Managing patient expectations involves influencing the patient regarding the anticipation of symptom development or effectiveness of an intervention through education and discussion. This type of intervention is based on the idea that if patients expect to have a problem, they are more likely to do so, and if patients expect an intervention for symptoms to be effective, it is more likely to be effective. Education and discussion are pointed to diminish negative expectations. Managing patient expectations has been examined in patients with cancer for prevention and management of chemotherapy-induced nausea and vomiting (CINV).
Colagiuri, B., & Zachariae, R. (2010). Patient expectancy and post-chemotherapy nausea: A meta-analysis. Annals of Behavioral Medicine, 40, 3–14.
To evaluate the relationship between patient expectations of postchemotherapy nausea and subsequent reports of nausea
Databases searched were MEDLINE, PsycINFO, and CINAHL.
Search keywords were expectancy, expectations, placebo effects or placebo responses with chemotherapy and nausea or emesis.
Studies were included if they
Studies were excluded if they focused only on anticipatory nausea.
The authors independently coded the sample characteristics, the independent and dependent variables, and whether the study met the inclusion criteria for each study. Differences were discussed, and a final assessment negotiated for each study. A global effect size was calculated for each study. No formal scoring was used to assign a quality score to each study. Publication bias was addressed using the Egger test and calculations of failsafe.
This meta-analysis confirmed that nausea expectations and experience of post-chemotherapy nausea are positively correlated. The discussion also identified research methods, such as incorporating expectancy-based manipulations that consider the source of the patient’s expectations, actively investigating the possible moderators of the association between expectancy and post-chemotherapy nausea (e.g., age, anxiety), and measuring the expectancies before the first chemotherapy administration.
Prechemotherapy assessment needs to include patient expectations regarding the experience of postchemotherapy nausea. If a patient expects that he or she will experience nausea, additional evidence-based interventions to minimize nausea should be used prior to and during chemotherapy administration.
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
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 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.
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.
Shelke, A.R., Roscoe, J.A., Morrow, G.R., Colman, L.K., Banerjee, T.K., & Kirshner, J.J. (2008). Effect of a nausea expectancy manipulation on chemotherapy-induced nausea: A University of Rochester Cancer Center Community Clinical Oncology Program study. Journal of Pain and Symptom Management, 35, 381–387.
To evaluate the effectiveness of educational interventions in reducing patients’ nausea expectations by dispelling misconceptions about chemotherapy-induced nausea and vomiting (CINV) and building confidence in antiemetic regimens
Patients were randomized one of two arms. Both arms received the same educational materials except that arm 2 patients received an additional handout emphasizing the benefits and effectiveness of ondansetron in the control of nausea and vomiting. Both arms received a standardized antiemetic regimen including ondansetron and dexamethasone on day one. Nausea and vomiting were measured in a patient-reported diary from day one to day four following chemotherapy treatment.
The study was conducted at 18 medical oncology practices (all Community Clinical Oncology Programs [CCOPs]) across the United States.
All patients were in active treatment.
This was a randomized, multicenter, clinical trial.
Although the expectancy manipulation reduced patients’ reported expectations for the development of nausea, the occurrence of nausea was not reduced. Changing nausea expectancies did not affect the occurrence of nausea.
Educational interventions to increase awareness of nausea prior to first chemotherapy administration may reduce patients’ expectations for subsequent CINV. However, these interventions may not reduce actual nausea severity or occurrence.