Optimizing placebo and minimizing nocebo effects through communication: e-learning and virtual reality training development

BMC Medical Education, vol. 24, pp. 707

Abstract

BACKGROUND: The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. METHODS: The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. RESULTS: Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0-10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0-10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. CONCLUSIONS: We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes.

Authors 9

1. Janine Westendorp corresponding Aachen Center for Interdisciplinary Placebo Studies (IPS) Leiden Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands. j.westendorp@fsw.leidenuniv.nl

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. j.westendorp@fsw.leidenuniv.nl

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands

2. Liesbeth Mirjam van Vliet Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands

3. Stefanie H. Meeuwis Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands

4. Tim C. olde Hartman

   Radboud University Medical Center

   Affiliation as printed

   Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands

5. Ariëtte R.J. Sanders
   Affiliation as printed

   General Medical Practice Van Lennep Huisartsenpraktijk, Driebergen, The Netherlands

6. Eric Jutten
   Affiliation as printed

   The Simulation Crew (TSC), Nijmegen, The Netherlands

7. Monique Dirven

   Instituut voor Verantwoord Medicijngebruik

   Affiliation as printed

   Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands

8. Kaya J. Peerdeman Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands

9. Andrea W.M. Evers Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands