Your words matter: Using positive language to enhance patient outcomes

It is increasingly recognised that healthcare goes beyond biology. The biopsychosocial model offers an example of a framework that acknowledges the interplay between biological, psychological, and social factors in illness. (1)

Receiving a life-changing label such as “incurable” can be emotionally devastating. In fact, even a diagnosis of a minor, curable condition can be burdensome for patients and affect their overall wellbeing and quality of life. During these moments of uncertainty and vulnerability, patients often look to their healthcare professionals (HCPs) for guidance and, in many cases, depend on them for holistic, positive outcomes.

The way patient-facing physicians communicate with individuals—from the moment of diagnosis and throughout their healthcare journey—has the power to shape a patient’s mindset and outcomes. Therefore, HCPs must be mindful of the impact that their words can have. While they must convey a realistic outlook on a patient’s disease, forward-looking, positive language is critical to set the patient up for success.

Understanding the nocebo effect

Unlike the placebo effect—a phenomenon in which positive expectations of taking a treatment (albeit a sugar pill or saline injection) improve health outcomes in clinical settings—the nocebo effect is often overlooked. (2,3) The National Cancer Institute defines the nocebo effect as ‘A situation in which a patient develops side effects or symptoms that can occur with a drug or other therapy just because the patient believes they may occur’, highlighting the influence of one's mental beliefs on psychological and neurobiological mechanisms. (2,4) 

The nocebo effect of treatment has been observed in real-world healthcare settings, often due to patients’ awareness of side effects associated with investigational therapies. A meta-analysis revealed that during the COVID-19 pandemic, approximately 35% of participants receiving a placebo first dose of the COVID-19 vaccine reported side effects, particularly headache and fatigue. By comparing side effects between the placebo and vaccine groups, 76% of all side effects were a direct result of the nocebo phenomenon rather than the treatment itself. (5) Further, research has revealed that anxiety about a medical intervention (sometimes referred to as procedural anxiety) can amplify the pain that the procedure inflicts. For example, patients who catastrophise an endoscopy (an examination where a flexible tube with a camera is inserted into the body) experience heightened sensations of pain. (6)

Strategies to overpower the nocebo effect

As an industry, we can adopt two simple techniques to minimise the impact of the nocebo effect on a patient's health.

Educating patients about the nocebo effect is the first step to overcoming negative perceptions around treatments. In a randomised controlled trial, Michnevich and colleagues (2022) investigated whether briefing gastrointestinal cancer patients on the nocebo effect can improve pre-treatment expectations and reduce the intensity of self-reported side effects following chemotherapy. Patients who were informed of this phenomenon provided lower side effect intensity scores (a grading out of 10), with a mean difference of 4.04 from those in the attention control group. While these scores are susceptible to biases, they highlight the potential for nocebo education in minimising adverse patient outcomes. (7) 

Secondly, the value of positive, hope-inspiring language should not be underestimated. In gastrointestinal oncology, chemotherapy is associated with a wide range of side effects, with 88% of cancer patients reporting fatigue and 75% reporting diarrhoea, for example. (7) These statistics can induce anxiety in those preparing for treatment, framing chemotherapy as something to dread. Disproportional fear may worsen the patient's experience of care by increasing side effects, raising the likelihood of treatment discontinuation. While we cannot conceal the reality of negative side effects and experiences, we can shift the conversation toward positive patient stories and position chemotherapy as a potentially life-saving intervention.

At Synthesis, we believe fostering a positive, supportive healthcare environment has the power to improve patients' emotional wellbeing and medical outcomes. Our expert writers are dedicated to building strong patient partnerships based on effective communication to shape positive mindsets and encourage patient resilience. Contact us at info@synthesishealth.co.uk to learn how we can help shift the narrative among industry professionals toward more positive communication and support your patient engagement initiatives to inspire a more hopeful perspective on care.

References

1. Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin Rehabil. 2017;31(8):995-1004. doi:10.1177/0269215517709890

2. Munnangi S, Sundjaja JH, Singh K, et al. Placebo Effect. [Updated 2023 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513296/

3. Jakovljevic M. The placebo-nocebo response: controversies and challenges from clinical and research perspective. Eur Neuropsychopharmacol. 2014;24(3):333-341. doi:10.1016/j.euroneuro.2013.11.014

4. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/nocebo-effect

5. Haas JW, Bender FL, Ballou S, et al. Frequency of Adverse Events in the Placebo Arms of COVID-19 Vaccine Trials: A Systematic Review and Meta-analysis [published correction appears in JAMA Netw Open. 2022 Feb 1;5(2):e221277. doi: 10.1001/jamanetworkopen.2022.1277.]. JAMA Netw Open. 2022;5(1):e2143955. Published 2022 Jan 4. doi:10.1001/jamanetworkopen.2021.43955

6. Lauriola M, Tomai M, Palma R, et al. Procedural Anxiety, Pain Catastrophizing, and Procedure-Related Pain during EGD and Colonoscopy. South Med J. 2020;113(1):8-15. doi:10.14423/SMJ.0000000000001058

7. Michnevich T, Pan Y, Hendi A, Oechsle K, Stein A, Nestoriuc Y. Preventing adverse events of chemotherapy for gastrointestinal cancer by educating patients about the nocebo effect: a randomized-controlled trial. BMC Cancer. 2022;22(1):1008. Published 2022 Sep 23. doi:10.1186/s12885-022-10089-2