Surgeons’ behaviors and beliefs regarding placebo effects in surgery

Abstract

Background and purpose — Emerging evidence from sham-controlled trials suggest that surgical treatment entails substantial non-specific treatment effects in addition to specific surgical effects. Yet, information on surgeons’ actual behaviors and beliefs regarding non-specific treatment and placebo effects is scarce. We determined surgeons’ clinical behaviors and attitudes regarding placebo effects.

Methods — A national online survey was developed in collaboration with surgeons and administered via an electronic link.

Results — All surgical clinics in Sweden were approached and 22% of surgeons participated (n = 105). Surgeons believed it was important for them to interact and build rapport with patients before surgery rather than perform surgery on colleagues’ patients (90%). They endorsed the importance of non-specific treatment effects in surgery generally (90%) and reported that they actively harness non-specific treatment effects (97%), including conveying confidence and calm (87%), building a positive interaction (75%), and making eye contact (72%). In communication regarding the likely outcomes of surgery, surgeons emphasized accurate scientific information of benefits/risks (90%) and complete honesty (63%). A majority felt that the improvement after some currently performed surgical procedures might be entirely explained by placebo effects (78%). Surgeons saw benefits with sham-controlled surgery trials, nevertheless, they were reluctant to refer patients to sham controlled trials (46%).

Interpretation — Surgeons believe that their words and behaviors are important components of their professional competence. Surgeons saw the patient–physician relationship, transparency, and honesty as critical. Understanding the non-specific components of surgery has the potential to improve the way surgical treatment is delivered and lead to better patient outcomes.

Supplementary data

Full version of the survey is available as supplementary data in the online version of this article, http://dx.doi.org/10.1080/17453674.2021.1941627

The authors wish to thank Dr Kristofer Bjerså and Dr Jeremy Howick for invaluable help with the preparation of the survey.

Conceptualization: KBJ, AR, LS. Data curation and formal analysis: AR, AE. Funding acquisition: KBJ. Methodology: AR, LS, TJK. Project administration: KBJ, AR, AE. Validation: KBJ, AR, AE, PG, AE. Writing original draft: AR, AE, LS, TJK, KBJ. Review of writing and editing: AR, AE, LS, PG, AW, TJK, KBJ.

Acta thanks Ian Harris and Karolina Wartolowska for help with peer review of this study.