Using contextual factors to elicit placebo and nocebo effects: An online survey of healthcare providers’ practice

Contextual factor use by healthcare professionals has been studied mainly among nurses and physiotherapists. Preliminary results show that healthcare professionals use contextual factors without specifically labelling them as such. The main objective of this study was to evaluate knowledge and explore voluntary contextual factor use among various healthcare professions. The results aim to facilitate hypothesis-generation, to better position further research to explain and characterise contextual factor use. We conducted a web-based questionnaire cross-sectional observational study on a non-probabilistic convenience sample. Face and content validity were tested through cognitive interviews. Data were analysed descriptively. The target population was the main healthcare profession, or final year students, defined by the French public health law. The countries of distribution of the questionnaire were the French-speaking European countries. Among our 1236 participants, use of contextual factors was widespread. Those relating to the therapeutic relationship (e.g., communication) and patient characteristics (e.g., past experiences) were reportedly the most used. Meanwhile, contextual factors related to the healthcare providers’ characteristics and their own beliefs were reported as less used. Despite high variability, respondents suggested contextual effects contribute to approximately half of the overall effect in healthcare and were perceived as more effective on children and elderly adults. Conceptual variations that exist in the literature are also present in the way healthcare providers consider contextual effects. Interestingly, there seems to be common ground between how physiotherapists, nurses and physicians use different contextual factors. Finally, in the present study we also observed that while there are similarities across usage, there is lack of both an epistemological and ethical consensus among healthcare providers with respect to contextual factors.


Introduction
Welcome to this survey !Dear colleagues and students, The aim of this survey is to investigate the extent to which health professionals use the context in which they care for their patients.This can improve or worsen the outcome of the treatments they administer.Indeed, it is recognized that factors related to the provider-patient relationship or the environment can influence treatment outcomes: these are known as contextual factors.For example, the words used to address the patient, the posture adopted by the professional or the fact of wearing a gown can influence the perception of pain, the level of anxiety or the physical performance of a patient.
Practicing health professionals in France, Switzerland and Belgium as well as healthcare students in France, Switzerland or Belgium can answer this questionnaire.
In the following questions, we ask you to answer according to your own experience.
Your participation in the survey takes 10-15 minutes and your contribution will only be recorded if the whole questionnaire is completed.Therefore, if you choose not to complete the questionnaire, no data will be recorded.There is no direct risk or benefit to participants in this study.In this respect, this study has been declared to the Research Ethics Committee of Grenoble Alpes University.The responses are pseudo-anonymous and will only be used for research purposes.The data produced is stored and processed in compliance with the RGPD on Université Grenoble Alpes servers that comply with the RGPD requirements.The data processing complies with a national methodology of reference (MR004) of the CNIL.
By clicking on "Next", you agree to participate in the study and consent to the use of the data produced by the response to this questionnaire under the conditions described above.The results of this research will undergo scientific publication and be presented at conferences.Under no circumstances can the anonymity of participation be lifted and the results will only be presented in an aggregate.
If at the end of the study you wish to withdraw your participation or if you need information, you can contact the study coordinator: EMAIL ADRESS

What do you think is the state of your knowledge about contextual effects?
No knowledge Excellent knowledge on the topic

In your opinion, does this knowledge influence your clinical practice?
Not at all A lot According to you, the contextual effect is defined as : A manifestation of symptoms of a condition or their evolution, positive or negative, in absence of treatment

I don't know
A treatment with no specific efficacy A positive (beneficial) or negative (detrimental) psycho-physiological effect observed after a treatment regardless of its specific efficacy An effect of the interaction with a therapist

None of the following
The order of items is random

General understanding
In the rest of the questionnaire we will consider the contextual effect as being a positive (beneficial) or negative (damaging) psycho-physiological effect observed after any kind of treatment.This can improve or deteriorate the outcome of the treatments administered.Indeed, it is accepted that certain elements of the context can influence the results of treatments: these are called contextual factors.Commonly the term placebo effect is often associated with what is defined here as a contextual effect.
In your opinion, the contextual effects depend strongly on the following parameters (several options possible): Where care is provided to women, contextual factors alone account for : Where care is provided to men, contextual factors alone account for : Where care is provided to children, contextual factors alone account for : Where care is provided to adults, contextual factors alone account for : Where care is provided to older people, contextual factors alone account for :

Reminder of definition :
The contextual effect is a positive (beneficial) or negative (damaging) psychophysiological effect observed after any treatment.It can improve or deteriorate the outcome of the treatments administered.Indeed, it is accepted that certain elements of the context can influence the results of treatments: these are called contextual factors.Commonly, the term placebo effect is often associated with what is defined here as a contextual effect.

Demography for students
Treatment characteristics (type, duration, administration mode, etc) situation(s) where contextual effects are present:When the patient takes a treatment without advice from or interaction with a health professional (i.e.self-medication) When the treatment is not medicinal When the consultation does not lead to treatment When the consultation takes place at the patient'role (student, intern, head of department, specialist, etc.)Reputation in the professionPrice of treatment remaining to be paid (additional fees, nonnomenclature procedures, etc.) Patient's expectations and preferences Past experiences of patients Beliefs or representations of the patient about his/her pathology, therapist, treatment Verbal or non-verbal communication Quality of the care relationship (general attitude of the professional) Past experiences of the carer Beliefs and representations of the carer about the disease, the patient, the treatment Physical contact with the patient Consultation environment (comfort of installation, working clothes, place of care, etc.) How often ?Have you already implemented strategies for adapting the care environment (comfort of installation, working clothes, place of care) in order to improve the clinical outcome of your care?
In the context of effective treatments provided to optimise clinical outcomesTo compensate for the lack of effect of a treatment without proven effectiveness To meet a need to improve patient satisfaction When you are in a therapeutic impasse To better cope with the side effects of effective treatments Other motivations Pharmacology SpeciliatyIn which year of your course are you (e.g.3rd year since the baccalaureate without counting repeated years, put "3")?  