Roscoe, J.A., O’Neill, M., Jean-Pierre, P., Heckler, C.E., Kaptchuk, T.J., Bushunow, P., … Smith, B. (2010). An exploratory study on the effects of an expectancy manipulation on chemotherapy-related nausea. Journal of Pain and Symptom Management, 40, 379–390.

To test whether providing information about the expected efficacy of acupressure bands would enhance their effectiveness in reducing nausea

• Chemotherapy naïve patients completed baseline questionnaires then received acupressure wristbands.
• Patients were randomized to the following groups.
  • 1: neutral handout and neutral compact disk (CD)
  • 2: acupressure-enhancing handout and neutral CD
  • 3: neutral handout and acupressure-enhancing CD
  • 4: acupressure-enhancing handout and acupressure-enhancing CD
• Patients were instructed to use the acupressure wristband and CD as needed during chemotherapy to prevent or alleviate nausea.
• Patients recorded antiemetic use, severity of nausea and vomiting, and wristband and CD usage in diaries.

• The study consisted of 74 participants.
• Mean age was 51.5 years with a range of 28–74.
• All participants were female patients with breast cancer.
• The majority of patients were White (93%), married (76%), had graduated from high school (99%), and had graduated or attended college (66%).
• The majority of patients were receiving doxorubicin-based chemotherapy (82%). The remaining were receiving docetaxel combined with either cyclophosphamide or carboplatin.

The study was conducted in a single outpatient setting. The location was not stated.

All patients were in active treatment.

This was a double-blind, four-arm, randomized, clinical intervention study.

• Patients reported their experiences in diaries.
• A nausea tool developed by Burish and Carey was used to measured nausea and vomiting on a 7-point Likert-type scale. No reliability or validity information was provided.
• Patients rated nausea expectancy on a 5-point Likert-type scale.
• Patients rated wristband effectiveness expectancy on a 5-point Likert-type scale.
• A study data questionnaire was used to gather demographic and clinical information.
• A feedback questionnaire evaluated the use of and recommendations for the acupressure wristband and CD.

• Results indicated that 15% of the sample experienced vomiting.
• The interaction of high-versus-low levels of nausea expectancy and neutral-versus-enhanced intervention showed a statistically significant difference for peak nausea (p = 0.030) but not for average nausea (p = 0.084).
• Patients who received the neutral materials took more antiemetic than patients who received the acupressure enhancing materials (p = 0.003).
• Expected nausea correlated with average nausea (p = 0.014) and peak nausea (p = 0.002).

Patients with enhanced information required less antiemetics and had less nausea than patients with neutral information. Managing expectations may facilitate chemotherapy-induced nausea and vomiting (CINV) management.

• The sample size was small with fewer than 100 patients.
• Differences in the types of chemotherapy and antiemetic medications and providers' discussion about nausea could have affected the study outcomes.
• The placebo effect of nausea intervention could have modified patients' expectations and response to the treatment.

This study illustrates the need for nurses to assess and be aware of patient’s nausea expectations during chemotherapy. Patients with high expectations may benefit from information or discussion of the expected benefits of interventions on reducing nausea.