Doctors shouldn’t fear giving patients with long-term medical conditions hope
LONDON – Doctors have been urged to encourage patients with long-term medical conditions to be hopeful about their treatment, experts have recommended, with those who were were more likely to manage their illness effectively.
A study by researchers from London and Sao Paulo, Brazil, found more children with asthma or type-1 diabetes complied with monitoring and treatment regimes if they were ‘hopeful’ than those who were merely ‘optimistic’.
They defined optimism as “an individual’s confidence in a good outcome, whereas hope is a goal oriented way of thinking that makes an individual invest time and energy in planning how to achieve their aims”.
“Training tells us to avoid saying, ‘You are going to get better,’ because there is rarely such certainty and, in the case of poor outcomes, unfulfilled expectations will erode trust”, the study’s authors wrote in a paper published in the British Medical Journal.
“Clinicians are apprehensive about offering false hope and can end up ignoring the question of hope altogether. This is particularly challenging for those of us caring for patients with chronic and progressive diseases—we fear looking incompetent when we have no curative treatments to offer.”
However they found hope was a “powerful predictor” of adherence to asthma treatment in children, with those who were hopeful more inclined to carry their inhaler in case in was required, and those who were merely optimistic more likely to leave it at home.
A similar pattern was observed in a group of diabetic children aged 10-16 who were followed for six months. Blood glucose levels were seen to decrease, while the number of self-tests went up.
Sukhi Shergill, professor of psychiatry and systems neuroscience at King’s College, London, said the discovery may have significant implications for the management of patients with conditions such as cancer, heart disease and schizophrenia.
He compared hope’s physical effects on the brain with those observed when patients are told they are being given a powerful painkiller, when in reality they may be taking little more than a placebo.
He said: “Optimism is a feeling of confidence but doesn’t necessarily require you to take action, while having hope means”you’re planning that something else might happen, and the motivation to do something about it.
“Only the hopeful people, the ones who had a high level of both of those things, were the ones that showed a benefit.
“We see a bunch of people who have suffered from schizophrenia and psychotic illness who really haven’t well in their local services, they arrive with us and more often than not it’s not the actual illness, the severe symptoms of that illness that we need to work on first, but the fact that they and their carers are just so disheartened at the lack of progress.
“So our first job is really to try and engender some hope that things can improve, and recent studies have shown that hope seems to work in the same way as the placebo effect.”
Doctors, Professor Shergill told BBC Radio 4’s Today programme, could play an important role in engendering hope in their patients by helping to “frame that placebo effect positively.
“We know that expectancy changes the brain’s neural transmitter systems. Being treated with the placebo during pain the brain will release opioids, which is the same transmitter as when you take strong painkillers such as codeine or morphine.“
“So the way you send the message, the person who’s communicating that, changes the expectancy in the patient who’s receiving that, and we know that expectancy changes the brain’s neural transmitter systems”. – The Telegraph