title: Placebo use in the UK: a qualitative study exploring GPs' views on placebo effects in clinical practice.
abstract: BACKGROUND
  Surveys show GPs use placebos in clinical practice and reported prevalence rates vary widely.
  
  
  OBJECTIVE
  To explore GPs' perspectives on clinical uses of placebos.
  
  
  METHODS
  A web-based survey of 783 UK GPs' use of placebos in clinical practice.
  
  
  METHODS
  Qualitative descriptive analysis of written responses ('comments') to three open-ended questions.
  
  
  RESULTS
  Comments were classified into three categories: (i) defining placebos and their effects in general practice; (ii) ethical, societal and regulatory issues faced by doctors and (iii) reasons why a doctor might use placebos and placebo effects in clinical practice. GPs typically defined placebos as lacking something, be that adverse or beneficial effects, known mechanism of action and/or scientific evidence. Some GPs defined placebos positively as having potential to benefit patients, primarily through psychological mechanisms. GPs described a broad array of possible harms and benefits of placebo prescribing, reflecting fundamental bioethical principles, at the level of the individual, the doctor-patient relationship, the National Health Service and society. While some GPs were adamant that there was no place for placebos in clinical practice, others focused on the clinically beneficial effects of placebos in primary care.
  
  
  CONCLUSIONS
  This study has elucidated specific costs, benefits and ethical barriers to placebo use as perceived by a large sample of UK GPs. Stand-alone qualitative work would provide a more in-depth understanding of GPs' views. Continuing education and professional guidance could help GPs update and contextualize their understanding of placebos and their clinical effects.
authors.affiliation: Faculty of Social and Human Sciences, Centre for Applications of Health Psychology, University of Southampton, Southampton, F.L.Bishop@southampton.ac.uk.
authors.forename: Felicity L
authors.initials: FL
authors.lastname: Bishop
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford and.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Howick
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford and.
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford and.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stevens
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford and.
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.affiliation: Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, UK.
authors.forename: George
authors.initials: G
authors.lastname: Lewith
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D015990:Placebo Effect; D036301:Qualitative Research; D006113:United Kingdom
keywords: Attitudes; general practice; health knowledge; placebo effects; placebos; qualitative research.
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