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Anatomy of positive messages in healthcare consultations: component analysis of messages within 22 randomised trials

Jeremy Howick, Emily Lyness, Charlotte Albury, Kirsten A Smith, Hajira Dambha-Miller, Mohana Ratnapalan, Jane Vennik, Stephanie Hughes, Jennifer Bostock, Leanne Morrison, Christian Mallen, Hazel Everitt, Sue Dean, Tracy Levett-Jones, Serra Ivynian, Paul Little, Felicity L Bishop


Background: Patients desire both honesty and hope from their healthcare practitioners. A recent systematic review found that healthcare practitioners who deliver positive messages improve patient outcomes, most notably by reducing pain. However, the verbal and non-verbal components of positive messages within these trials varied greatly, which presents a barrier to the implementation of this evidence and person-centered care.

Objective: To investigate common components of positive messages within the reviewed trials.

Methods: We extracted the verbal and non-verbal language used to deliver positive messages in 22 trials from a recent systematic review. Three independent researchers coded the components of the messages using content analysis.

Results: Positive messages in our sample had between 2 and 18 different components. These were clustered into 5 areas: specifying the positive outcomes, making the message personal, drawing on associations and meanings, providing a supportive psychological context and providing a rationale. Messages were reinforced through repetition in half the studies. Within the clusters, the most common components of positive messages were suggestions of specific effects (18 studies) and personalised formulations (15 studies). Most studies did not describe the components of positive messages adequately.

Conclusions: Positive messages within randomized trials are complex interventions, with most including strong suggestions about specific effects, presented confidently and made personally relevant to the individual patient. Future trials of positive messages should report all components of these interventions.


Communication, communication skills, complex interventions, empathy, ethics, mechanisms of action, pain, pain reduction, person-centered healthcare, positive communication, randomised controlled trials

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