| 1. |
- Annoni, Marco, et al.
(författare)
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A critical (and cautiously optimistic) appraisal of moerman’s" meaning response"
- 2018
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Ingår i: Perspectives in biology and medicine. - : Johns Hopkins University Press. - 0031-5982 .- 1529-8795. ; 61:3, s. 379-387
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Tidskriftsartikel (refereegranskat)abstract
- In this article we propose a critical reassessment of Daniel Moerman's "meaning response." First, we reconstruct and criticize Moerman's original proposal of introducing the "meaning response" as a way of clarifying some terminological and conceptual issues in the placebo debate. Next we evaluate the criticisms that Moerman's proposal is epistemically moot since other existing and more empirically grounded models already account for all the phenomena that fall under the concept of the "meaning response." We conclude that Moerman's original proposal is inherently problematic and that, in order to be instrumentally useful in the future, the meaning response must be reconceived so that it may finally support, rather than oppose, other theoretical and empirical lines of research currently ongoing in the field of placebo studies.
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| 2. |
- Annoni, Marco, et al.
(författare)
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Persons over models : shared decision-making for person-centered medicine
- 2020
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5648 .- 2052-5656. ; 8:3, s. 355-362
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Tidskriftsartikel (refereegranskat)abstract
- In the last decades “shared decision-making” has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of “shared decision-making”. Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the ‘instrumental’; (ii) the ‘paternalistic’; (iii) the ‘informative’; (iv) the ‘interpretative’; and (v) the ‘persuasive’ models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons - and their unique lives and philosophies - rather than around abstract frameworks.
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| 4. |
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| 5. |
- Bernstein, Michael H, et al.
(författare)
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How do US orthopaedic surgeons view placebo-controlled surgical trials? : A pilot online survey study
- 2022
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Ingår i: Journal of Medical Ethics. - : BMJ Publishing Group Ltd. - 0306-6800 .- 1473-4257.
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Tidskriftsartikel (refereegranskat)abstract
- Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as 'completely' or 'mostly' unethical. Participants were also asked to rank-order the value of five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7 .% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects.
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| 6. |
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| 7. |
- Bernstein, Michael H, et al.
(författare)
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Primary care providers’ use of and attitudes towards placebos : An exploratory focus group study with US physicians
- 2020
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Ingår i: British Journal of Health Psychology. - : John Wiley & Sons. - 1359-107X .- 2044-8287. ; 25:3, s. 596-614
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine how primary care physicians define placebo concepts, use placebos in clinical practice, and view open-label placebos (OLPs).Design Semi-structured focus groups that were audio-recorded and content-coded.Methods Two focus groups with a total of 15 primary care physicians occurred at medical centres in the New England region of the United States. Prior experience using placebo treatments and attitudes towards open-label placebos were explored. Themes were analysed using an inductive data-driven approach.Results Physicians displayed a nuanced understanding of placebos and placebo effects in clinical contexts which sometimes focused on relational factors. Some respondents reported that they prescribed treatments with no known pharmacological effect for certain conditions and symptoms ('impure placebos') and that such prescriptions were more common for pain disorders, functional disorders, and medically unexplained symptoms. Opinions about OLP were mixed: Some viewed OLPs favourably or considered them 'harmless'; however, others strongly rejected OLPs as disrespectful to patients. Other issues in relation to OLPs included the following: lack of guidelines, legal and reputational concerns, and the notion that such treatments would run counter to customary medical practice.Conclusions A number of physicians reported prescribing impure placebos in clinical care. Although some primary care physicians were resistant to the possibility of recommending OLPs, others regarded OLPs more favourably, viewing them as potential treatments, albeit with restricted potential.
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| 8. |
- Bernstein, Michael H, et al.
(författare)
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Putting the art into the art of medicine : The under-explored role of artifacts in placebo studies
- 2020
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Research in social psychology demonstrates that physical environmental factors - or "artifacts" such as provider clothing and office decor - can influence health outcomes. However, the role of artifacts in augmenting or diminishing health outcomes is under-explored in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts may carry significant potential in informing how placebo effects can be maximized, and nocebo effects minimized in clinical settings. We discuss the potential mechanisms, including classical conditioning, response expectancy, and mindsets, by which artifacts might enhance or diminish these effects. Next, we propose testable hypotheses to investigate how placebo and nocebo effects might be elicited by artifacts in care settings, and conclude by providing innovative research designs to advance this novel research agendum.
