Don't be a nocebo! Why healthcare organizations should value patients' expectations

This opinion paper explores how healthcare organizations can inadvertently contribute to nocebo effects—negative patient experiences stemming from unmet expectations—by examining the interplay between organizational policies, practices, and the expectations of patients at different levels of the healthcare system. The authors propose three scenarios: (1) a disconnect between an organization's stated values (e.g., person-centered care) and its operational realities; (2) conflicting perspectives on patient expectations between clinicians (individualized focus) and managers (aggregate measures); and (3) inadequate training of front-line staff, leading to poor management of patient expectations. The authors suggest several strategies to mitigate nocebo effects, including integrating patient voices in organizational decision-making, aligning performance metrics with patient values, providing comprehensive staff training in person-focused care and communication, and ensuring that front-line staff operate within their defined roles and responsibilities. The paper highlights the need for a broader understanding of nocebo effects beyond the clinician-patient interaction, focusing on the organization as a whole in shaping patient experiences.

David Poulter, Maxi Miciak, Jerry Durham, Alvisa Palese, Giacomo Rossettini