The nocebo effect - negative outcomes driven by negative expectation - is substantially less studied than its placebo counterpart, particularly in surgical contexts. This proposal aims to quantify its magnitude across elective procedures and assess whether structured pre-surgical psychological preparation can meaningfully improve recovery outcomes. If the effect size is large enough, the implications for how surgeons communicate risk to patients are significant.
The informed consent angle is where this gets ethically complex. If telling patients the risk of a complication makes them more likely to experience it, that creates a genuine tension with the obligation to disclose. A well-designed study would need to engage with that, not just report effect sizes.