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| 9. |
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| 10. |
- Blease, Charlotte, et al.
(författare)
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Are ME/CFS Advocacy Organisations militant? : Patient Protest in a Medical Controversy
- 2018
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Ingår i: Journal of Bioethical Inquiry. - : Springer Nature. - 1176-7529 .- 1872-4353. ; 15:3, s. 393-401
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Tidskriftsartikel (refereegranskat)abstract
- Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) is a contested illness category. This paper investigates the common claim that patients with ME/CFSand by extension, ME/CFS patient organizations (POs)exhibit militant social and political tendencies. The paper opens with a history of the protracted scientific disagreement over ME/CFS. We observe that ME/CFS POs, medical doctors, and medical researchers exhibit clear differences in opinion over how to conceptualize this illness. However, we identify a common trope in the discourse over ME/CFS: the claim of militant patient activism. Scrutinizing this charge, we find no compelling evidence that the vast majority of patients with ME/CFS, or the POs representing them, have adopted any such militant political policies or behaviours. Instead, we observe key strategic similarities between ME/CFS POs in the United Kingdom and the AIDs activist organizations of the mid-1980s in the United States which sought to engage scientists using the platform of public activism and via scientific publications. Finally, we explore the contours of disagreement between POs and the medical community by drawing on the concept of epistemic injustice. We find that widespread negative stereotyping of patients and the marginalization and exclusion of patient voices by medical authorities provides a better explanation for expressions of frustration among patients with ME/CFS.
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| 11. |
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| 12. |
- Blease, Charlotte, et al.
(författare)
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Artificial intelligence and the future of primary care : exploratory qualitative study of UK general practitioners' views
- 2019
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 21:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: The potential for machine learning to disrupt the medical profession is the subject of ongoing debate within biomedical informatics and related fields.Objective: This study aimed to explore general practitioners' (GPs') opinions about the potential impact of future technology on key tasks in primary care.Methods: In June 2018, we conducted a Web-based survey of 720 UK GPs' opinions about the likelihood of future technology to fully replace GPs in performing 6 key primary care tasks, and, if respondents considered replacement for a particular task likely, to estimate how soon the technological capacity might emerge. This study involved qualitative descriptive analysis of written responses ("comments") to an open-ended question in the survey.Results: Comments were classified into 3 major categories in relation to primary care: (1) limitations of future technology, (2) potential benefits of future technology, and (3) social and ethical concerns. Perceived limitations included the beliefs that communication and empathy are exclusively human competencies; many GPs also considered clinical reasoning and the ability to provide value-based care as necessitating physicians' judgments. Perceived benefits of technology included expectations about improved efficiencies, in particular with respect to the reduction of administrative burdens on physicians. Social and ethical concerns encompassed multiple, divergent themes including the need to train more doctors to overcome workforce shortfalls and misgivings about the acceptability of future technology to patients. However, some GPs believed that the failure to adopt technological innovations could incur harms to both patients and physicians.Conclusions: This study presents timely information on physicians' views about the scope of artificial intelligence (AI) in primary care. Overwhelmingly, GPs considered the potential of AI to be limited. These views differ from the predictions of biomedical informaticians. More extensive, stand-alone qualitative work would provide a more in-depth understanding of GPs' views.
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| 13. |
- Blease, Charlotte, et al.
