Many clinicians and researchers believe that patients who expect that a specific treatment will relieve their symptoms will be more likely to benefit from that treatment. However, analyses of data from clinical trials evaluating complementary and alternative medicine (CAM) treatments for chronic back pain have not consistently found pre-treatment expectations to be predictive of superior outcomes. Interpretation of these conflicting results has been complicated by the absence of an adequate conceptual model of how patient expectations might affect treatment outcomes and the lack of a validated questionnaire for capturing patient expectations. To help advance understanding of the relationship between expectations and treatment outcomes, this application proposes to systematically develop and validate a questionnaire to assess patient expectations of CAM therapies for chronic back pain. Phase I of this 3-phase project will focus on gaining a comprehensive understanding of the issues underlying the concept of treatment expectations. This will involve conducting interviews to collect qualitative information about expectations from patients with back pain as well as from providers of four CAM therapies commonly used for back pain (acupuncture, chiropractic, massage, yoga). Rigorous qualitative research methods will be used to analyze this interview data in order to identify key conceptual domains associated with the development of expectations. The results of these analyses will then be used to create a conceptual model about how patient expectations of treatment success develop and change after initiation of treatment. Phase II activities will focus on developing a questionnaire to assess patient expectations and Phase III will feature testing the psychometric properties of the questionnaire (e.g., reliability and validity). The questionnaire will be tested in diverse clinical and research populations. This project is expected to result in the creation of a psychometrically sound questionnaire that can be used by the CAM and conventional research communities to measure the importance of patient expectations of treatment outcomes in clinical trials of non-pharmacologic treatments for chronic back pain. Development of a conceptual model for understanding the relationship between patient expectations and treatment outcomes and creation of a valid and reliable questionnaire for assessing patient expectations will provide valuable tools for future research on how context effects influence treatment outcomes. Such research has the potential to improve understanding of how to most effectively translate the results of randomized efficacy trials into clinical practice.

Public Health Relevance

In order to improve care for persons with chronic back pain, a better understanding of how patient's beliefs about the effectiveness of the treatments they receive is needed. This project will develop a questionnaire to measure such expectations for complementary medicine (CAM) treatments. This questionnaire will provide researchers with a valuable tool for determining how patient expectations affect outcomes and for exploring the potential for using this knowledge to improve patient care.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Project (R01)
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Special Emphasis Panel (ZAT1-RB (02))
Program Officer
Weber, Wendy J
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Group Health Cooperative
United States
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Jones, Salene M W; Lange, Jane; Turner, Judith et al. (2016) Development and Validation of the EXPECT Questionnaire: Assessing Patient Expectations of Outcomes of Complementary and Alternative Medicine Treatments for Chronic Pain. J Altern Complement Med 22:936-946
Eaves, Emery R; Sherman, Karen J; Ritenbaugh, Cheryl et al. (2015) A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies. BMC Complement Altern Med 15:12
Eaves, Emery R; Ritenbaugh, Cheryl; Nichter, Mark et al. (2014) Modes of hoping: understanding hope and expectation in the context of a clinical trial of complementary and alternative medicine for chronic pain. Explore (NY) 10:225-32
Hsu, Clarissa; Sherman, Karen J; Eaves, Emery R et al. (2014) New perspectives on patient expectations of treatment outcomes: results from qualitative interviews with patients seeking complementary and alternative medicine treatments for chronic low back pain. BMC Complement Altern Med 14:276
Sherman, Karen J (2014) The benefits of acupuncture: what you think is what you get, or is it? Acupunct Med 32:2-3
Sherman, Karen J; Eaves, Emery R; Ritenbaugh, Cheryl et al. (2014) Cognitive interviews guide design of a new CAM patient expectations questionnaire. BMC Complement Altern Med 14:39
Schafer, Lisa M; Hsu, Clarissa; Eaves, Emery Rose et al. (2012) Complementary and alternative medicine (CAM) providers' views of chronic low back pain patients' expectations of CAM therapies: a qualitative study. BMC Complement Altern Med 12:234