Cited by 212Pain Management and Placebo EffectStatistical Methods in Clinical TrialsPsychotherapy Techniques and Applications

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Development of the Stanford Expectations of Treatment Scale (SETS): A tool for measuring patient outcome expectancy in clinical trials

Younger, Jarred, Gandhi, Vanisha, Hubbard, Emily, Mackey, Sean·2012·Clinical Trials

DOI 10.1177/1740774512465064

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Abstract

Background: A patient’s response to treatment may be influenced by the expectations that the patient has before initiating treatment. In the context of clinical trials, the influence of participant expectancy may blur the distinction between real and sham treatments, reducing statistical power to detect specific treatment effects. There is therefore a need for a tool that prospectively predicts expectancy effects on treatment outcomes across a wide range of treatment modalities. Purpose: To help assess expectancy effects, we created the Stanford Expectations of Treatment Scale (SETS): an instrument for measuring positive and negative treatment expectancies. Internal reliability of the instrument was tested in Study 1. Criterion validity of the instrument (convergent, discriminant, and predictive) was assessed in Studies 2 and 3. Methods: The instrument was developed using 200 participants in Study 1. Reliability and validity assessments were made with an additional 423 participants in Studies 2 and 3. Results: The final six-item SETS contains two subscales: positive expectancy (α = 0.81–0.88) and negative expectancy (α = 0.81–0.86). The subscales predict a significant amount of outcome variance (between 12% and 18%) in patients receiving surgical and pain interventions. The SETS is simple to administer, score, and interpret. Conclusion: The SETS may be used in clinical trials to improve statistical sensitivity for detecting treatment differences or in clinical settings to identify patients with poor treatment expectancies.

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“cochlear implant and auditory/cognitive rehabilitation) [30].”
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“As predicted, the TCQ-C subscales showed negative correlations with the positive expectations subscale of the SETS, and positive correlations with the negative expectations subscale of the SETS (see Table 5).”
BackgroundMethodInfluential
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Browne, K., Bałkowiec-Iskra, E., Elferink, A. J. A., Haberkamp, M., Straus, S. M. J. M., Sepodes, B. M. N., Silva, F., Butlen‐Ducuing, F., Jansen, J., Silva, I., et al. (2025) · ACS Pharmacology & Translational Science · doi:10.1021/acsptsci.5c00456 · Cited by 1
Expectations and Outcomes of Genetics Services
McAllister, M. (2013) · Encyclopedia of Life Sciences · doi:10.1002/9780470015902.a0025145
Turning PAGES with Health Coaching and Family Involvement
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“Es por lo tanto, que la respuesta de un paciente ante un tratamiento va a estar influenciada por las expectativas que el paciente pueda tener o recibir antes de iniciar el mismo (Younger et al., 2012; Faasse & Petrie, 2013).”
Background
Measuring General Expectations of Advanced Stage Treatment Outcomes in Parkinson’s Disease
Loftus, A. M., Nielsen, C., Corti, E. J., STARKSTEIN, S. E., Gasson, N., & Egan, S. J. (2021) · Journal of Parkinson s Disease · doi:10.3233/jpd-212777
“Future research should consider the moderating inﬂuence of prior treatment exposure on treatment expectations and outcomes in PD [44].”
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“Before the therapy began, participants were asked to fulfill a demographic characteristic, ODI [20], and SETS [21] questionnaires.”
Method
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“Existing measures that informed this process include measures of expectations, such as the Stanford Expectations of Treatment Scale (SETS), Younger et al. (2012;)”
Method
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“…concise than the multidimensional TEX-Q [30] and the EXPECT [31] questionnaire, yet—unlike the ultra-brief ETS [32] and the valence-oriented SETS [33]—it captures not only outcome expectations but also process expectations, thereby ofering a broader view of how patients anticipate their…”
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Influential
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“…directions to be considered: (1) Pre-screening for expectancy and prior experience: Incorporating expectancy or experience assessments before trials may help generate functional covariates for analysis, and belief inventories or treatment-expectancy scales 24,25 can provide additional insights.”
Additional file 1 of Neurological and psychological mechanisms of the specific and nonspecific effects of acupuncture on knee osteoarthritis: study protocol for a randomized, controlled, crossover trial
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Additional file 1 of A randomized, double-blind, placebo-controlled, hybrid parallel-arm study of low-dose naltrexone as an adjunctive anti-inflammatory treatment for major depressive disorder
Plank, J. R., Glover, S. C., Moloney, B. D., Hoeh, N. R., Sundram, F., Sumner, R. L., Muthukumaraswamy, S. D., & Lin, J. C. (2022) · Figshare · doi:10.6084/m9.figshare.21251678
Low-dose naltrexone as an adjunctive treatment for major depressive disorder: findings from a randomized, double-blind, placebo-controlled hybrid parallel-arm study
Moloney, B. D., Forsyth, A., Sumner, R. L., Glover, S. C., Hoeh, N. R., Sundram, F., Cavadino, A., Muthukumaraswamy, S. D., & Lin, J. C. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1767654
“The Stanford Expectation of Treatment Scale (SETS) was also used to assess expectancy effects at baseline (Younger et al., 2012).”
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Clinical Efficacy of Integrated Acupuncture and Moxibustion Therapy Combined with Drugs in the Treatment of Acute Depressive Disorder: Protocol for a Pragmatic Randomized Controlled Trial
Fu, W., Liu, Y., Lin, D., Wang, S., Liang, X., Wu, B., Wan, L., Yuanyuan, L., Wang, T., Liu, H., et al. (2026) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s601078
Supporting tailored adaptive change and reinforcement for medication adherence program (STAR-MAP): Rationale and design of a randomized controlled clinical trial
Peacock, E., Mohundro, B. L., Li, J., BAZZANO, L., Shankar, A., Petty, R., Kegan, R. G., & Krousel-Wood, M. A. (2026) · Contemporary Clinical Trials · doi:10.1016/j.cct.2026.108353

Authors: Younger, J., Gandhi, V., Hubbard, E., & Mackey, S.
Affiliations: Stanford Medicine (US)
ORCID: Younger, Jarred
Hubbard, Emily
Mackey, Sean
Venue: Clinical Trials
Publisher: SAGE Publications
Published: 2012-11-20
Volume: 9
Issue: 6
Pages: 767-776
ISSN: 1740-7745 (ISSN-L)
1740-7753
DOI: 10.1177/1740774512465064
OpenAlex: W2020646491
Cited by: 212
References: 69
Citations by year: 2026: 27 · 2025: 33 · 2024: 24 · 2023: 23 · 2022: 26 · 2021: 21 · 2020: 14 · 2019: 10 · 2018: 15 · 2017: 8 · 2016: 5 · 2015: 3 · 2014: 2 · 2013: 1
FWCI: 0.98
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Clinical Trials (publishedVersion)
PubMed (publishedVersion)
Funders: School of Medicine, Stanford University
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: treatment expectancy, patient expectations, placebo effect, expectancy effects, scale development, psychometric validation, surgical treatment, pain interventions, statistical power
MeSH terms: Adult, Aged, Attitude to Health, Clinical Trials as Topic, Data Interpretation, Statistical, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Psychometrics, Surveys and Questionnaires, Research Design, Reproducibility of Results, Placebo Effect, Research Subjects

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Development of the Stanford Expectations of Treatment Scale (SETS): A tool for measuring patient outcome expectancy in clinical trials

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