Table 2 Brief discussion points from the leaflet of the nocebo-education

Information sheet about side effects

A) The occurrence of side effects has two essential causes:

 • Pharmacological (substance-dependent) causes which activate biochemical reactions in the body

 • Psychological (non-substance dependent) causes which mainly include prior experiences and expectations of patient and relevant aspects of the therapeutic context (called the nocebo effect)

B) Nocebo effects: education and exemplification

 • Nocebo effects are no illusions, but real and biologically measurable effects.

 • Prior negative experiences with adverse effects of drugs or even just reading about them in a medication leaflet can increase negative expectations of developing side effects. This might in turn lead to an increased actual occurrence of side effects.

C) Case example of nocebo effects:

 • “For my next checkup, I was to receive a contrast agent. I was anxious, knowing that my body reacts strongly to that kind of thing. The nurse hooked me up to the IV, through which the contrast agent would enter my body. She told me that the contrast agent would make me feel hot and that there might be a burning sensation. She then left me alone. The minute she left the room, I felt the heat washing over me, it streamed through my body and it burned. I knew this checkup was going to be awful. I felt extremely frightened. After a few minutes the doctor entered the room and she told me: Ok, let‘s inject the contrast agent, shall we?” (adapted from [29])

D) Empathetic encouragement to explore own examples of nocebo effects. Gain reassurance that possible adverse effects of chemotherapy may be affected by own expectations.