Why Patients’ Expectations Matter
Patients’ expectations in the context of medical treatment represent a growing area of research, with increasing evidence suggesting their impact on health outcomes across a wide range of physical and mental health conditions. For example, expectations have been associated with treatment course and outcomes in patients with heart disease, stroke, cancer, musculoskeletal disorders, injuries, and obesity. They have also been shown to predict outcomes in patients undergoing various types of surgery. Moreover, expectations are a key mechanism underlying the placebo and nocebo effects – a phenomena in which subjective and physiological changes occur due to inert or non-specific treatment components.
Positive expectations may lead to improved treatment outcomes, whereas negative expectations can result in reduced efficacy and an increase in adverse effects. Effectively managing patient expectations may therefore improve treatment success and reduce the need for additional interventions arising from dissatisfaction or side effects following the initial consultation.
Difficulties in Synthesising Current Evidence
Despite a growing number of studies examining expectations across different medical conditions, integrating existing findings remains challenging. A major limitation identified in several systematic reviews and meta-analyses is the heterogeneity in how expectations are conceptualised and assessed. Some theoretical models refer to similar aspects of expectations but use different terminology, which further complicates the synthesis of evidence. Additionally, many studies focus on only one or a few facets of expectations, limiting our understanding of the distinct effects of different expectation components.
Additional Factors to Consider
Expectations regarding treatment and behavioural outcomes may concern both benefits and side effects and can relate to internal outcomes (e.g., symptom relief) or external ones (e.g., reactions from others). Timeline expectations, as well as structural and procedural aspects of care, are also relevant. Furthermore, generalised expectations such as self-efficacy and optimism should be considered, along with other psychological factors of interest – particularly depression, which is known to be a predictor of long-term disability.
The timing of expectation assessment is also crucial. Most studies measure expectations prior to treatment or diagnostic procedures – understandably so, as these are salient events likely to elicit strong anticipatory beliefs. However, it is reasonable to assume that expectations may evolve over the course of treatment or diagnosis. The effects of assessment timing remain unclear, as they have rarely been examined systematically. To understand the temporal dynamics and stability of patients’ expectations, they should ideally be assessed at multiple time points (before, during, and after the course of treatment or diagnosis).
The Role of Physicians’ Expectations
The expectations of healthcare providers, including physicians, may also significantly influence treatment outcomes. Although research in this area is limited, some studies suggest a link between physicians’ expectations and patient outcomes. Importantly, when physicians convey high expectations to patients, this can in turn elevate patients’ own expectations.
Creating a More Comprehensive Understanding
Although numerous instruments exist for assessing various aspects of treatment expectations, many lack conceptual clarity and robust psychometric evaluation. Many tools are treatment-specific and therefore not suitable for comparison across different medical conditions.
To develop a more comprehensive understanding of the effects of expectations in medical care, future research should utilise standardised, psychometrically validated instruments and adopt consistent, clearly defined terminology. It is essential to assess the multidimensional nature of patients’ expectations across a range of treatments. Further investigation is needed into the interrelationships within, and between different expectation constructs and the factors that influence them. Crucially, future studies should explore the connection between physicians’ and patients’ expectations. Doing so could support the development of interventions aimed at optimising patient expectations to improve health outcomes.
Veronique Ropion, MD
Source:
- Laferton JAC. et al. Improving Patients’ Treatment Expectations. JAMA Insights | COMMUNICATING MEDICINE, Published online June 4, 2025.
- Laferton JAC. Et al. Patients’ Expectations Regarding Medical Treatment: A Critical Review of Concepts and Their Assessment. Front. Psychol. 2017;8:233. doi: 10.3389/fpsyg.2017.00233
- Levenig CG., et al. Treatment Expectations—You Get What You Expect—and Depression Plays a Role. The Journal of Pain, Vol 25, No. 9 (September), 2024: 104582.