(författare)
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Artificial intelligence and the future of psychiatry : qualitative findings from a global physician survey
- 2020
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Ingår i: Digital Health. - : SAGE Publications. - 2055-2076. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- The potential for machine learning to disrupt the medical profession is the subject of ongoing debate within biomedical informatics.ObjectiveThis study aimed to explore psychiatrists’ opinions about the potential impact innovations in artificial intelligence and machine learning on psychiatric practiceMethodsIn Spring 2019, we conducted a web-based survey of 791 psychiatrists from 22 countries worldwide. The survey measured opinions about the likelihood future technology would fully replace physicians in performing ten key psychiatric tasks. This study involved qualitative descriptive analysis of written responses (“comments”) to three open-ended questions in the survey.ResultsComments were classified into four major categories in relation to the impact of future technology on: (1) patient-psychiatrist interactions; (2) the quality of patient medical care; (3) the profession of psychiatry; and (4) health systems. Overwhelmingly, psychiatrists were skeptical that technology could replace human empathy. Many predicted that ‘man and machine’ would increasingly collaborate in undertaking clinical decisions, with mixed opinions about the benefits and harms of such an arrangement. Participants were optimistic that technology might improve efficiencies and access to care, and reduce costs. Ethical and regulatory considerations received limited attention.ConclusionsThis study presents timely information on psychiatrists’ views about the scope of artificial intelligence and machine learning on psychiatric practice. Psychiatrists expressed divergent views about the value and impact of future technology with worrying omissions about practice guidelines, and ethical and regulatory issues.
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| 16. |
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| 17. |
- Blease, Charlotte
(författare)
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Biomedical Sciences
- 2010
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Ingår i: Studies in History and Philosophy of Biological and Biomedical Sciences. ; 41, s. 333-339
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Tidskriftsartikel (refereegranskat)
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| 18. |
- Blease, Charlotte, et al.
(författare)
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ChatGPT and mental healthcare : balancing benefits with risks of harms
- 2023
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Ingår i: BMJ Mental Health. - : BMJ Publishing Group Ltd. - 2755-9734. ; 26:1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Against the global need for increased access to mental services, health organisations are looking to technological advances to improve the delivery of care and lower costs. Since November 2022, with the public launch of OpenAI's ChatGPT, the field of generative artificial intelligence (AI) has received expanding attention. Although generative AI itself is not new, technical advances and the increased accessibility of large language models (LLMs) (eg, OpenAI's GPT-4 and Google's Bard) suggest use of these tools could be clinically significant. LLMs are an application of generative AI technology that can summarise and generate content based on training on vast data sets. Unlike search engines, which provide internet links in response to typed entries, chatbots that rely on generative language models can simulate dialogue that resembles human conversations. We examine the potential promise and the risks of using LLMs in mental healthcare today, focusing on their scope to impact mental healthcare, including global equity in the delivery of care. Although we caution that LLMs should not be used to disintermediate mental health clinicians, we signal how-if carefully implemented-in the long term these tools could reap benefits for patients and health professionals.
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| 19. |
- Blease, Charlotte, et al.
(författare)
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Computerization and the future of primary care : a survey of general practitioners in the UK
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe the opinions of British general practitioners regarding the potential of future technology to replace key tasks carried out in primary care.DesignCross sectional online survey.Participants1,474 registered GPs in the United Kingdom.Main outcome measuresInvestigators measured GPs’ opinions about the likelihood that future technology will be able to fully replace–not merely aid–the average GP in performing six primary care tasks; in addition, if GPs considered replacement for a particular task likely, the survey measured opinions about how many years from now this technological capacity might emerge.ResultsA total of 720 (49%) responded to the survey. Most GPs believed it unlikely that technology will ever be able to fully replace physicians when it comes to diagnosing patients (489, 68%), referring patients to other specialists (444, 61%), formulating personalized treatment plans (441, 61%), and delivering empathic care (680, 94%). GPs were not in agreement about prognostics: one in two participants (380, 53%) considered it likely that technology will be fully capable of replacing physicians in performing this task, nearly half (187, 49%) of whom believed that the technological capacity will arise in the next ten years. Against these findings, the majority of GPs (578, 80%) believed it likely that future technology will be able to fully replace humans to undertake documentation; among them 261 (79%) estimated that the technological wherewithal would emerge during the next ten years. In general, age and gender were not correlated with opinions; nor was reported burnout and job satisfaction or whether GPs worked full time or part time.ConclusionsThe majority of UK GPs in this survey were skeptical about the potential for future technology to perform most primary care tasks as well as or better than humans. However, respondents were optimistic that in the near future technology would have the capacity to fully replace GPs’ in undertaking administrative duties related to patient documentation.
