Universiteit Leiden

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Research project

Topic: The placebo and nocebo effects of communication

We study how communication can heal and harm when patients are confronted with an illness. Most of our studies focus on serious illnesses such as advanced cancer. Communication lies at the heart of medicine, yet we do not always know which specific communication helps patients. Moreover, many complaints in medical care are about communication, but we lack an understanding of which specific communication can harm patients. We aim to understand the evidence-base of communication. To do so, we combine insights from communication & palliative care & placebo-and nocebo-effect research. Creating better insight into which communication can influence patient outcomes can help to improve care. Our ultimate ambition is to improve patients’ and their loved ones’ quality of life via optimal communication at the moment in time this is most important.

Liesbeth van Vliet


Liesbeth leads the research line on how communication heals and harms in (serious) illness.  She is interested in the evidence-base of various communication elements; ranging from information-provision to clinician-expressed empathy. Most of her research focusses on oncology, but she has also experience in the domains of e.g. neurology and pediatric palliative care. She is experienced in a range of quantitative and qualitative methodologies; from experimental video-vignette designs to clinical RCTs.

She works as an Assistant Professor/Research Fellow at the Health- Medical and Neuropsychology Department of Leiden University and is also aligned to the OLVG Hospital in Amsterdam. In addition, she serves as a Board Member of the Dutch Organization for Psychosocial Oncology (NVPO); as a Deputy National Representative of the European Association in Healthcare Communication (EACH), and as an Associate Editor of BMC Palliative Care.

See her personal website for more information: www.liesbethvanvliet.wordpress.com

Maartje works as a researcher at the Health- Medical and Neuropsychology Department of Leiden University. Her main interest lies in doctor-patient communication and palliative care. For the past few years she has been working on Liesbeth’s personal fellowship on communication in advanced breast cancer care.

In addition, Maartje teaches communication skills to medical students at the Academic Medical Center (location AMC) and is a co-founder of metanoia.health, a platform for personal growth and development of healthcare professionals.

Janine works as a researcher at the Health- Medical and Neuropsychology Department of Leiden University. Her main interest lies in doctor-patient communication, especially in cancer care. In 2018 she started working for Liesbeth as a research intern. Nowadays Janine and Liesbeth are still working together on several projects (e.g., the ERC grand of PI Prof. Dr Andrea Evers: creating an innovative virtual training tool that trains healthcare providers to interact with patients in a way that optimizes placebo effects and minimizes nocebo effects).

Description of topic

Our research

We study how communication can heal and harm when patients are confronted with an illness; and focus mostly on serious illnesses. For example, we look at the effect of (various forms of) clinician-expressed empathy on patients’ anxiety and recall of provided information. But we also try to understand how we can best inform patients about aspects of their illness; such as their diagnoses, treatment options and potential side-effects. Next, we want to unravel which communication might harm patients. For example, we want to understand for whom and under which conditions open information provision is not the ideal.

For our projects we collaborate with clinicians, other (international) researchers, and of course patient representatives. We make use of various designs; ranging from experimental (lab-based) video-vignette studies, observational work, qualiative and survey designs, and randomized clinical trials in clinical practice.

Specific projects

There are several projects we are currently working on. An overview of some of the studies we are involved in:

  1. Dutch Cancer Society Young Investigator Grant (2018-2023)
    5-year personal fellowship on communication in advanced breast cancer care
    Collaboration with the Dutch Breast Cancer Society (BVN)
    Funder: Dutch Cancer Society
  2. Nocebo-effects of communication (2020-2022)
    Several projects on potential harmful communication in advanced cancer care                                                                  Funders: KNAW Early Career Partnership & Leids University Funds & L’Oreal-UNESCO FWIS/NIAS-KNAW
  3. Virtual communication training tool (2021-2022)
    Development of a virtual communication tool to improve the doctor-patient relationship based on our work on placebo and nocebo effects
    Collaborators: Andrea Evers (PI), Kaya Peerdeman, Stefanie Meeuwis Funder: European Research Council
  4. Placebo effects of communication on clinical (pain) perceptions (ongoing)
    Ongoing project on disentangling the placebo effects of communication on pain and other patient outcomes.
    Collaborators: Marc Godfried & Bram Thiel (OLVG)
    Funders: Stichting OLVG & Foundation for The Science of the Therapeutic Encounter


