Pediatricians' approaches to communicating side effects: a national survey

Most parents and adolescents want comprehensive information about potential side effects (SE) of medication. However, such information can sometimes trigger side effects due to negative expectations: the so-called nocebo effect. To develop evidence-based strategies that meet information needs while minimizing nocebo effects, this study examined how pediatricians currently communicate about side effects when prescribing medications. A national multicenter survey among pediatricians and pediatric residents was performed. A 9-item questionnaire assessed education on SE communication, awareness of the nocebo effect, and communication about SE for ondansetron, inhaled steroids, and amoxicillin/clavulanic acid. A total of 438 respondents were included (80.1% pediatricians, 19.9% pediatric residents). Only 6.8% had received education on SE communication during medical school. The extent of information on SEs varied widely per medication type. Nearly half of the respondents (48.9%) never inquired about parents' or patients' informational needs on side effects. They were significantly more likely to never discuss side effects for all studied medications compared to those who did inquire needs. Awareness of the nocebo effect and its consideration in communication was reported by 41.3% of respondents. These respondents provided significantly more often minimal instead of extensive information compared to respondents not aware of the nocebo effect and/or not considering it in their communication.

There is substantial variability in pediatricians' approaches to communicating SEs when prescribing medications, alongside a lack of education on this topic. These findings underscore the need for standardized, evidence-based guidelines and training supporting transparent communication while minimizing the nocebo effect.

• Poor adherence to treatment regimens is a major global problem, with side effects being an important contributor. • The way physicians discuss potential side effects can itself influence the occurrence of side effects through the nocebo effect.

• There is substantial variability among physicians in how side effects are communicated, depending on medication type, information framing, and tailoring to patients' informational needs. • Formal education on discussing side effects during medical school or postgraduate training is scarce among pediatricians and residents.