the particular diagnosis involved.

Authors+Show Affiliations

Brigham andWomen’s/Faulkner Hospitals, Harvard Medical School, John R. Graham Medical Center, 1153 Centre St., Suite 4970, Boston, MA 02130, USA. rwells3@partners.orgNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

22416745

Citation

Wells, Rebecca Erwin, and Ted J. Kaptchuk. "To Tell the Truth, the Whole Truth, May Do Patients Harm: the Problem of the Nocebo Effect for Informed Consent." The American Journal of Bioethics : AJOB, vol. 12, no. 3, 2012, pp. 22-9.
Wells RE, Kaptchuk TJ. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. Am J Bioeth. 2012;12(3):22-9.
Wells, R. E., & Kaptchuk, T. J. (2012). To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. The American Journal of Bioethics : AJOB, 12(3), pp. 22-9. doi:10.1080/15265161.2011.652798.
Wells RE, Kaptchuk TJ. To Tell the Truth, the Whole Truth, May Do Patients Harm: the Problem of the Nocebo Effect for Informed Consent. Am J Bioeth. 2012;12(3):22-9. PubMed PMID: 22416745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. AU - Wells,Rebecca Erwin, AU - Kaptchuk,Ted J, PY - 2012/3/16/entrez PY - 2012/3/16/pubmed PY - 2012/5/9/medline SP - 22 EP - 9 JF - The American journal of bioethics : AJOB JO - Am J Bioeth VL - 12 IS - 3 N2 - The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event-especially subjective self-appraised symptoms-can actually increase side effects. Describing one version of what might happen (clinical "facts") may actually create outcomes that are different from what would have happened without this information (another version of "facts"). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white "truth." This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through "contextualized informed consent," which takes into account possible side effects, the patient being treated, and the particular diagnosis involved. SN - 1536-0075 UR - https://www.unboundmedicine.com/medline/citation/22416745/To_tell_the_truth_the_whole_truth_may_do_patients_harm:_the_problem_of_the_nocebo_effect_for_informed_consent_ L2 - http://www.tandfonline.com/doi/full/10.1080/15265161.2011.652798 DB - PRIME DP - Unbound Medicine ER -