Optimizing patient expectations to improve therapeutic response to medical treatment: A randomized controlled trial of iron infusion therapy

Pre-treatment expectations and their influence on subjective symptom change in Crohn's disease

BACKGROUND

Treatment expectations reportedly shape treatment outcomes, but have not been studied in the context of multimodal therapy in Crohn's disease (CD). Therefore, the current study investigated the role of treatment expectations for subjective symptom changes in CD patients who have undergone an integrative multimodal therapy program.

METHODS

Validated questionnaires were completed at the start of the treatment program and post intervention. Pre-treatment expectations and experienced symptom change were assessed with the Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE); stress levels were quantified with the Perceived Stress Scale (PSS-10) and disease specific quality of life was quantified with the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). We performed multiple linear and Bayesian regression to determine how expectations related to symptom change.

RESULTS

N = 71 CD patients (66.2% female) were included. Stronger expectations regarding symptom improvement (b = 0.422, t = 3.70, p < .001) were associated with higher experienced symptom improvement. Additionally, Bayesian analysis provided strong evidence for including improvement expectations as a predictor of improvement experience (BFinclusion = 13.78).

CONCLUSIONS

In line with research in other disorders, we found that positive treatment expectations were associated with experienced symptom improvement. In contrast, we found no indication that an experience of symptom worsening was associated with positive or negative baseline treatment expectations. Induction of positive expectations might be a potential avenue for improving treatment outcomes in CD therapy.

Changing Mindsets About Side Effects of the COVID-19 Vaccination: A Randomized Controlled Trial

BACKGROUND

Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Identifying cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy-without withholding information about side effects-is critical.

PURPOSE

Determine whether a brief symptom as positive signals mindset intervention can improve vaccine experience and reduce vaccine hesitancy after the COVID-19 vaccination.

METHODS

English-speaking adults (18+) were recruited during the 15-min wait period after receiving their second dose of the Pfizer COVID-19 vaccination and were randomly allocated to the symptom as positive signals mindset condition or the treatment as usual control. Participants in the mindset intervention viewed a 3:43-min video explaining how the body responds to vaccinations and how common side effects such as fatigue, sore arm, and fever are signs that the vaccination is helping the body boost immunity. The control group received standard vaccination center information.

RESULTS

Mindset participants (N = 260) versus controls (N = 268) reported significantly less worry about symptoms at day 3 [t(506)=2.60, p=.01, d=0.23], fewer symptoms immediately following the vaccine [t(484)=2.75, p=.006, d=0.24], and increased intentions to vaccinate against viruses like COVID-19 in the future [t(514)=-2.57, p=.01, d=0.22]. No significant differences for side-effect frequency at day 3, coping, or impact.

CONCLUSIONS

This study supports the use of a brief video aimed at reframing symptoms as positive signals to reduce worry and increase future vaccine intentions.

CLINICAL TRIAL INFORMATION

Australian New Zealand Clinical Trials Registry: ACTRN12621000722897p.

Moving forward: Implementing health psychology research to improve patient acceptance of biosimilars

As more biosimilars enter the pharmaceutical market, patient acceptance remains a significant barrier to their uptake. Psychological factors, such as negative expectations, are important causes of patient hesitancy. As a result, patients can develop nocebo responses following a transition, discontinue biosimilar treatment early, or have poor adherence. These negative outcomes may offset some of the cost-saving potential of biosimilars. Key healthcare professionals such as pharmacists, physicians, and nurses already play a noteworthy role in educating and transitioning patients. However, given the psychological aspect of biosimilar acceptance, it is logical for healthcare professionals and researchers to draw on research and theory from health psychology. This commentary outlines how a multidisciplinary approach can add to the understanding of the mechanisms behind patient resistance to biosimilars and help engage patients in the transitioning process. It also explores how health psychology strategies that have been successful in similar areas can be translated to help conduct more effective transitions. Future directions in research are discussed.