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Overlap and Differences Between Patient and Provider Expectations for Treatment Outcomes: The Case of Acupuncture

  • Jürgen Barth
    Correspondence
    Address reprint requests to Jürgen Barth, PhD, Institute for Complementary and Integrative Medicine, University Hospital Zurich, Sonneggstrasse 6, Zurich 8091, Switzerland.
    Affiliations
    Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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  • Larissa Schafroth
    Affiliations
    Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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  • Claudia M. Witt
    Affiliations
    Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland

    Institute for Social Medicine, Epidemiology and Health Economics, Charité- Universitätsmedizin Berlin, Berlin, Germany
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Published:February 24, 2016DOI:https://doi.org/10.1016/j.jpain.2016.01.477

      Highlights

      • Treatment expectations predict therapy outcomes in acupuncture treatment.
      • Patients and providers might differ in their expectations.
      • These dyads of patients and providers were clustered in six homogenous clusters with high reliability.
      • A good match between expectations increased the chances of treatment benefits and vice versa.

      Abstract

      Our study aimed to identify patient–provider clusters with different patterns of expectations for treatment outcomes. All patients (n = 885) received acupuncture treatment from physicians for their migraine, headache, osteoarthritis, or chronic low back pain. We identified 6 robust patient–provider expectation clusters (PPECs; interclassification reliability >.89) showing differences between patients and providers in their expected treatment responses (eg, unrealistic optimists, optimistic doubters). For example, the optimistic doubters had high expectations for their treatment outcomes but were skeptical of the benefits of acupuncture in general. The providers expected good improvements for these patients. These 6 PPECs differed in their clinical characteristics and in the associated treatment responses. For example, unrealistic optimists showed the weakest treatment benefits after 6 months; other PPECs and clinical patterns are also presented in the report. Our study suggests that comparing the expectations of patients and providers is a valuable approach to identify groups of patients with greater responsiveness and those with limited treatment benefits.

      Perspective

      Patients and providers of acupuncture might vary in their expectation of the treatment effect and in clinical practice the overlap of expectations of patients and providers should be considered as important in initial consultations.

      Key words

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