Relevant: Wie ben jij en wat heb jij nodig (8-5-2021) ‘Wie ben jij en wat heb je nodig?’ – Relevant 2021-2 (nvve.nl)

Hart voor de Jeugd: Empathische communicatie, lukt jou dat? (12-1-2021) https://hartvoordejeugd.online/empathische-communicatie-lukt-jou-dat/


Reformatorisch Dagblad: Patiënt is minder angstig dankzij invoelende arts. (1-12-2020) Patiënt is minder angstig dankzij invoelende arts (https://www.rd.nl/artikel/902434-patient-is-minder-angstig-dankzij-invoelende-arts)

Faculty of Skills: Empathie als medicijn (26-11-2020) Empathie als medicijn: over de skills van artsen (https://www.faculty.nl/nl/blog/de-medicinale-werking-van-empathie-van-een-arts)

Volkskrant: Empathische dokters voeren betere slechtnieuwsgesprekken. ‘Hét moment waarop je als arts het verschil kunt maken’ (25-8-2020) (https://www.volkskrant.nl/nieuws-achtergrond/empathische-dokters-voeren-betere-slechtnieuwsgesprekken-het-moment-waarop-je-als-arts-het-verschil-kunt-maken~b0ae2acd/)

NEMO Kennislink: ‘Artsen moeten zich bewust zijn van de impact van communicatie’ (19-6-2020) (https://www.nemokennislink.nl/publicaties/artsen-moeten-zich-bewust-zijn-van-de-impact-van-communicatie/)


NOS, Met het oog op morgen: ‘Wordt de Wetenschap nog altijd beheerst door mannen’ (11-2-2019) (https://www.nporadio1.nl/nos-met-het-oog-op-morgen/onderwerpen/38675-2019-02-11-wordt-de-wetenschap-nog-altijd-beheerst-door-mannen)

See for an overview of all our publications:  https://www.researchgate.net/profile/Liesbeth_Van_Vliet

Westendorp J, Stouthard J, Meijers MC, Neyrincke BAM, de Jong P, van Dulmen S, van Vliet LM. The power of clinician-expressed empathy to increase information recall in advanced cancer care; an observational study in clinical care exploring the mediating role of anxiety. Patient Educ Couns. 2020 Online ahead of print https://doi.org/10.1016/j.pec.2020.10.025.

Hoffstädt H, Stouthard J, Meijers MC, Westendorp J, Henselmans I, Spreeuwenberg P, de Jong P, van Dulmen S, van Vliet LM. Patients’ and clinicians’ perceptions of clinician-expressed empathy in advanced cancer consultations and associations with patient outcomes. Palliative Medicine Reports: 2020, 1(1)

Van Vliet LM, Godfried MB, van Deelen GW, Kaunang M, Kaptchuk TJ, van Dulmen S, Thiel B, Bensing JM. Placebo-effects of communication alongside standard medical care: results of a randomized controlled trial in clinical tonsillectomy care. Psychother Psychosom. 2020;89:56-58.

van Vliet LM, Harding R, Bausewein C, Payne S, Higginson IJ; EUROIMPACT. How should we manage information needs, family anxiety, depression, and breathlessness for those affected by advanced disease: development of a Clinical Decision Support Tool using a Delphi design. BMC Med. 2015;13:263 https://doi.org/10.1186/s12916-015-0449-6

Van Vliet LM, Epstein AS. The current state of the art and science of patient-clinician communication in progressive disease: Patients’ need to know and need to feel known. J Clin Oncol 2014;32:3474-8 https://pubmed.ncbi.nlm.nih.gov/25267758/

van Vliet LM, van der Wall E, Plum NM, Bensing JM. Explicit prognostic information and reassurance about non-abandonment when entering palliative breast cancer care: findings from a scripted video-vignette study. J Clin Oncol 2013;31:3242-9 https://ascopubs.org/doi/10.1200/JCO.2012.45.5865

Social media

Personal website: www.liesbethvanvliet.wordpress.com

Researchgate: https://www.researchgate.net/profile/Liesbeth_Van_Vliet

Linkedin: https://nl.linkedin.com/public-profile/in/liesbeth-van-vliet-b851a811

Twitter: https://twitter.com/Liesbeth_vVliet

Researchgate: https://www.researchgate.net/profile/Maartje-Meijers

Linkedin: https://www.linkedin.com/in/maartje-meijers/

Linkedin: https://www.linkedin.com/in/janine-westendorp/

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