Can nocebo information and empathy alleviate symptoms in advanced cancer? An videovignette study.

ABSTRACT: Introduction To alleviate anti-cancer treatment burden in advanced breast cancer, patient-clinician communication strategies based on nocebo-effect mechanisms are promising. We assessed distinct/combined effects on psychological outcomes (e.g. anxiety; main outcome) and side-effect expectations of i) nocebo information about the (non)pharmacological origin of side effects, and ii) clinician-expressed empathy through reassurance of continuing support. Furthermore, we explored whether information and empathy effects on side-effect expectations were mediated by decreased anxiety. Methods In a two-by-two experimental video-vignette design, 160 cancer patients/survivors and healthy women watched one of four videos differing in level of nocebo information (+/-) and empathy (+/-). Regression and mediation analysis were used to determine effects of information/empathy and explore anxiety’s mediating role. Results Anxiety was not influenced by empathy or information (Stai-state: p=.295; p=.390, VAS p=.399; p=.823). Information improved (specific) side-effect coping expectations (p<.01). Empathy improved side-effect intensity expectations (p<.01=specific; p<.05=non-specific/partial) and specific side-effect probability expectations(p<.01), and increased satisfaction, trust, and self-efficacy (p<.001). No mediating effects were found of anxiety on expectations. Conclusion Mainly empathy, but also nocebo information improved psychological outcomes and – mainly specific – side-effect expectations. Exploring the power of these communication elements in clinical practice is essential to diminish the anti-cancer treatment burden in advanced breast cancer.