Take Home Messages:

A patient's expectations about getting better are just as important as their physical symptoms. In general, patients with low expectations for improvement in their condition will have the poorest recovery, while those with the highest expectations will have the best recovery.

The more a patient can be influenced to believe they will make a full recovery, the more likely they are to recover completely.  However, it is important that a balance is struck between generating false hopes and fostering attitudes and expectations that will enhance the patient's outcomes.

Healthcare professionals have an important role in engendering a positive attitude toward recovery by:

• Providing patients with appropriate information regarding their condition and its management;
• Exploring and clarifying patient's expectations regarding their likely outcome; and
• Providing ongoing reassurance and encouragement to patients throughout their recuperation.

Why the research matters:

Clinicians have long recognized that a patient's belief in their medical care and attitude toward their recovery can have an important influence on their health outcomes. The findings of a systematic review of the medical literature by Mondloch and colleagues from the Institute for Work and Health in Toronto provide further evidence of the role of a patient's expectations in predicting their recovery.

What the research involved:

The researchers performed a comprehensive keyword search of the medical literature published between 1966 and 1998. This search identified 45 original clinical studies that independently measured patients' expectations for recovery and their subsequent health outcomes and analysed the relationship between these measures.

The researchers then quantitatively assessed the validity of the studies and the quality of their findings using predefined criteria:

• Case definition (exclusion criteria);
• Patient selection;
• Patient follow-up;
• Health outcomes;
• Instruments used to measure recovery expectations;
• Reporting of data; and
• Statistical analysis.

Sixteen studies were rated as providing at least moderate quality evidence and were included in the review.

The studies examined patient expectations and health outcomes in a range of medical, psychological and surgical conditions, including:

• Myocardial infarction (3 studies)
• Cardiac surgery (2)
• Chronic pain (2)
• Psychiatric conditions (2)
• Abdominal hysterectomy (1)
• Abortion (1)
• Alcoholism (1)
• Benign prostatic hyperplasia surgery (1)
• Hip fracture (1)
• Laparoscopic surgery (1)
• Obesity (1)

Summary of research findings:

Of the sixteen studies reviewed, fifteen demonstrated that a patient's expectations for recovery are predictive of their health outcomes.  Thus, independent of physical, psychological or social factors, positive expectations were associated with improved recovery from disease.

The size of the effect of a patient's beliefs and expectations on their disease outcome varied across the studies reviewed: 

• Six studies reported a large effect;
• Five studies reported a moderate effect; and
• Four studies reported a small effect 

In general, patients with low expectations for improvement in their condition will have the poorest recovery, while those with the highest expectations will have the best recovery.

The researchers also noted that the effect of a patient's expectations on their recovery tended to be smaller for psychological conditions (eg social phobia) and larger for medical conditions (eg obesity).

The review concludes that a patient's expectations about getting better are just as important as their physical symptoms.  These findings are consistent with the broader literature that indicates that beliefs and perceptions can influence disease processes through both behavioural and physiological mechanisms.

For healthcare professionals, these findings highlight that the more that a patient can be influenced to believe they will make a full recovery, the more likely they are to recover completely.  However, it is important that a balance is struck between generating false hopes and fostering attitudes and expectations that will enhance the patient's outcomes. Healthcare professionals have an important role in engendering a positive attitude toward recovery by:

• Providing patients with appropriate information regarding their condition and its management;
• Exploring and clarifying patient's expectations regarding their likely outcome; and
• Providing ongoing reassurance and encouragement to patients throughout their recuperation.
   

Original research:

Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes.

Mondloch MV, Cole DC, Frank JW.

Canadian Medical Association Journal. 2001;165:174-179

Link to PubMed abstract