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| 20. |
- Blease, Charlotte
(författare)
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Consensus in placebo studies : lessons from the philosophy of science
- 2018
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Ingår i: Perspectives in biology and medicine. - : Johns Hopkins University Press. - 0031-5982 .- 1529-8795. ; 61:3, s. 412-429
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Tidskriftsartikel (refereegranskat)abstract
- In the relatively nascent field of placebo studies, empirical studies have burgeoned. Yet debate about how to define the terms placebo and "placebo effect" has not abated. A number of prominent scholars (drawn from medical practice, as well as philosophy, psychology, and anthropology) continue to propose and defend different conceptual models for these terms, and the perception that conceptual debate persists is often given as one justification for new definitions. Paradoxically in spite of this lively debate this article finds considerable underlying agreement about definitional matters within placebo studies. Drawing on key insights from philosophy of science, and by exploring the nature of scientific consensus and normal scientific research, this paper argues that well-developed placebo concepts form the basis for a placebo paradigm and that conceptual disagreement is overstated.
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| 21. |
- Blease, Charlotte, et al.
(författare)
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COVID-19 and Open Notes : A New Method to Enhance Patient Safety and Trust
- 2021
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Ingår i: JMIR Mental Health. - : JMIR Publications. - 2368-7959. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic.
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| 23. |
- Blease, Charlotte, et al.
(författare)
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Does disclosure about the common factors affect laypersons’ opinions about how cognitive behavioral psychotherapy works?
- 2018
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Written and online information about cognitive-behavioral therapy (CBT) prioritizes the role of specific techniques (e.g., cognitive restructuring) and typically omits discussion of “common factors” (e.g., the working alliance, or therapist empathy). However, according to extensive psychotherapy process research the common factors may be important mediators of client improvement.Objectives: This study aimed to assess lay opinions about the role of specific and common factors in CBT for depression. We also aimed to determine how different client disclosure processes might affect lay opinions about the relative importance of specific and common factors in CBT.Methods: We conducted a web-based experiment involving a sample of US participants who had never undergone psychotherapy. All participants were presented with similar vignettes describing an individual suffering from depression whose doctor recommends CBT. Participants were randomized to read one of six vignettes created in a 2 × 3 factorial design that crossed client gender with type of informed consent (Standard CBT Disclosure vs. Common Factors and CBT Disclosure vs. No Disclosure).Results: Disclosure type had a significant effect on participants' ratings of Common and Specific factors in psychotherapy. As compared to the CBT disclosure, participants allocated to the Common Factors disclosure rated Empathy and Positive Regard as significantly more important to treatment outcome, and rated the Specific factors of CBT as significantly less important to outcome. There were no significant differences between No Disclosure and Standard CBT Disclosure, and these participants rated Specific factors of CBT and the Working Alliance as more important components in treatment, and Empathy and Positive Regard as less important.Conclusions: The content of information disclosures influences lay opinions about the importance of specific and common factors in CBT. Further research should investigate ethically acceptable disclosures to CBT and other forms of psychotherapy, including whether disclosure practices affect treatment outcome.
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| 24. |
- Blease, Charlotte, et al.
(författare)
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Does Patient Access to Clinical Notes Change Documentation?
- 2020
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Ingår i: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Open, honest, and trustworthy communication is crucial to ensure the effective responses of citizens. Paralleling transparency in the arena of public health are new practice policies that are set to transform the transmission of information at the level of doctors and patients. While patients have legally been entitled to obtain copies of their records for many years, in March 2020 federal legislation in the United States (U.S.) mandated that health providers offer all patients rapid and secure online access to their clinical notes via patient portals (“open notes”) (1). Similar developments are underway in the United Kingdom (U.K.) where in April 2020 it was announced that patients in NHS England will be granted online access, albeit prospectively, to their full general practitioners' notes (2). Worldwide, open notes have already been enacted in more than ten countries including Sweden, Estonia, and Norway (3).A variety of surveys have been conducted into patients' and doctors' experiences of open notes but much less is understood about the objective changes in documentation that may arise as a result of patient access (4–7). We review current research into open notes including clinicians' reports on how they have modified their notes as a result of implementing the practice. Highlighting the potentially beneficial and harmful effects that different types of documentation changes might have on the therapeutic relationship and on patient outcomes, we argue that more research is needed to investigate objective changes in notes as a result of patient access.
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