The power of placebo

Abstract

Research in medicine and psychology has demonstrated that placebo treatments can lead to clinically meaningful effects which are created by the context of the treatment. Therapeutic rituals are acknowledged as the core of contextual healing effects. To design for contextual healing in clinical practice, more insight is needed in the key ingredients of a ‘ successful’ therapeutic ritual and in their working towards healing. Research was executed in a hand therapeutic context. Because data from patient’s questionnaires by the Xpert Clinic indicates that expectancies of conservative treatments are lower than that of surgical treatments, the question arose how to increase this treatment outcome expectancies by integrating contextual healing mechanisms in a patient’s journey for hand and wrist physiotherapeutic treatment? Through a literature study, placebo mechanisms were identified. These mechanisms lead to directly increased expectancies to heal, but they also affect each other. Impact and mechanisms of the placebo effect are context-, illness- and patient-dependent. However, patient-practitioner interaction is considered as the most important factor in contextual healing. To understand the presence of placebo mechanisms in the hand therapeutic context, observations were made during different phases of the patient journey. Also, the presence of mechanisms was discussed with medical professionals, and patients were interviewed about their belief in treatment outcomes. Several mechanisms were already used by doctors and therapists, although not always in a conscious way. For example, patients are involved in diagnosis and treatment decisions. However, it was seen that patients’ belief in a treatment was influenced by the overall appearance of the therapist they were facing. Finally, an important patients’ motivator to belief in their treatment is the experience of improvement in daily life activities. Using the insights on the presence of placebo mechanisms in the context of hand therapeutic treatments, several design concepts were made to foster placebo mechanisms. Among them were concepts that made results more experienceable, a concept that focussed on managing patient’s expectations, a concept that stressed the hand-touching moment within a therapy session as an important moment of the therapeutic ritual and a concept that created better understanding to patients about their disease and reasoning for their exercises. The concept that was chosen to continue with was aimed at increasing the professional appearance and behaviour of therapists, in order to increase patients’ belief in positive treatment outcomes. A final design was made that fosters placebo mechanisms by increasing the way patients experience the therapist as a skilled medical professional. The specialised measuring tool organiser for hand therapists, presents the measurement tools in an open, professional way to the patient. The design motivates the therapist to measure with a professional and structured attitude. The presentation of the tools lifts them towards the level of medical equipment. Being involved in a session with a skilled professional, the placebo effect on patients is increased. By use of a prototype, the organiser was tested in actual therapeutic practice. Results showed more structured therapists’ behaviour and showed patients’ fascination for and attraction towards the design, indicating that the professional appearance and behaviour of the hand therapist and the session room is increased. Although direct involvement of patients could be improved, and a more suitable place for the design in the room has to be found, the design is assessed as useful by therapists. When patients experience the therapist, through the use of the design, as a more skilled professional, the design might contribute to contextual healing.