An intriguing paper published toward the end of 2022 examines how patient belief is associated with treatment outcomes.1 While the analysis evaluated how patient belief regarding the effectiveness of antibiotics can impact required appendectomies as decided by the surgeon, the outcomes have clinical applications DCs may want to consider.
In the study, patients were surveyed to see how effective they thought antibiotics would be in resolving their appendicitis. The survey was taken before patients were assigned to a specific treatment. They were then assigned to one of three groups based on their belief that antibiotics would be: unsuccessful/unsure, intermediate or completely successful.
At the end of the study period, the authors found that "positive beliefs at baseline regarding the likelihood of success of antibiotics were associated with a lower risk of appendectomy within 30 days, with a marked effect within the first 48 hours. Participants' beliefs were also associated with self-reported resolution of signs and symptoms by 30 days. Moreover, the magnitudes of some of these associations were large; those who believed that antibiotics could be completely successful had about half as many appendectomies after antibiotics in the first 30 days as those who believed that antibiotics could be unsuccessful or were unsure."
If belief in the success of antibiotics can cut the need for surgery in half, how much more can patients' belief in the success of chiropractic accomplish? Given the results of this study, how important is it that chiropractic patients have positive expectations after receiving your care? Based on the above, it could very well be a factor in saving a patient from surgery or other less conservative care.
(Please note that I am not suggesting patients should be taking antibiotics – or suggesting chiropractic's effectiveness is belief reliant. However, this paper provides considerable food for thought given the outcomes.)
A number of other papers have examined how sham interventions can still provide positive results. An earlier paper looking at endoscopic surgery found that "sham controlled endoscopic and injection benign prostatic hyperplasia interventions demonstrate a considerable and statistically significant change in symptom scores and maximum urinary flow, which is comparable to the response seen in medication trials."2
As you look to care for the whole person, engaging patients' minds and expectations in the process is certainly a factor in how effective your care will be. Your relationship with your patients, the trust they have in you and how you communicate all have an impact on the results of your care.
This year, we face new opportunities to be more deliberate about what we do as we strive to improve over previous years. You already know the power of chiropractic because you see it every day. But for the new patient (and even some long-term patients), there may still be some underlying uncertainty or even doubt. They need to know what you know.
- Writing Group for the CODA Collaborative. Association of patient belief about success of antibiotics for appendicitis and outcomes: a secondary analysis of the CODA randomized clinical trial. JAMA Surg, 2022;157(12):1080-1087.
- Welliver C, et al. Clinically and statistically significant changes seen in sham surgery arms of randomized, controlled benign prostatic hyperplasia surgery trials. J Urol, 2015;194(6):1682-1687.
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