Talking placebo: A qualitative study of patients' attitudes towards open-label placebo implementation into clinical practice

Antje Frey Nascimento^1*Berfin Bakis¹Jens Gaab¹Tobias Schneider²Athina Papadopoulou²Milena Ritter²Michael Bernstein^3,4Charlotte R Blease^5,6Cosima Locher^1,7

• ¹University of Basel, Basel, Switzerland
• ²University Hospital of Basel, Basel, Basel-Stadt, Switzerland
• ³Brown University, Providence, Rhode Island, United States
• ⁴Rhode Island Hospital, Providence, Rhode Island, United States
• ⁵Uppsala University, Uppsala, Uppsala, Sweden
• ⁶Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
• ⁷University of Zurich, Zürich, Zürich, Switzerland

Background: For more than a decade, studies have supported the efficacy and safety of placebos without deception -so-called open-label placebos (OLPs) -to harness placebo effects in primary care while aligning with key ethical principles. Since treatment acceptance, feasibility, and successful implementation of novel interventions into clinical practice depend on patients' attitudes, patients' perspectives, perceived obstacles, and ideas on OLP use in clinical practice have yet to be elucidated.Therefore, patient and public involvement is increasingly demanded in research and its implementation into clinical practice. Qualitative research offers a unique opportunity to comprehensively understand attitudes, expectations, perceived benefits, and barriers from a patient's point of view. Thus, we studied patients' attitudes, concerns, and ideas towards OLP implementation into clinical practice with focus group discussions (FGDs).In 2022, three exploratory online FGDs, each including two patients with the same condition, were conducted with adult patients affected by chronic back pain (n=2), chronic migraine (n=2), or chemotherapy-induced emesis/nausea (n=2). Physicians recruited participants in three outpatient clinics at the University Hospital Basel in Switzerland. The FGDs were held online for 60 minutes. Qualitative data was analyzed using Reflexive Thematic Analysis, applying an inductivedeductive hybrid approach within a social constructivist framework.In total, five semantic-latent subthemes were identified, entailing: i) Placebos: Promising but risky; ii) Acceptance of OLPs depends on a myriad; iii) Be trustworthy, but deception may be necessary; iv) Harnessing placebo effects without placebos; v) From bench to bedside: Clinical transference of OLPs. The themes reflect an in-depth discussion of the usage of OLPs in the clinical context, accompanied by different ambivalences regarding implementation, prerequisites, and the provider role.