Optimizing Patient Expectations to Improve Therapeutic Response to Medical Treatment: A Randomized Controlled Trial of Iron Infusion Therapy

Amelia Akroyd, University of Auckland
Kerry N. Gunn, Auckland City Hospital
Sarah Rankin, University of Auckland
Meihana Douglas, University of Auckland
Maria Kleinstäuber, University of Otago
Winfried Rief, University of Marburg
Keith J. Petrie, University of Auckland


Objectives: Patient expectations have the ability to influence health outcomes and have been shown to play an important role as part of the placebo effect to influence the response to medical treatments. Increasing positive expectations have been proposed as an intervention to improve treatment response, although evidence for this to date is limited. We investigated whether a brief 10-min intervention directly targeting patient expectations prior to an iron infusion could enhance expectations and improve treatment response, in terms of patients' reported fatigue. Design: Randomized controlled trial. Methods: Forty-three patients diagnosed with iron deficiency anaemia were randomized to a brief expectation intervention or active control group prior to an intravenous iron infusion. Chalder Fatigue Scale scores were assessed prior to randomization and at one and four weeks. Results: The expectation intervention significantly improved patients' expectations about the effectiveness of the intravenous iron infusion, t(21) = −3.95, p = .001. While there were no significant differences between groups in fatigue at the one-week follow-up, fatigue was significantly lower in the intervention group at the four-week follow-up compared to the control group, F(1, 25) = 6.25, p = .019. This was largely influenced by a significant reduction in physical, as opposed to mental fatigue scores. Conclusions: Boosting patients' positive expectations may be an effective way of enhancing patient response to treatment. In particular, targeting patient expectations with a brief intervention prior to medical treatments may result in a greater and longer therapeutic effect.