Table 1 Axial codes, individual codes and example quotations for the qualitative focus group results

Ethical considerations

Trust and understanding

“…if it’s for something that is, I don’t know, like managing pain, if my GP gave me a placebo and I found out it was like a blinded placebo, I think I would have been annoyed and I think it potentially could undermine my relationship with my practitioner. So I would say it depends on how you use it and for what you use it” (FG4, P10)

Deontologicalism vs. utilitarianism

“…if you are prescribing in medical practice a blinded placebo, I think that’s really ethically problematic because you are lying. Well, not lying. You are, you are not giving the full information to patients. […]you are also asking GPs not to give the full information to their patients. So, I think it’s, it’s quite hard on both sides of the dynamic. If you’re going to […] replace a conventional treatment with a placebo.” (FG1, P1)

Contexts for use

“…as I mentioned like viral infections, you can’t treat with antibiotics because that only works for like bacterial infections. So I think in this case it’s OK to give, well in my opinion, it’s OK to give a placebo because antibiotics wouldn’t do anything for this particular case. And monitoring the patient to make sure it isn’t bacterial is like fine.” (FG4, P10)

Perceptions and conceptions of placebos

Terminology

“They don’t work, but they do help and there is a semantic definition between those two things, and I think that’s really important to keep in mind. Like, they don’t work. They absolutely don’t do anything, but they do help. They do, you know, provide support. They do. And, and whilst those two things I think can sometimes get conflated, I think for me, it feels very important to remember that they are quite separate.” (FG1, P1)

Conceptualising existing actions and substances as placebos

“…perhaps there is some form of like learned response that our body produces. So, for example, I don’t want to take decaf coffee […] almost like my body feels like that it is actual coffee because of the association I have with how it looks and all that stuff…” (FG4, P10)

A “non-real” treatment

“OK to me. I think a placebo is, you know, is designed to seem like a real treatment, but it’s, it’s not real and it doesn’t have a, an actual effect on the condition for the purpose of, of the treatment. And I think it also based on, you know, a kind of positive thinking that is like psychology.” (FG2, P6)

Attitudes around placebos

“I feel the mindset of, of the person taking this placebo is also considered. If you go with the mindset of what I’m taking is going to work for me, then definitely it’s going to work for you. But if you just taking it like, ok, this is what was administered to me. I just have to take it then then the probability of it working it’s let’s say it’s a 50–50 thing. So, it has to do with your mindset, your conviction, what you believe in. (FG4, P12)

Practicalities of placebo use

Practicalities of use

“For me, looking at this placebo, it didn’t fall from the sky. So if I give it to you, you have to pay for it. So he’s, he’s gonna pay for it.” (FG4, P13)

Wider ramifications of use

“This is the other thing is that if you start prescribing these things and giving them out for free, it’s quite likely you will see an uptake in people going to their GP for things that they don’t need to go to a GP for. And that has its own impact in terms of people not being able to either get a GP appointment, things they do need. Or to GP’s just being overwhelmed with loads and loads of patients, who really, they don’t need to see.” (FG1, P1)

Individual physiological considerations

“…we have different body systems and the way our body responds to most of these medications, they differ. So what might what work in your body system not really work for me. So, we really need to check out how our system responds to this treatment […] to know if this placebo that’s been administered to us has been effective or not.” (FG4, P13)