Frequency and circumstances of placebo use in clinical practice--a systematic review of empirical studies.
Frequency and circumstances of placebo use in clinical practice--a systematic review of empirical studies.
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DOI：
10.1186/1741-7015-8-15
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发表时间：
2010-02-23
期刊：
影响因子：
9.3
通讯作者：
Linde K
中科院分区：
文献类型：
--
作者：
Fässler M;Meissner K;Schneider A;Linde K
在临床试验之外使用安慰剂干预措施在伦理、专业和法律上都存在争议。对于临床实践中安慰剂使用的频率和情况知之甚少。我们的目的是总结解决这些问题的现有实证研究。我们检索了 PubMed 和 EMBASE 从成立到 2009 年 7 月的数据，以确定在医疗保健专业人员、学生或患者中进行的横断面调查、定性或纵向研究，这些研究至少调查了以下问题之一：安慰剂使用频率或使用安慰剂干预措施的态度或动机。至少有两名评审员提取了有关研究方法、参与者和结果的信息。每项研究至少由两名评审员通过迭代过程准备描述性摘要。来自 12 个不同国家的 22 项研究符合纳入标准。大多数研究都有相关的缺陷。表示在职业生涯中使用过“纯”安慰剂（例如注射生理盐水）的受访者比例在医生中为 17% 至 80%，在护士中为 51% 至 100%，但实际使用频率似乎很少。 “不纯”或“活性”安慰剂（例如，用于治疗病毒感染的抗生素）的使用可能会更加频繁。然而，不可能做出可靠的估计，因为对于不纯的安慰剂可能是什么尚未达成一致。使用定性方法或要求参与者判断案例的研究表明，使用安慰剂的动机和态度很复杂，医疗保健提供者常常面临两难境地。尽管现有证据不完整且有时令人困惑，但毫无疑问，临床试验之外使用安慰剂的普遍性不容忽视，而且个人（医疗保健专业人员和患者）对安慰剂使用的看法和态度存在很大差异。需要进一步研究来澄清这些问题。
The use of placebo interventions outside clinical trials is ethically, professionally and legally controversial. Little is known about the frequency and circumstances of placebo use in clinical practice. Our aim was to summarize the available empirical studies addressing these issues. We searched PubMed and EMBASE from inception to July 2009 in order to identify cross-sectional surveys, qualitative or longitudinal studies among health care professionals, students or patients which investigated at least one of the following issues - frequency of placebo use or attitudes to, or motivations for, the use of placebo interventions. At least two reviewers extracted information on the study methods, participants and findings. Descriptive summaries were prepared in an iterative process by at least two reviewers per study. Twenty-two studies from 12 different countries met the inclusion criteria. Most studies had relevant shortcomings. The proportion of respondents reporting that they had applied 'pure' placebos (for example, saline injection) during their professional life varied between 17% and 80% among physicians and between 51% and 100% among nurses, but it seems that the actual frequency of such use seems to be rare. The use of 'impure' or 'active' placebos (for example, antibiotics for viral infections) is likely to be much more frequent. However, it is impossible to make a reliable estimation because there is no agreement of what an impure placebo might be. Studies using qualitative methods or asking participants to judge case examples suggest that motivations and attitudes towards placebo use are complex and health care providers are often faced with a dilemma. Although the available evidence is incomplete and confusing at times there can be little doubt that the prevalence of placebo use outside of clinical trials is not negligible and that views and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues.
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